Paediatric GI, Genitourinary & Neurologic Disorders - Cheat Sheet
Your final 30-minute review companion for high-yield paediatric conditions: pyloric stenosis, Hirschsprung disease, intussusception, Wilms tumour, nephrotic syndrome, acute glomerulonephritis, hydrocephalus, cerebral palsy, meningitis, spina bifida, and seizures. Every item here is testable. Master the red flags, nursing priorities, and do's/don'ts.
Paediatric Fluid & Electrolyte Fundamentals
Formulas
Maintenance Fluids (Holliday–Segar / 4-2-1 Rule): First 10 kg = 100 mL/kg/day | Next 10 kg = 50 mL/kg/day | Each kg >20 kg = 20 mL/kg/day
Meaning
kg = child's weight in kilograms; mL/kg/day = volume per kilogram per 24 hours
Watch out
Students often ADD the three components separately then multiply — instead, calculate EACH component based on the TOTAL weight range, then SUM them. Example: 15 kg child = (10 × 100) + (5 × 50) = 1000 + 250 = 1250 mL/day
When to use
Calculate daily IV maintenance fluid requirement for ANY paediatric patient without ongoing losses
Urine Output Target: 1–2 mL/kg/hour
Meaning
mL = millilitres; kg = child's weight; hour = per 60 minutes
Watch out
For a 10 kg child, expect 10–20 mL/hour, NOT 10–20 mL/day. A common error is confusing hourly vs daily targets.
When to use
Assess adequacy of hydration and renal perfusion; calculate expected hourly urine output
Common values
Value
12–18 months
Symbol
N/A
Quantity
Normal Anterior Fontanelle Closure Age
Value
<2 seconds
Symbol
CRT
Quantity
Normal Capillary Refill Time
Value
Soft and flat
Symbol
N/A
Quantity
Normal Anterior Fontanelle Pressure (infant supine, quiet)
Important facts
- Infants have ↑ body-surface-area-to-mass ratio, ↑ metabolic rate, and IMMATURE kidneys — fluid loss is RAPID and DANGEROUS.
- Vomiting or diarrhoea in an infant can cause shock within hours.
- Fontanelle (anterior) and skin turgor are unreliable in severe dehydration or obesity.
- Urine output is the BEST bedside indicator; oliguria (<1 mL/kg/hr in infants) = red flag.
- Always WEIGH the child daily at the SAME time (morning, before feeding) on the SAME scale.
Key definitions
Total Body Water (TBW) in Infants
Example
A 5 kg infant has ~3.5 kg of TBW; loss of 500 mL represents 14% of TBW — mild-to-moderate dehydration.
~70–75% of body weight (vs ~60% in adults); makes infants extremely vulnerable to dehydration and electrolyte imbalance.
Most Sensitive Indicator of Hydration Status
Example
A 10 kg infant who weighed 9.8 kg yesterday has lost 0.2 kg (2%) — warrants urgent IV fluid reassessment.
WEIGHT CHANGE — a loss or gain of 1% per day signals fluid imbalance; coupled with urine output, fontanelle, skin turgor, and capillary refill (<2 sec = adequate).
Diagrams to know
- Signs of dehydration (mild 3–5%, moderate 5–10%, severe >10%)
- IV fluid composition (D5/0.45 NS vs LR vs normal saline) and when each is used
Pyloric Stenosis (Hypertrophic Pyloric Stenosis)
Important facts
- NON-BILIOUS vomiting — obstruction is PROXIMAL to the duodenum (before bile entry).
- Visible peristaltic waves (left-to-right) and 'olive-shaped' RUQ mass are CLASSIC.
- Infant is HUNGRY and eagerly feeds after vomiting — 'hungry vomiter'.
- FLUID & ELECTROLYTE CORRECTION FIRST, then pyloromyotomy (Fredet-Ramstedt) — do NOT rush to surgery.
- Post-op: position UPRIGHT and RIGHT LATERAL after feeds; start small, frequent feeds as ordered.
Key definitions
Pyloric Stenosis
Example
3-week-old firstborn male: projectile vomiting after every feed, hungry infant, RUQ 'olive' mass palpable.
Hypertrophy of the pyloric muscle → gastric outlet obstruction; presents 2–8 weeks (peak 3–5 weeks); M:F = 4:1, first-born.
