Paediatrics and Neonatology for PRES Level 2: Infants to Adolescents

Why children are different on this exam

A paediatric stem changes three things at once: the normal values, the drug doses and the legal framework. A heart rate that is normal in an infant is a problem in an adult. A drug that is safe in adults may be dangerous in a child. And the person who consents may be a parent, the child or a court. Candidates who trained mostly in adult medicine tend to lose marks to the first two, and candidates trained abroad to the third.

What is tested

• The newborn. Neonatal jaundice and neonatal emergencies, feeding problems and failure to thrive, vomiting in infancy including pyloric stenosis and its acid-base picture.
• Development. Milestones and developmental delay.
• Respiratory. Acute asthma, bronchiolitis, croup, epiglottitis and the febrile child.
• Gastrointestinal and fluids. Gastroenteritis, dehydration and paediatric fluid resuscitation.
• Neurology. Febrile seizures, reflex anoxic seizures and epilepsy.
• Cardiac, renal and haematological. Murmurs and congenital heart disease, haemolytic uraemic syndrome, Kawasaki disease, Henoch-Schonlein purpura and childhood rashes.
• Prevention. The childhood immunisation schedule and contraindications.
• Protection. Safeguarding, bruising and non-accidental injury.
• Genetic, endocrine and surgical. Cystic fibrosis, childhood diabetes, hernia, intussusception and bladder outlet obstruction.
• Behaviour and prescribing. Child mental health and enuresis, and weight-based dosing.

Local guideline points

• Immunisation. The HSE primary childhood schedule changed for babies born on or after 1 October 2024. Reports describe GP visits at 2, 4, 6, 12 and 13 months, the removal of the MenC dose at 6 months, the addition of varicella vaccine at 12 months and a 6-in-1 vaccine with a separate MenC dose at 13 months. Check the HSE National Immunisation Office schedule before you rely on this summary, and learn contraindications from the Immunisation Guidelines for Ireland.
• RSV. Nirsevimab was offered in maternity hospitals to babies born between 1 September 2024 and 28 February 2025 as a pathfinder programme.
• Child protection. Concerns about abuse or neglect are reported to Tusla under the Children First Act 2015. Know that you document carefully, and check in the Guide and the Act how consent and confidentiality apply when you share a protection concern.
• Consent for minors. Learn how the Medical Council's Guide treats consent for children and young people, and how confidentiality applies to a young person.
• Prescribing. Doses are by weight. Use the formulary and check units.

How the questions are framed

Paediatric stems give the age first, and the age often decides the answer. A vomiting two-week-old and a vomiting two-year-old need different thinking. Many stems describe a parent's account, then examination findings, then one investigation. The question asks for the diagnosis, the first test or the first action. Safeguarding stems describe an injury and a history that do not fit together, and the answer is to act on the mismatch.

Three typical traps

1. Using adult normal values. Check age against heart rate, respiratory rate and blood pressure before judging severity.
2. Waiting for certainty in suspected non-accidental injury. The correct answer is to escalate and report on suspicion, with careful documentation, not to investigate alone.
3. Applying an adult fluid or drug plan. Paediatric fluid resuscitation and dosing are weight-based. An answer that ignores weight is usually wrong.

How to revise it

1. Learn the milestones as a table by age for gross motor, fine motor, language and social skills.
2. Build an age-by-age vomiting and feeding sheet from the newborn to the toddler.
3. Write the emergency pathways for the child with breathing difficulty, seizure, dehydration and sepsis.
4. Memorise the immunisation schedule from the HSE page, and the contraindications.
5. Practise weight-based dose calculations by hand until they are quick and accurate.

Pair this domain with obstetrics and gynaecology for the newborn, with psychiatry for child mental health, and with professionalism for consent and confidentiality in young people.

Subtopic notes: the decision behind each topic

• Neonatal jaundice. Timing of onset separates physiological from pathological causes, and decides whether tests and treatment are needed.
• Vomiting in infancy. Pyloric stenosis and its metabolic picture, reflux, obstruction and infection, with the age at which each presents.
• Failure to thrive and feeding. Organic versus non-organic causes, growth charts and the first investigations.
• Developmental delay. Milestones, red flags and the referral pathway.
• Respiratory illness. Bronchiolitis, croup, epiglottitis and acute asthma: signs of severity and the treatment for each.
• The febrile child. Risk stratification and the signs that mean serious bacterial infection.
• Gastroenteritis and dehydration. Assessing dehydration, oral versus intravenous fluids and the complication of haemolytic uraemic syndrome.
• Seizures. Febrile seizure advice, reflex anoxic seizures and the first epilepsy work-up.
• Cardiac conditions. Innocent versus pathological murmurs and presentations of congenital heart disease.
• Vasculitis and rashes. Kawasaki disease, Henoch-Schonlein purpura and the non-blanching rash.
• Immunisation. The schedule, catch-up, and genuine contraindications.
• Non-accidental injury. Patterns of bruising, a history that does not fit, and the steps you take.
• Cystic fibrosis and genetic disease. Presentation, screening and complications.
• Childhood diabetes. Presentation with ketoacidosis and the careful fluid approach.
• Paediatric surgery. Hernia, intussusception and outlet obstruction.

Revising across two weeks

Spend the first week on the newborn, growth, development and common infections, and the second on emergencies, immunisation and safeguarding. Practise weight-based dosing every day for ten minutes. Learn the vital sign ranges by age until you can state them without a table. Review one safeguarding scenario daily and write the steps you would take. End each week with a timed block of 30 questions, and in the final days mix paediatrics with obstetrics to practise the newborn and maternal overlap.