Children and Young People

Paediatric presentations in primary care are a major AKT topic. You need to recognise common childhood conditions, understand developmental milestones, know the immunisation schedule, and be confident in safeguarding processes.

Child development milestones are tested frequently. Key milestones include smiling at 6 weeks, sitting unsupported at 6 months, first words at 12 months, walking at 12-18 months, and combining two words by 2 years. You need to know when to refer for developmental concerns and which milestones are most predictive of later problems.

Safeguarding is a core competency. You should understand the categories of abuse (physical, emotional, sexual, neglect), recognise concerning presentations (unexplained injuries, failure to thrive, inappropriate sexual behaviour, frequent attendance), and know the referral pathway. GPs have a duty to share information with children's social care if they have concerns about a child's welfare. Fraser competence and Gillick competence govern consent in under-16s.

Common childhood infections tested include chickenpox (infectivity period, management, when to refer), hand foot and mouth disease, scarlet fever (notifiable, requires antibiotics), measles (notifiable, complications including encephalitis), slapped cheek (parvovirus B19, risk in pregnancy), and meningitis (non-blanching rash, when to give IM benzylpenicillin).

The childhood immunisation schedule is a reliable source of AKT questions. The 6-in-1 vaccine is given at 8, 12, and 16 weeks. MenB is given at 8 weeks, 16 weeks, and 1 year. PCV is given at 12 weeks and 1 year. MMR is given at 1 year and 3 years 4 months. The Hib/MenC booster is at 1 year.

Adolescent health covers areas including eating disorders (NICE recommends SCOFF screening), self-harm (assess intent, mental state, safeguarding), acne (stepped treatment approach), and sexual health (confidentiality for under-16s, Fraser competence). Mental health presentations in young people are increasingly common and the AKT reflects this.

Red flags in paediatrics include non-blanching rash, bulging fontanelle, bile-stained vomiting in neonates, and limp in a child with fever.