Hypochloremic, Hypokalemic Metabolic Alkalosis
Example
Infant with pyloric stenosis: ABG shows pH 7.52, Cl⁻ 95 (normal 98–107), K⁺ 3.2 (normal 3.5–5.0).
Loss of HCl (gastric acid) via vomiting → ↑ blood pH, ↓ Cl⁻, ↓ K⁺; can cause cardiac arrhythmias and respiratory depression.
Diagrams to know
- Anatomy: pyloric muscle hypertrophy blocking gastric outlet
- Fluid loss pathway: vomiting → HCl loss → alkalosis + hypokalemia + hypochloremia
Hirschsprung Disease (Congenital Aganglionic Megacolon)
Common values
Value
Within 24–48 hours
Symbol
N/A
Quantity
Normal Age for First Meconium
Important facts
- FAILURE TO PASS MECONIUM within 24–48 hours in a term neonate = first clue.
- Rectal biopsy (absence of ganglion cells) is DEFINITIVE diagnostic test.
- Ribbon-like, foul-smelling stools; failure to thrive in older infants.
- Management: temporary COLOSTOMY first, then pull-through surgery later.
- WATCH for enterocolitis — report explosive diarrhoea, fever, abdominal pain immediately; give fluids, NPO, antibiotics, and notify surgeon.
Key definitions
Hirschsprung Disease
Example
Neonate: no meconium passed by 48 hours, abdominal distension, bilious vomiting.
Absence of ganglion cells (aganglionosis) in a segment of distal colon → no peristalsis → functional obstruction + proximal dilation.
Enterocolitis (Hirschsprung Complication)
Example
Infant with Hirschsprung: sudden explosive, foul-smelling diarrhoea, abdominal tenderness, fever 39.5°C — report STAT.
Explosive diarrhoea, fever, severe distension, sepsis; a MEDICAL EMERGENCY — may occur pre-op or post-op.
Diagrams to know
- Segment of aganglionosis (aganglionic zone) → proximal bowel dilation (megacolon)
- Clinical progression: no meconium → abdominal distension → bilious vomiting → enterocolitis risk
Intussusception
Important facts
- CLASSIC TRIAD: sudden colicky pain, palpable 'sausage' mass, currant-jelly stools.
- Peak age ~5–9 months; often in previously HEALTHY infants (distinguish from other GI obstruction).
- Air or BARIUM/HYDROSTATIC ENEMA is BOTH diagnostic AND therapeutic — can reduce non-surgically.
- PASSAGE OF NORMAL BROWN STOOL = reduction achieved; report immediately.
- Surgery if enema fails or bowel is perforated/necrotic.
Key definitions
Intussusception
Example
Previously healthy 8-month-old: sudden colicky pain (infant draws knees up, screams), palpable 'sausage-shaped' RUQ mass, currant-jelly stools.
Telescoping of one bowel segment into another (usually ileocolic); most common in 3 months–3 years (peak 5–9 months).
Currant-Jelly Stools
Example
Infant with intussusception strains and passes dark red, mucoid stool — indicates mucosal injury from ischemia.
Blood + mucus from bowel ischemia; a LATE sign (not always present initially).
Diagrams to know
- Ileocolic intussusception anatomy: ileal segment invaginating into caecum
- Clinical presentation timeline: acute onset colicky pain → vomiting → currant-jelly stool
Wilms Tumour (Nephroblastoma)
Important facts
- UNILATERAL mass (one side only) that DOES NOT cross the midline — classic presentation.
- Surgery (nephrectomy) within 24–48 hours + chemotherapy ± radiation.
- Associated syndromes: WAGR syndrome (Wilms, Aniridia, GU abnormality, Retardation), Beckwith-Wiedemann syndrome.
- Prognosis GOOD with early treatment (~90% 5-year survival if early stage).
- Hematuria and hypertension may occur; monitor BP and urine output post-op.
Key definitions
Wilms Tumour
Example
2.5-year-old: parent notices firm lump in left flank during bathing; hematuria present; BP elevated.
Most common renal malignancy of childhood (~2–3 years); firm, non-tender unilateral abdominal mass NOT crossing midline.
CRITICAL NURSING RULE: DO NOT PALPATE
Example
Admit child with Wilms → post sign 'DO NOT PALPATE ABDOMEN' at bedside; use latex-free gloves (associated syndrome risks); bathe gently without pressing on flank.
