Knowledge guides

LG11: Foundations of general paediatrics

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations.

More detailed conditions and presentations according to organ system are presented as an appendix.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Appendix

Advanced Trainees will have knowledge of a variety of presentations and conditions across the scope of general paediatrics, including but not limited to those listed here.

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Infant / Child health / Undifferentiated presentations

  • Abdominal pain
  • Allergy
  • Anaemia
  • Anaphylaxis
  • Behavioural concerns
  • Bloody stools
  • Breath holding
  • Brief resolved unexplained event
  • Carer stress / concern
  • Chest pain
  • Constipation
  • Continence issues
  • Cough
  • Chronic pain
  • Developmental delay
  • Diarrhoea
  • Diurnal enuresis
  • Emotional dysregulation
  • Enlarged lymph nodes
  • Enuresis
  • Faltering growth
  • Fatigue
  • Feeding difficulties
  • Fever
  • Fit / Faint / Funny turn
  • Floppy infant / Hypotonia
  • Growth and puberty issues
  • Headache
  • Head size / Head shape
  • Hearing impairment
  • Heart murmur
  • Jaundice
  • Learning difficulties
  • Limping or non-weight bearing
  • Musculoskeletal and joint pain
  • Nausea
  • Neurodiversity
  • Obesity
  • Oncological presentations
  • Palpitations
  • Rash
  • Recurrent fever / Recurrent illness
  • Recurrent urinary tract infection
  • School refusal
  • Seizures
  • Sensory issues
  • Skin conditions
  • Shortness of breath
  • Speech / Language delay
  • Sleep difficulties
  • Suspected abuse and neglect, including suspected sexual abuse
  • Syncope / Collapse
  • Toxidrome
  • Unsettled infant
  • Unwell infant or child
  • Vision impairment
  • Vomiting
  • Vulnerability and neglect
  • Wheeze

For each presentation and condition, Advanced Trainees will know how to:

