Topics

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22q11.2 deletion syndrome

A fellowship approach to 22q11.2 deletion syndrome: recognise the multisystem fingerprint (conotruncal cardiac defect, cleft palate, neonatal hypocalcaemia, thymic and T-cell deficiency, characteristic facies) that earns a chromosomal microarray, confirm the deletion with a microarray rather than a karyotype, stage every organ system at diagnosis, defer live vaccines until T-cell deficiency is excluded, and run an age-based multidisciplinary surveillance plan through to adult transition.

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Acute metabolic decompensation: recognition and stabilisation

Acute metabolic decompensation is the life-threatening biochemical collapse that occurs when an inherited metabolic disorder is unmasked by catabolic stress. Recognition is pattern-based (encephalopathy with high anion-gap acidosis, hyperammonaemia, or hypoketotic hypoglycaemia) and stabilisation is time-critical: reverse the catabolic state, clear the toxin, and protect the brain.

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Amino-acid disorders including phenylketonuria and MSUD

A fellowship approach to the inherited amino-acid disorders: recognise phenylketonuria, maple syrup urine disease, tyrosinaemia type I and homocystinuria as autosomal-recessive blocks in amino-acid catabolism that share a single dangerous mechanism — a blocked step, an accumulating neurotoxic or tissue-toxic metabolite, and preventable brain injury — distinguish them on newborn-screen, metabolite and clinical signatures, deliver the acute 'switch off catabolism, clear the toxin' protocol for an MSUD crisis, and lock in long-term diet-plus-cofactor-plus-transplant management knowing that outcome tracks time on the toxic metabolite.

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Chromosomal microarray, exome and genome sequencing

Fellowship approach to choosing between chromosomal microarray, whole-exome and whole-genome sequencing in a child with congenital anomalies, developmental delay or a suspected monogenic disorder: what each platform detects, the resolution ladder, diagnostic yields, variant interpretation, secondary findings, consent, and rapid sequencing in the critically ill infant.

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Dietary, cofactor and emergency management of metabolic disease

The day-to-day and crisis treatment of inherited metabolic disease rests on four pillars: dietary substrate restriction with medical foods, cofactor or vitamin therapy that rescues a deficient enzyme, an emergency sick-day regimen that reverses catabolism, and toxin-specific detoxification with scavenger drugs or dialysis. Each pillar is disorder-tailored but follows one principle — restore pathway flux and protect the developing brain.

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Disorders of metal metabolism: Wilson and Menkes disease

A fellowship approach to the two inherited copper-transporting ATPase disorders: Wilson disease, in which a defective ATP7B gene causes copper to accumulate and poison the liver and basal ganglia, and Menkes disease, in which a defective ATP7A gene prevents copper from ever leaving the gut and reaching the brain so that copper-dependent enzymes fail. Recognise Wilson by its hepatic and neuropsychiatric faces and the Kayser-Fleischer ring, confirm with low ceruloplasmin and high urinary copper, and treat with chelation or zinc, reserving transplant for acute failure. Recognise Menkes in the hypotonic, failing infant with kinky hair and seizures, confirm with low serum copper, and treat with subcutaneous copper histidinate as early as possible.

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Down syndrome

A fellowship approach to Down syndrome: recognise the three genetic mechanisms (free trisomy 21, Robertsonian translocation, mosaicism) and why a karyotype changes genetic counselling, map the comorbidities by organ system (cardiac, gastrointestinal, endocrine, airway and sleep, haematology, neurodevelopment), and apply an age-stratified health-supervision schedule that is a checklist rather than a single visit.

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Dysmorphology examination and syndrome recognition

Fellowship approach to a structured dysmorphology examination using standard Elements of morphology terminology, classifying anomalies by mechanism and significance, generating and narrowing a syndrome differential, ordering first-tier chromosomal microarray then exome or genome, and communicating uncertainty and recurrence risk to a family.

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Ethical issues in genomic diagnosis and cascade testing

A fellowship approach to the ethics of genomic diagnosis and cascade testing in children: apply the AAP, ACMG, and ASHG framework that governs consent, predictive testing, secondary findings, and disclosure; defer predictive testing for adult-onset disease and carrier status to preserve the child's right to an open future; manage the ACMG secondary-findings list with genuine opt-in consent; and coordinate cascade testing of at-risk relatives while respecting confidentiality and the right not to know — because the genomic result belongs to the child, the family, and the future adult the child will become.

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Fatty-acid oxidation disorders

A fellowship approach to the fatty-acid oxidation disorders: recognise the child who cannot switch to fat-burning during fasting and so presents with hypoketotic hypoglycaemia, cardiomyopathy, rhabdomyolysis or sudden death; treat the acute crisis with intravenous glucose to shut off fatty-acid mobilisation; confirm with plasma acylcarnitines and molecular testing; and prevent recurrence with avoidance of fasting, an emergency sick-day plan, and for long-chain defects triheptanoin and carnitine.

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Fragile X syndrome

A fellowship approach to fragile X syndrome: recognise the X-linked FMR1 CGG-repeat expansion as the commonest inherited cause of intellectual disability, confirm the molecular diagnosis with PCR plus methylation analysis, build multidisciplinary developmental and behavioural support around the child, and run cascade testing of the wider family — because no curative therapy exists and every at-risk relative is a candidate for counselling.