Risk of rupturing the tumour capsule and spreading malignant cells; post bedside sign; handle child GENTLY; avoid aggressive diapering/bathing over the mass.
Diagrams to know
- Location of Wilms tumour: renal parenchyma, unilateral, does not cross midline
- Staging and management pathway: diagnosis → surgery → chemotherapy/radiation
Nephrotic Syndrome
Common values
Value
>3.5 g/day (children often >40 mg/kg/day)
Symbol
N/A
Quantity
Proteinuria in Nephrotic Syndrome
Value
<2.5 g/dL (normal 3.5–5.5)
Symbol
Alb
Quantity
Serum Albumin
Important facts
- PERIORBITAL EDEMA (worse on waking) is the classic first sign — often missed by parents.
- Urine is FROTHY (proteinuria >3.5 g/day in children).
- STEROID-RESPONSIVE in ~90% of children (prednisone is first-line); ~80% relapse.
- DIET: normal protein, LOW SODIUM during acute edema phase.
- INFECTION RISK: children are immunosuppressed (losing immunoglobulins + corticosteroids) — prevent infection (varicella exposure, prophylaxis if needed).
- Monitor: daily weight, abdominal girth, I&O, urine dipstick for protein, BP, edema severity.
- Skin care: prevent breakdown on edematous areas; reposition frequently.
Key definitions
Nephrotic Syndrome
Example
4-year-old: periorbital edema (worse on waking), dependent edema (legs, sacrum), ascites, weight gain, frothy urine.
Glomerular disorder (typically minimal change disease, peak 2–7 years) with MASSIVE PROTEINURIA, hypoalbuminemia, EDEMA, and hyperlipidemia — the classic TETRAD.
Nephrotic Edema vs Nephritic Edema
Example
Nephrotic: edema-first, mild HTN. Nephritic: hematuria + HTN first, edema secondary.
NEPHROTIC = massive protein loss → severe, generalised edema (periorbital, dependent, ascites), normal/LOW BP, frothy urine, hyperlipidemia. NEPHRITIC = hematuria + hypertension + mild edema.
Diagrams to know
- Pathophysiology: increased glomerular permeability → massive proteinuria → ↓ serum albumin → edema
- Nephrotic vs Nephritic comparison
Acute Glomerulonephritis (AGN / Post-Streptococcal)
Important facts
- GROSS HEMATURIA (tea/cola-coloured urine) is the hallmark — distinguishes from nephrotic.
- HYPERTENSION is a major sign — risk of hypertensive encephalopathy (headache, confusion, seizures, papilledema).
- Mild periorbial edema, oliguria, azotemia (↑ creatinine, ↑ BUN).
- Usually SELF-LIMITING with GOOD prognosis in children (vs adults).
- Management: RESTRICT sodium and fluids during acute phase; monitor BP closely (goal <90th percentile for age); I&O, daily weight; continue antibiotics if residual strep infection.
- Monitor for hypertensive crisis: headache, visual changes, seizures → report STAT; may need antihypertensive.
Key definitions
Acute Glomerulonephritis (AGN)
Example
6-year-old: had strep throat 10 days ago; now presents with GROSS HEMATURIA (tea/cola-coloured urine), mild periorbital edema, hypertension (BP 110/70).
Post-streptococcal immune-complex inflammation of glomeruli; occurs 1–2 weeks after strep throat or skin infection; school-age children.
NEPHRITIC vs NEPHROTIC — Key Distinction
Example
NEPHRITIC: cola urine + HTN = AGN. NEPHROTIC: frothy urine + massive edema = nephrotic syndrome.
NEPHRITIC (AGN) = HEMATURIA + HYPERTENSION + mild edema. NEPHROTIC = PROTEINURIA + severe edema + normal/low BP.
Diagrams to know
- Post-strep immune complex formation → glomerular inflammation → hematuria + hypertension
- Nephritic vs Nephrotic clinical presentation table
Urinary Tract Infection (UTI) & Vesicoureteral Reflux
Important facts
- Infant UTI signs are SUBTLE & NON-SPECIFIC: fever, poor feeding, irritability, jaundice, vomiting, not 'dysuria' or urgency.
- Obtain PROPER specimen: clean-catch mid-stream (toilet-trained) or catheterised (non-toilet-trained); not bag specimens (too many false positives).