Synthesise
  • recognise the clinical presentation
  • identify relevant epidemiology, pathophysiology, and clinical science
  • take a relevant clinical history
  • conduct an appropriate examination
  • establish a differential diagnosis
  • plan and arrange appropriate investigation
  • consider the impact of illness and disease on patients and their quality of life
Manage
  • provide evidence-based management
  • for less common or more complex presentations and conditions, the trainee must also seek expert opinions
  • prescribe therapies tailored to patients’ needs and conditions
  • recognise potential complications of disease and its management, and initiate preventative strategies
  • involve multidisciplinary teams
Consider other factors
  • identify individual and social factors and the impact of these on diagnosis and management
  • Aetiology and natural history for common and uncommon paediatric medical conditions
  • Diagnosis, natural history, and treatment options for infants, children, and young people with complex, multisystem, and chronic disorders
  • Epidemiology, pathophysiology, and basic sciences as required for Basic Training in Paediatrics and Child Health, with a focus on clinical manifestations and complications of disease, pharmacology, and evidence-based management
  • Pharmacology of medications prescribed in children and adolescents, including paediatric use of:
    • ADHD medications
    • anti-depressants
    • anti-psychotics
    • anxiolytics
    • mood stabilisers
    • simple analgesics
    • strong analgesics
Investigations
  • Audiology
  • Blood tests, such as:
    • bacterial and viral PCR
    • biochemistry
    • blood gases
    • endocrinological
    • genetic investigations
    • haematological
    • immunological and allergen testing
    • inflammatory markers
    • metabolic screening tests
    • microscopy, culture, and antimicrobial sensitivity
    • serology
  • Bone densitometry scan
  • Cardiac investigations:
    • echocardiography
    • electrocardiography (ECG)
    • exercise testing
    • Holter monitoring
  • Other pathology, such as:
    • cerebral spinal fluid:
      • culture and antimicrobial sensitivity
      • indications for additional testing (e.g., autoimmune / metabolic)
      • microscopy
    • genetic:
      • chromosomal microarray analysis (CMA)
      • whole exome sequencing (WES)
    • site swabs (from sterile and non-sterile sites):
      • culture and antimicrobial sensitivity
      • microscopy
      • viral and bacterial PCR
    • stool:
      • calprotectin
      • culture
      • faecal occult blood
      • malabsoprtion tests
      • microscopy
      • ova, cysts, parasites
      • specific antigen (e.g., Helicobacter pylori)
      • toxin
    • sweat test
    • urine:
      • biochemistry
      • culture and antimicrobial sensitivity
      • microscopy
      • toxicology screening
  • Radiology:
    • CT scan
    • MRI
    • plain x-ray
    • ultrasound
    • knowledge of indications for additional specialist radiological investigations, including:
      • barium studies
      • nuclear medicine studies, including MAG3 and bone scan
      • PET
      • specialist x-rays, including bone age and skeletal survey
  • Respiratory investigations:
    • bronchoalveolar lavage
    • nasopharyngeal aspirate
    • overnight oximetry
    • polysomnography
    • pulmonary function tests
  • Skin biopsies
  • Skin prick testing
  • Wood lamp examination
Procedures
  • Blood collection
  • Blood product transfusion
  • Bowel wash out protocol
  • Cannulation
  • Food allergen challenge
  • Fundoscopy
  • Iron infusion
  • Joint aspiration
  • Lumbar puncture
  • Nasogastric tube insertion
  • Pleural aspiration and drainage
  • Procedural sedation
  • Skin scraping
  • Sterile urine collection
Clinical assessment tools
  • Anthropometric assessment
  • Blood pressure monitoring
  • Cognitive assessment and developmental screening tools
  • Growth charts
  • Orchidometry and pubertal staging
  • Pain severity measurement:
  • Psychosocial assessments (e.g., HEADSS)
  • Visual acuity
  • Adolescent health
  • Biological, physical, and psychosocial elements of infant and child feeding
  • Broad health and wellbeing considerations of the child and their context, such as:
    • adverse childhood experiences and early life trauma
    • caregivers who are neurodiverse, have mental health issues, or sustance misuse
    • cultural, geographical, and socioeconomic barriers to health
    • inequities in child health
    • intergenerational trauma
  • Child and adolescent education access
  • Child health and wellbeing implications and impact of colonisation, and current and historical government policies on First Nations People
  • Child health and wellbeing implications and impact of conflict / persecution / disaster fled, transit journeys, and current and historical government policies on refugee and asylum seeker children
  • Child health promotion and education, such as:
    • child safety
    • food allergy prevention and management
    • safe sleeping
    • screen time and online safety
    • sleep habits
  • Child safety and maltreatment (see LG16)
  • Chronic and complex care, such as:
    • awareness and access to appropriate school and disability services and aids
    • coordination of care, including prevention of hospitalisation
    • developing acute and chronic care plans
    • identification and management of complex or multiple comorbidities and complications
    • impact of chronic health conditions on children, adolescents, and families
    • impact of cognitive, intellectual, and physical disabilities
  • Chronic pain management:
    • awareness of referral criteria and conditions treated at children’s chronic pain clinics
    • awareness of the psychosocial consequences of chronic pain:
      • anxiety
      • depression
      • family disharmony
      • insomnia
      • school loss
      • work loss
    • awareness of treatment strategies for chronic pain management including pharmacological and non-pharmacological and specific strategies for children with ASD and ADHD
  • Collaboration with primary and community health to provide continuity of care
  • Continence management
  • Critical appraisal of research evidence
  • End-of-life and palliative care considerations, such as:
    • advanced care planning for children with life-limiting conditions
    • considering ethical and practical aspects of advance care planning
    • considering suitability of discussions regarding organ donation
    • determining the goals of care and interventions that should and should not be provided
    • discussing resuscitation and ceiling of care
    • importance of assessing needs of families and carers, and respecting their wishes
    • medicolegal aspects of end-of-life care
    • recognition of the dying phase
    • responding to the questions of a dying child
    • undertaking a process of discussions between families and health care providers about preferences for care, treatments, and goals in the context of the patient’s current and anticipated future health
  • Expected behaviours and care needs of infants, children, and young people
  • Family violence awareness and screening
  • Gender diversity considerations, such as:
    • appreciation of gender diversity
    • principles of medical care and referral pathways
  • Health status and needs of children and families from special populations, such as:
    • Aboriginal and Torres Strait Islander peoples
    • asylum seekers, migrants, refugees, and children with refugee-like backgrounds
    • children in out-of-home care
    • Māori and Pasifika peoples
    • regional and remote communities
    • socioeconomically disadvantaged communities
  • Immunisation
  • Infant mental health impacts, such as:
    • attachment styles and infant temperament
    • cognitive development of infants
    • emotional
    • families, and wider social and cultural context
    • influence of maternal-infant dyad
    • social
  • Population and global health consideration, such as:
    • burden of disease in population groups, nationally and globally
    • child health indicators and priorities locally, nationally, and globally
    • disease prevention
    • environmental influences on child health
    • global emergencies and the broad impact on children
    • immunisation health
    • impact on child health of climate change
    • outbreak and disease control
  • Principles of patient / family-centred care
  • Principles of trauma-informed care
  • Procedural pain and anxiety management, such as:
    • non-pharmacological
    • pharmacological
  • Psychosocial impacts of child health, such as:
    • bullying
    • family functioning and parenting styles
    • maternal-infant dyad
    • social media
  • Rehabilitation considerations, such as:
    • assessment of degree of impairment, disability, and activity limitation or participation restriction, and potential for rehabilitation
    • assessment of patients following head injury, including assessment of the severity of injury and the need for ongoing therapy and follow-up
    • biopsychosocial model, and its application to patient care
    • indications for referral to occupational therapy, orthotics, physiotherapy, psychology, speech therapy, and other allied health services
    • long-term follow-up of infants born premature, low birth weight, or with serious medical conditions
    • pain and irritability assessment in children with severe disability
    • sequelae following brain injury, and appreciation of executive dysfunction and its impact on learning
    • use and purpose of early screening for cerebral palsy, including General Movements Assessment and Hammersmith Infant Neurological Examination, and referral pathways for children identified as at risk
  • Role of primary health and local and community-based services in delivery of health care for infants, children, and young people
  • Rural and remote paediatric medicine (see LG17)
  • Support services available in the local community for specific case management, such as:
    • allied health
    • financial
    • medical
    • respite
    • support groups
  • Technology assisted conditions, including:
    • CPAP
    • tracheostomy
  • The importance of Te Tiriti o Waitangi
  • The importance of the United Nations Convention on the Rights of the Child
  • Transitions in care, such as:
    • adolescents with chronic health conditions transitioning to adult health care services
    • transitions between practitioners
    • transitions between settings
  • Typical infant, child, and adolescent growth and development, including importance of the first 1000 days
  • Values, beliefs, and traditions related to country, family, identity, and spirituality of First Nations People, and the relation to health and wellbeing

