Paediatrics and neonatology is 15% of our bank, 22 to 23 items on a 150-item paper, and a quarter of the published blueprints: 25% in the SMLE and 37 of 150 items (about 25%) at Qatar DHP. The SMLE rates gastroenteritis, febrile seizures, bronchiolitis, UTI, rickets, immunisation, development, congenital heart disease, croup, cystic fibrosis, nephrotic syndrome, hypoglycaemia and haemoglobinopathies at mastery level 3. Most items are age-dependent, so the first job in every stem is to read the age.
Weight and expected items
| Source | Share | Items on 150 |
|---|---|---|
| Our bank (editorial) | 15% | 22 to 23 |
| SMLE 2026 blueprint | 25% (can vary by plus or minus 5) | about 37 to 38 if applied to 150 |
| Qatar DHP GP blueprint | about 25% (our arithmetic) | 37 |
As with obstetrics and gynaecology, our weight is lower than the published ones because the bank is wider. If you are sitting the SMLE or the Qatar exam, add hours to this domain.
What is tested
- Neonatal: jaundice with G6PD deficiency and ABO or Rhesus disease, respiratory distress, prematurity and transient tachypnoea, neonatal sepsis and the infant of a diabetic mother.
- Growth and prevention: growth, development and red flags; the immunisation schedule and catch-up; failure to thrive, malabsorption (coeliac disease, cystic fibrosis), rickets and nutritional deficiencies.
- Acute illness: gastroenteritis and dehydration; bronchiolitis, croup and asthma; pneumonia, otitis media and tonsillitis; fever and febrile seizures; meningitis and encephalitis; paediatric emergencies including anaphylaxis, foreign body and intussusception.
- Systems: urinary tract infection and nephrotic or nephritic syndrome; congenital heart disease and Kawasaki disease; epilepsy, cerebral palsy and hypotonia; Henoch-Schonlein purpura, juvenile arthritis and rheumatic fever; type 1 diabetes and DKA in children.
- Blood and genetics: iron deficiency, thalassaemia, sickle cell disease, leukaemia and common tumours; inborn errors of metabolism and genetic syndromes linked to consanguinity.
- Safeguarding: child abuse, poisoning and ingestion.
Guideline points to hold
| Topic | Point | Guideline |
|---|---|---|
| Kawasaki disease | Fever for 5 days or more with at least 4 of 5 features (bilateral non-purulent conjunctivitis, oral changes, cervical lymphadenopathy, rash, extremity changes); IVIG 2 g/kg once plus aspirin; coronary aneurysm is the key complication | AHA 2017 |
| Croup | Oral dexamethasone 0.15 mg/kg once; nebulised adrenaline in severe croup | NICE CKS |
| Gastroenteritis | Oral rehydration solution first line (WHO low-osmolarity); zinc 20 mg daily for 10 to 14 days over 6 months, 10 mg under 6 months | WHO |
| Anaphylaxis | Adrenaline IM: 500 micrograms over 12 years, 300 micrograms for 6 to 12 years, 150 micrograms for 6 months to 6 years; repeat at 5 minutes; lateral thigh | Resuscitation Council UK |
| Rickets | Low sun exposure, covering clothing, exclusive breast-feeding without vitamin D, dark skin; low calcium or phosphate, raised alkaline phosphatase, widened metaphyses and bowed legs; treat with vitamin D and calcium | NICE CKS |
| Sickle cell disease | Penicillin V prophylaxis from about 2 months to at least 5 years, pneumococcal and Haemophilus b vaccination, hydroxycarbamide to reduce crises | UK screening programme standards |
G6PD deficiency is X-linked and neonatal jaundice is a classic presentation, with haemolysis triggered by oxidant drugs and infection. When both parents are thalassaemia carriers, each pregnancy carries a 25% risk of thalassaemia major.
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The febrile child
Fever in a child is the commonest presentation and a frequent source of exam items. Sort the child first by age and appearance, then by focus. A well-appearing child with a clear source needs treatment of that source. A febrile infant, a child with a non-blanching rash, neck stiffness, altered consciousness, or signs of shock needs urgent assessment and treatment for sepsis or meningitis without delay. Febrile seizures sit in the same cluster: the typical simple febrile seizure needs reassurance and a search for the source, while an atypical one needs further evaluation. The stem usually gives the age and one discriminating sign, and the correct answer is the action that is safe for that age, not the one that suits the average child.
Three typical traps
- Applying an adult dose or an adult threshold. Doses are weight-based or age-banded, and normal values change with age. The anaphylaxis doses above show how the same drug changes across three age bands. Always find the age before the drug.
- Calling early jaundice physiological. Jaundice in a newborn in the first day points to haemolysis, such as G6PD deficiency or ABO or Rhesus disease, and not to the common later pattern. The age at onset is the discriminator.
- Missing the safeguarding clue. A history that does not fit the injury, a delay in presentation or repeated attendances is the test. The answer is to recognise and act, not to treat the injury alone.
How to revise it
- Organise by age band: neonate, infant, toddler, school age. For each band list the common conditions and the emergencies.
- Learn the dose tables once, then rehearse them with the questions. Anaphylaxis, croup and rehydration come up repeatedly.
- Use the SMLE mastery level 3 list from high-yield topics as your checklist.
- Learn development as red flags: what a child should be doing at each stage and what should prompt referral.
- Link to adult domains: DKA with endocrine, thalassaemia and sickle cell with haematology, and rickets with vitamin D.
The study plan places paediatrics in week 5 of the 8-week version and week 7 of the 12-week version.
Frequently asked questions
How is paediatrics weighted?
Our bank gives it 15%, 22 to 23 items on a 150-item paper. The SMLE blueprint gives it 25%, and Qatar DHP lists 37 of 150 items.
What are the croup and gastroenteritis treatments?
Croup: oral dexamethasone 0.15 mg/kg once, with nebulised adrenaline for severe croup. Gastroenteritis: oral rehydration first line, with zinc 20 mg daily for 10 to 14 days in children over 6 months and 10 mg under 6 months.
What are the adrenaline doses by age?
500 micrograms IM for over 12 years, 300 micrograms for 6 to 12 years, and 150 micrograms for 6 months to 6 years, repeated after 5 minutes if needed, in the lateral thigh.
Are national immunisation ages tested?
We could not verify the UAE national schedule ages, so we do not teach them as facts. Use WHO schedule logic.
Which Gulf conditions appear in paediatrics?
Rickets, G6PD-related neonatal jaundice, haemoglobinopathies, sickle cell disease and consanguinity-linked genetic and metabolic disease are the main regional themes.