- Complete the FULL antibiotic course (even if symptoms resolve) to prevent resistance and recurrence.
- PREVENTION: ↑ fluids, front-to-back wiping (girls), cotton underwear, avoid bubble baths, complete/regular voiding.
- Recurrent UTIs warrant investigation: renal ultrasound, VCUG, and possible prophylactic antibiotics.
- Teach parents to recognise fever in infants (rectal temperature gold standard) and seek early treatment.
Key definitions
UTI in Children
Example
3-month-old with fever, poor feeding, foul-smelling urine (confirmed by catheterised specimen) → presumed UTI; start antibiotics empirically pending culture.
More common in girls (shorter urethra); infants present with NON-SPECIFIC signs: fever, poor feeding, irritability, vomiting, foul-smelling urine.
Vesicoureteral Reflux (VUR)
Example
Infant with RECURRENT UTIs (>2 episodes) should be screened for VUR via voiding cystourethrogram (VCUG).
Retrograde flow of urine from bladder to ureters/kidneys; increases infection risk and can cause RENAL SCARRING if recurrent UTIs.
Diagrams to know
- Normal vs abnormal (reflux) bladder-ureteric anatomy
- UTI prophylaxis and management pathway
Hydrocephalus
Common values
Value
~0.5 cm/week
Symbol
N/A
Quantity
Normal Head Circumference Growth
Value
>1 cm/week
Symbol
N/A
Quantity
Abnormal Head Circumference Growth (hydrocephalus concern)
Important facts
- INFANT SIGNS (open fontanelles/sutures): ↑ head circumference (measure daily), bulging/tense anterior fontanelle, widely separated sutures, 'sunset eyes' (sclera visible above iris), high-pitched cry, irritability, distended scalp veins.
- OLDER CHILD SIGNS (closed sutures): headache, projectile vomiting (often on waking), altered consciousness, papilledema.
- Treatment: VENTRICULOPERITONEAL (VP) SHUNT to drain CSF.
- POST-OP POSITIONING (CRITICAL): keep child FLAT and on the NON-operative side to prevent too-rapid CSF drainage (risk of subdural bleeding); raise head GRADUALLY as ordered.
- Monitor for SHUNT COMPLICATIONS: malfunction (returning ↑ICP signs) and INFECTION (fever, poor feeding, redness along tract, meningeal signs) — most serious.
- Measure head circumference daily; gently support head when lifting infant.
Key definitions
Hydrocephalus
Example
Infant born with myelomeningocele develops hydrocephalus; head circumference increases 2 cm/week (normal ~0.5 cm/week).
Excess cerebrospinal fluid (CSF) in the ventricles from overproduction, obstruction (obstructive/non-communicating), or impaired absorption (communicating) → ↑ intracranial pressure (ICP).
Cushing's Triad (LATE ↑ICP Sign)
Example
Infant with shunt malfunction: HR 80 (slow for age), BP 95/65 (high for infant), irregular breathing → EMERGENCY.
Bradycardia + HYPERTENSION with widened pulse pressure + irregular respirations — LATE, OMINOUS sign of severe ↑ICP; by this point, brain is herniation-level.
Diagrams to know
- CSF production-absorption imbalance → ventricle dilation → ↑ICP
- VP shunt anatomy and placement
- Infant ↑ICP signs vs older child signs
Cerebral Palsy (CP)
Important facts
- NON-PROGRESSIVE — the brain lesion doesn't worsen, but motor skills may improve with therapy or decline if contractures develop.
- Early clues: delayed motor milestones (no head control by 3 months, not rolling by 6 months), abnormal posturing, feeding difficulty (risk of aspiration).
- Management is SUPPORTIVE & MULTIDISCIPLINARY: physical/occupational/speech therapy, braces & mobility aids, seizure meds (if seizures present), anti-spasticity meds (baclofen, botulinum toxin), safe feeding with aspiration precautions.
- GOAL: MAXIMISE FUNCTION & INDEPENDENCE, NOT cure (CP cannot be cured).
- Associated problems: intellectual disability (50%), seizures (30%), visual/hearing impairment, speech disorders, contractures.
- Family support & education critical: realistic expectations, long-term management, emotional support.
Key definitions
Cerebral Palsy
Example
Term infant with perinatal asphyxia → develops hypertonia, scissoring legs, abnormal reflexes by 3 months → CP diagnosis.