Cardiology

  • Cardiomyopathies
  • Heart failure
  • Hypertension
  • Infective endocarditis
  • Pericarditis
  • Rare congenital cardiac conditions

Ear, nose, and throat

  • Airway stenosis
  • Cleft palate
  • Pierre Robin Sequence
  • Tracheostomy

Endocrinological

  • Addison disease
  • Congenital adrenal hyperplasia
  • Cushing syndrome
  • Disorders of growth
  • Disorders of sexual differentiation
  • Hyperthyroidism
  • Osteoporosis
  • Parathyroid disease
  • Pituitary disease
  • Rickets
  • Transgender endocrine management

Gastrointestinal

  • Congenital GIT malformations
  • Cyclical vomiting
  • Eosinophilic oesophagitis
  • Hirschprung disease
  • Liver disease
  • Malabsorption syndromes
  • Neurogenic bowel
  • Pancreatitis

Genetic and metabolic medicine

  • Achondroplasia
  • Alagille syndrome
  • Alpha-1 antitrypsin deficiency
  • Angelman syndrome
  • Beckwith–Wiedemann syndrome
  • Fragile X syndrome
  • Genetic malignancies
  • Marfan syndrome
  • Mitochondrial disorders
  • Myotonic dystrophy
  • Osteogenesis syndromes
  • Prader–Willi syndrome
  • Storage disorders
  • Sturge–Weber syndrome
  • Substrate metabolism disorders
  • Treacher Collins syndrome
  • Trisomy 13
  • Trisomy 18
  • Williams syndrome

Haematological / Oncological

  • Asplenia
  • Bone marrow failure
  • Cancer predisposing syndromes
  • Hypersplenia
  • Hyposlenia
  • Iron overload
  • Leucocyte disorders
  • Neutropenia
  • Rare leukaemias
  • Rare solid tumours
  • Red cell structural disorders
  • Thrombosis

Immunological

  • Autoimmune disorders
  • Complement deficiencies
  • Immunodeficiency syndromes
  • Neutrophil abnormalities

Infectious diseases

  • Arboviruses
  • Dengue fever
  • Emerging viruses
  • Hepatitis viruses
  • Human immunodeficiency virus (HIV)
  • Infections with antibiotic resistant organisms
  • Infective endocarditis
  • Japanese encephalitis
  • Malaria
  • Mycobacterial infections
  • Parasitic infections
  • Tuberculosis
  • Typhoid fever

Kidney

  • Alport syndrome
  • Bartter syndrome
  • Chronic kidney disease
  • Diabetes insipidus (nephrogenic)
  • Gitelman syndrome
  • Haemolytic uraemic syndrome
  • Interstitial nephritis
  • Kidney tubular disorders
  • Nephrotic syndrome
  • Renal calculi

Mental health

  • Bipolar and related disorders
  • Psychosis

Musculoskeletal and rheumatalogical

  • Chronic musculoskeletal pain
  • Juvenile dermatomyositis
  • Juvenile idiopathic arthritis
  • Localised scleroderma
  • Systemic lupus erythematosus

Neurological

  • Autonomic dysreflexia
  • Central nervous system inflammatory and immune mediated disorders
  • Central nervous system tumours
  • Central venous sinus thrombosis
  • Cerebellar disorders
  • Charcot–Marie–Tooth disease
  • Congenital eye abnormalities
  • Congenital myasthenic syndromes
  • Demyelinating disorders
  • Idiopathic intracranial hypertension
  • Motor neurone disease
  • Movement disorders
  • Muscular dystrophy
  • Myopathy
  • Neural tube defects
  • Neurocutaneous syndromes
  • Neurodegenerative disorders
  • Peripheral neuropathy
  • Spinal cord compression
  • Spinal muscular atrophy
  • Stroke

Respiratory

  • Chylothorax
  • Congenital lung abnormalities
  • Excessive daytime sleepiness and hypersomnolence
  • Interstitial lung disease
  • Narcolepsy
  • Pleural effusion
  • Pneumothorax
  • Respiratory failure