NON-PROGRESSIVE disorder of movement & posture from an insult to the developing brain (prenatal hypoxia, perinatal trauma, postnatal infection); brain lesion is STATIC but manifestations CHANGE as child grows.
Spastic CP (Most Common Type ~80%)
Example
2-year-old: walks on tiptoes, legs crossed (scissor gait), stiff movements, hands in fisted posture.
↑ muscle tone (hypertonia), SCISSORING of legs, hyperreflexia, persistent primitive reflexes (e.g., asymmetric tonic neck reflex), toe-walking.
Diagrams to know
- Types of CP: spastic (most common), athetoid (dyskinetic), ataxic, mixed
- Early motor milestone delays vs normal development timeline
Bacterial Meningitis
Important facts
- SIGNS: fever, SEVERE headache, PHOTOPHOBIA, NUCHAL RIGIDITY (stiff neck), vomiting, altered consciousness, seizures.
- INFANT SIGNS are SUBTLE: bulging fontanelle (may be the ONLY sign), high-pitched cry, poor feeding, irritability, paradoxical irritability when held.
- PETECHIAL/PURPURIC RASH suggests meningococcemia (medical emergency; risk of septic shock).
- PRIORITY NURSING: DROPLET PRECAUTIONS (isolation) IMMEDIATELY; assist with lumbar puncture; give IV ANTIBIOTICS PROMPTLY (after blood cultures); monitor ↑ICP & seizures; quiet, dimly lit environment (reduce stimulation).
- Meningococcal disease is NOTIFIABLE → close contacts need PROPHYLAXIS (rifampin, ceftriaxone).
- Lumbar puncture: CSF shows ↑ WBC (PMN predominant), ↑ protein, ↓ glucose.
Key definitions
Bacterial Meningitis
Example
5-year-old: fever 39.5°C, severe headache, neck can't touch chin (nuchal rigidity), photophobia, positive Kernig's and Brudzinski's signs.
Inflammation of the meninges, usually by Neisseria meningitidis, Streptococcus pneumoniae (or Hib historically); a MEDICAL EMERGENCY with high mortality/morbidity if untreated.
Kernig's Sign & Brudzinski's Sign
Example
During physical exam, when flexing neck, both knees involuntarily flex (positive Brudzinski's) → suspect meningitis.
Kernig's = thigh flexed at hip 90°, pain/resistance when straightening knee. Brudzinski's = neck flexion causes involuntary hip/knee flexion. Both suggest meningeal irritation.
Diagrams to know
- Pathway: bacterial infection → meningeal inflammation → CSF changes
- Infant meningitis subtle signs vs older child obvious signs
- DROPLET precaution setup
Spina Bifida (Myelomeningocele)
Common values
Value
400–800 mcg daily (higher if family history or prior affected child)
Symbol
N/A
Quantity
Folic Acid for Prevention
Important facts
- PRE-OP PRIORITY: PROTECT THE SAC — position PRONE (or side-lying), cover sac with STERILE, MOIST (saline-soaked) NON-ADHERENT DRESSING, prevent rupture & infection, avoid diapering over sac.
- Handle infant GENTLY; no pressure on the sac.
- Associated conditions: HYDROCEPHALUS (~80%), lower-limb paralysis (flaccid), bowel/bladder incontinence, Chiari malformation.
- LONG-TERM management: intermittent catheterisation, bowel protocol, physical therapy, adaptive devices, education on infection prevention (UTI risk) and skin care.
- PREVENTION (most important): maternal FOLIC ACID (400–800 mcg) before conception & during first trimester reduces neural tube defects by ~70% — critical PUBLIC HEALTH teaching.
- Surgery usually within first 24–48 hours to close the defect and reduce infection risk.
Key definitions
Spina Bifida / Myelomeningocele
Example
Neonate born with sac on lumbar spine protruding; legs flaccid (paralysed); no bowel/bladder control expected; MRI shows associated hydrocephalus.
Neural tube defect — vertebral column fails to close; myelomeningocele (most severe) = sac containing spinal cord & meninges; causes lower-limb paralysis, bowel/bladder dysfunction, often associated hydrocephalus.
Latex Allergy in Spina Bifida
Example
Infant with myelomeningocele: chart states 'LATEX-FREE CARE' in red; use non-latex gloves, non-latex catheters, cover any latex equipment with cotton.
High incidence (~50–70%) of latex sensitivity in these children due to repeated bladder catheterisations and medical exposures; use LATEX-FREE supplies always.
Diagrams to know
- Vertebral defect with protruding sac containing spinal cord & meninges
- Pre-op protective positioning (PRONE) and sac dressing technique
- Folic acid supplementation timeline (preconception through first trimester)
Seizure Disorders & Febrile Seizures
Common values
Value
>5 minutes OR repeated seizures without full recovery
Symbol
N/A
Quantity
Status Epilepticus Definition Duration
Value
6 months–5 years (peak 18–24 months)
Symbol
N/A
Quantity
Febrile Seizure Age Range
Important facts
- FEBRILE SEIZURE FACTS: peak 18–24 months; brief; good prognosis; treat FEVER (acetaminophen, tepid sponging), reassure parents (low risk of epilepsy later).
- PRIORITY DURING SEIZURE: protect airway & prevent injury. Turn child to SIDE-LYING (prevents aspiration); loosen tight clothing; ease to floor; pad hard surfaces nearby.
- DO NOT RESTRAIN the child and DO NOT PUT ANYTHING in the mouth (risk of airway obstruction).
- DO NOT move the child unless in danger; stay calm & present; provide privacy.
- TIME THE SEIZURE and observe/document type (tonic, clonic, absence, etc.), onset, duration, sequence of body movements.
- Have SUCTION and OXYGEN available; stay with the child until fully recovered.
- STATUS EPILEPTICUS: give IV LORAZEPAM (or DIAZEPAM) first-line for immediate seizure cessation; protect airway; prepare for intubation if needed.
- MAINTENANCE ANTICONVULSANTS: phenytoin, phenobarbital, valproic acid, carbamazepine, levetiracetam — must be taken strictly as prescribed; never abruptly stop (precipitates seizures).
- PHENYTOIN: ↑ gingival hyperplasia → meticulous oral care (brush & floss daily); also risk of hirsutism, coarsened facies, ataxia.
- VALPROIC ACID: hepatotoxicity risk → monitor LFTs; regular drug level checks.
Key definitions
Seizure
Example
5-year-old with fever 40°C suddenly becomes rigid, limbs jerk involuntarily, eyes roll back, lasts ~2 minutes → febrile seizure.
Abnormal, excessive neuronal electrical discharge; causes include epilepsy, fever, infection, trauma, metabolic imbalance, hypoxia.
Febrile Seizure
Example
Toddler with ear infection fever spikes suddenly; child seizes for 1 minute, then recovers fully; EEG and imaging normal.
Seizure triggered by RAPID RISE in body temperature in children 6 months–5 years; usually brief (sec–min), benign, and self-limiting; low risk of long-term complications.
Status Epilepticus
Example
Child seizes for 8 minutes without recovery → status epilepticus; give IV lorazepam immediately; prepare for airway management.
Seizure lasting >5 minutes OR repeated seizures without full recovery between episodes; a MEDICAL EMERGENCY with risk of hypoxia, acidosis, and brain damage.
Diagrams to know
- Acute seizure management flowchart: positioning → airway protection → timing → IV meds (status epilepticus)
- Types of seizures: generalised vs focal; tonic, clonic, tonic-clonic, absence, atonic
- Maintenance anticonvulsant selection & monitoring parameters
Must remember
- PYLORIC STENOSIS (3–5 weeks, firstborn ♂): projectile NON-bilious vomiting + olive RUQ mass = hypochloremic hypokalemic metabolic ALKALOSIS. CORRECT FLUIDS/ELECTROLYTES FIRST, then pyloromyotomy. Position upright post-op.
- HIRSCHSPRUNG: NO meconium 24–48 h + bilious vomiting = RECTAL BIOPSY (definitive; absent ganglion cells). WATCH for enterocolitis (explosive diarrhoea, fever, sepsis) — REPORT STAT. Temp colostomy → pull-through.
- INTUSSUSCEPTION (peak 5–9 mo): colicky pain (knees drawn up) + sausage mass + currant-jelly stool. Air/barium ENEMA is DIAGNOSTIC & THERAPEUTIC. NORMAL BROWN STOOL = reduction; report.
- WILMS TUMOUR (2–3 years): firm unilateral abdominal mass NOT crossing midline. DO NOT PALPATE (capsule rupture risk → spread). Surgery within 24–48 h. Post sign at bedside.
- NEPHROTIC SYNDROME: massive PROTEINURIA + hypoalbuminemia + SEVERE EDEMA (periorbital) + hyperlipidemia; normal/LOW BP. Steroid-responsive (prednisone); low-Na diet; PREVENT INFECTION (immunosuppressed).
- AGN (POST-STREP): GROSS HEMATURIA (tea/cola urine) + HYPERTENSION + mild edema. RESTRICT Na/fluids; MONITOR BP for hypertensive crisis (headache, confusion, seizures).
- HYDROCEPHALUS (infant): ↑ head circumference + bulging fontanelle + sunset eyes. VP SHUNT. POST-OP: FLAT + NON-operative side (prevent subdural bleed). WATCH for shunt malfunction/infection.
- SEIZURE ACUTE: SIDE-LYING (airway clear) + protect from injury + DO NOT RESTRAIN + NOTHING in mouth + TIME IT. Status epilepticus (>5 min): IV LORAZEPAM first-line.
- SPINA BIFIDA (myelomeningocele): PRONE position + STERILE MOIST SAC dressing + NO LATEX (allergy risk). PREVENT with maternal FOLIC ACID (400–800 mcg) before/during early pregnancy.
- MENINGITIS (fever + nuchal rigidity + photophobia + positive Kernig's/Brudzinski's): DROPLET PRECAUTIONS immediately + IV ANTIBIOTICS STAT + quiet dark room. Infant signs: bulging fontanelle, high-pitched cry (SUBTLE). Notifiable; close contacts need prophylaxis.
Last minute tips
- NLE LOVES POSITIONING & POST-OP CARE: Pyloric stenosis = upright after feeds. Hydrocephalus = flat + non-op side. Spina bifida = PRONE. Meningitis = quiet dark room. Seizure = SIDE-LYING. Nail these and you'll ace 30% of GI-neuro questions.
- FLUID FORMULAS: 4-2-1 rule for maintenance (first 10 kg = 100 mL/kg/day, next 10 = 50, >20 = 20). Urine output 1–2 mL/kg/hr. WEIGHT is the most sensitive hydration indicator. If question asks 'best indicator,' default to weight change + urine output.
- NEPHROTIC vs NEPHRITIC: This distinction ALWAYS appears. Nephrotic = frothy urine + massive edema + low BP. AGN = cola urine + HIGH BP + mild edema. Opposite BP = easy way to distinguish.
- WILMS TUMOUR RED FLAG: 'DO NOT PALPATE' — the NLE specifically tests this. If a question asks what to do when admitting a Wilms child, correct answer includes 'post sign, avoid palpation, gentle handling.' Capsule rupture = catastrophic spread.
- DIAGNOSTIC TESTS: Pyloric = ultrasound. Hirschsprung = rectal BIOPSY (definitive). Intussusception = air/barium enema (also treats). Wilms = CT/ultrasound + biopsy. Keep these straight — questions often ask 'which test confirms diagnosis?'
Comparison tables
Nephrotic Syndrome vs Acute Glomerulonephritis (AGN) — High-Yield Distinctions
| Feature | Nephrotic Syndrome | Acute Glomerulonephritis |
|---|---|---|
| Urine appearance | Frothy (proteinuria) | Tea/cola-coloured (hematuria) |
| Protein loss | MASSIVE (>3.5 g/day) | Mild to moderate |
| Blood pressure | Normal or LOW | ELEVATED (hypertension) |
| Edema severity | MASSIVE, generalised (periorbital, dependent, ascites) | Mild, periorbial only |
| Serum albumin | VERY LOW (<2.5 g/dL) | Normal to low-normal |
| Triglycerides/lipids | ELEVATED (hyperlipidemia) | Normal |
| Cause (children) | Minimal change disease (90%) | Post-streptococcal (most common) |
| Treatment | Corticosteroids (prednisone), low-Na diet, infection prevention | Restrict Na/fluids, BP monitoring, antibiotics if needed |
| Prognosis | Good; ~80% relapse (steroid-responsive) | Good; usually self-limiting in children |
| Hypertensive crisis risk | Rare | YES — monitor for encephalopathy |
Pyloric Stenosis vs Hirschsprung Disease vs Intussusception — GI Obstruction Comparison
| Feature | Pyloric Stenosis | Hirschsprung Disease | Intussusception |
|---|---|---|---|
| Age of onset | 2–8 weeks (peak 3–5 wk) | Neonatal (no meconium 24–48 h) | 3 mo–3 years (peak 5–9 mo) |
| Type of vomiting | Projectile, NON-bilious | Bilious (obstruction distal) | Present if high obstruction |
| Physical findings | Olive-shaped RUQ mass, visible peristalsis | Abdominal distension, ribbon-like stools | Sausage-shaped abdominal mass, currant-jelly stools |
| Cause | Pyloric muscle hypertrophy | Absence of ganglion cells (aganglionosis) | Telescoping bowel (ileocolic) |
| Diagnostic test | Ultrasound (pyloric muscle >4 mm) | Rectal biopsy (definitive) | Air/barium enema (diagnostic & therapeutic) |
| Fluid/electrolyte issue | Hypochloremic hypokalemic metabolic ALKALOSIS | Dehydration, enterocolitis risk | Dehydration |
| Management | Correct fluids/electrolytes FIRST, then pyloromyotomy | Colostomy, then pull-through surgery | Air/barium enema (reduce); surgery if fails |
| Prognosis | Excellent with surgery | Good; watch for enterocolitis | Good if reduced early; risk of recurrence ~10% |
Infant ↑ICP Signs (Hydrocephalus) vs Older Child ↑ICP Signs
| Sign | Infant (Open Fontanelles/Sutures) | Older Child (Closed Sutures) |
|---|---|---|
| Head growth | ↑ head circumference (>1 cm/week abnormal) | Fixed skull size; no HC growth |
| Fontanelle status | Bulging, tense, full when quiet | Fontanelle closed (not assessable) |
| Sutures | Widely separated | Closed; fused |
| Eyes | Sunset eyes (sclera visible above iris) | Papilledema (optic disc swelling) |
| Cry/irritability | High-pitched, shrill cry; irritability | Irritability; personality change |
| Vomiting | May be present | Projectile, especially on waking (CLASSIC) |
| Headache | Cannot report (non-verbal) | YES — may be severe; first complaint |
| Level of consciousness | Irritable; poor feeding | Altered (drowsy → coma as worsens) |
Febrile Seizure vs Status Epilepticus — Key Differences
| Feature | Febrile Seizure | Status Epilepticus |
|---|---|---|
| Duration | <5 minutes (usually 1–2 min) | >5 minutes OR repeated without full recovery |
| Trigger | RAPID RISE in fever (temp >38.5°C) | Epilepsy, infection, metabolic, trauma, etc. |
| Age group | 6 months–5 years (peak 18–24 mo) | Any age (common in children <3 years) |
| Recovery | Full, rapid recovery after seizure; alert | Slow or incomplete recovery; may remain altered |
| EEG/brain imaging | Normal (no workup typically needed) | Usually abnormal; imaging may show cause |
| Risk of epilepsy | LOW (<5% later develop epilepsy) | HIGH; indicates ongoing seizure disorder |
| IMMEDIATE management | Treat fever (acetaminophen, tepid bath); reassure parents | IV lorazepam/diazepam STAT; airway protection; O2 |
| Prognosis | Excellent; benign; recurrence ~30–40% | Poor if delayed treatment; risk of brain damage |
Diagrams
Gastrointestinal Obstruction Differential Diagnosis Flowchart
Decision tree for differentiating the three major paediatric GI obstructions based on age, vomiting type, physical findings, and diagnostic approach.
Paediatric Neurologic Disorders Overview
Comprehensive overview of five major paediatric neurologic conditions, showing key pathophysiology, clinical presentations, and management priorities.
Acute Seizure Management Protocol
Step-by-step protocol for managing an acute seizure, emphasizing airway protection, timing, and emergency recognition of status epilepticus.
Intussusception Reduction & Management Pathway
Management pathway for intussusception, showing how air/barium enema can be both diagnostic and therapeutic, and when surgical intervention is needed.
Hydrocephalus State Changes & Shunt Complications
State diagram showing the progression from normal CSF flow through hydrocephalus, shunt placement, and potential complications (malfunction and infection).
Folic Acid Prevention for Spina Bifida — Maternal Timeline
Critical timeline for maternal folic acid supplementation to prevent neural tube defects, emphasising the importance of preconception and early pregnancy dosing.