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Genetic deafness and blindness syndromes

A fellowship approach to genetic deafness and blindness syndromes: recognise the infant who fails newborn hearing screening as a candidate for GJB2 and Usher evaluation, build the diagnostic tier from audiology and ophthalmology through targeted gene panels, separate Usher as the dominant dual-sensory cause from single-sensory syndromes like Pendred, Waardenburg, Jervell and Lange-Nielsen, branchio-oto-renal, Leber congenital amaurosis and Norrie disease, and deliver early cochlear implantation, voretigene neparvovec for RPE65 retinal dystrophy, and cascade family testing.

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Genetic history, pedigree construction and inheritance patterns

A fellowship approach to the genetic family history: draw a standardised three-generation pedigree using National Society of Genetic Counselors nomenclature, recognise each inheritance pattern from its shape (autosomal dominant, autosomal recessive, X-linked, mitochondrial, imprinting, anticipation, multifactorial), apply the recurrence-risk arithmetic that flows from it, and counsel the family honestly and non-directively — including the confounders (variable expressivity, reduced penetrance, gonadal mosaicism, consanguinity, anticipation) that change the numbers.

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Genomic testing, variant interpretation and counselling

A fellowship approach to genomic testing in paediatrics: choose the right test from the hierarchy of karyotype, chromosomal microarray, gene panel, exome, and whole-genome sequencing; apply the ACMG/AMP five-tier variant classification framework to interpret results; manage variants of uncertain significance and secondary findings; and deliver pre- and post-test genetic counselling that equips families for diagnosis, uncertainty, and cascade testing — because the diagnostic yield of genome sequencing in rare paediatric disease now reaches 40 to 50 percent.

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Glycogen-storage and carbohydrate metabolism disorders

A fellowship approach to the glycogen-storage and carbohydrate metabolism disorders: recognise the hepatic glycogenoses through the signature of hepatomegaly with fasting hypoglycaemia and lactic acidosis, separate Pompe disease by its hypertrophic cardiomyopathy and hypotonia, place the muscle glycogenoses by exercise intolerance with a second wind, and hold galactosaemia and hereditary fructose intolerance as the toxic-sugar disorders — then deliver the unifying treatment principle of preventing fasting and catabolism, with enzyme replacement for Pompe and emerging gene and transplant therapy.

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Hypoglycaemia due to inherited metabolic disease

A fellowship approach to hypoglycaemia caused by inherited metabolic disease: recognise the fasted or febrile child with hypoketotic hypoglycaemia, seizures or hepatomegaly as an emergency, capture the critical sample before treating, then work through the three physiological failures — insulin-driven (congenital hyperinsulinism), glucose-production failure (glycogen storage disease, fructose-1,6-bisphosphatase deficiency), and fuel-oxidation block (fatty-acid oxidation defects) — each with its own acute and lifelong management.

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Inborn errors presenting with neurological regression

A fellowship approach to the inborn errors of metabolism that present with neurological regression: recognise loss of previously acquired milestones as a red flag, distinguish true progressive neurodegeneration from plateau and static loss, group the disorders by affected pathway (intoxicating small molecule, energy/mitochondrial, storage/lysosomal, lipid-traffic and metal), deploy a tiered metabolic-and-genomic investigation strategy, and crucially identify the treatable subset before labelling a child degenerative or palliative.

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Klinefelter syndrome and sex chromosome aneuploidy

A fellowship approach to sex chromosome aneuploidies: recognise that Klinefelter syndrome (47,XXY) is the commonest chromosomal aneuploidy in humans yet more than half of cases are never diagnosed, understand the extra-X dosage model that links the neurodevelopmental phenotype to the gonadal trajectory, and apply a lifespan surveillance framework covering testosterone replacement, bone health, metabolic and cardiovascular risk, fertility preservation, and psychosocial advocacy.

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Lysosomal storage disorders

A fellowship approach to the lysosomal storage disorders: recognise the clinical phenotypes that trigger the search (developmental regression with organomegaly, coarse facies, or cardiomyopathy), group them by stored substrate, confirm with a layered enzyme-and-genotype workup, and match the disease-modifying therapy — enzyme replacement, substrate reduction, or haemopoietic stem cell transplant — to whether the central nervous system is involved.

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Marfan syndrome and heritable connective-tissue disorders

A fellowship approach to Marfan syndrome and the heritable connective-tissue disorders: recognise the marfanoid child, confirm Marfan with the revised Ghent nosology and FBN1 sequencing rather than a karyotype, image the aortic root from diagnosis and protect it for life with beta-blockade or losartan and elective valve-sparing root repair, and separate Marfan from Loeys-Dietz syndrome, vascular and hypermobile Ehlers-Danlos, Beals syndrome and homocystinuria by gene and by the direction the lens has fallen.

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Mitochondrial disease

A fellowship approach to mitochondrial disease: recognise the energy-failure phenotype across high-demand tissues, hold the dual-genome logic (maternal mtDNA versus Mendelian nDNA) and the heteroplasmy-threshold principle that explains variability, investigate in tiers from lactate to dual-genome sequencing to selective muscle biochemistry, and manage with supportive multidisciplinary care plus the hard pharmacological constraints — above all the absolute avoidance of valproate in POLG-related disease.

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Mucopolysaccharidoses and oligosaccharidoses

A fellowship approach to the mucopolysaccharidoses and oligosaccharidoses: recognise the coarse-facies child with dysostosis multiplex and hepatosplenomegaly, group the disorders by stored substrate (glycosaminoglycans versus glycoprotein-derived oligosaccharides), confirm with urine metabolic screening then enzyme activity and molecular testing, and match the disease-modifying therapy — enzyme replacement, haemopoietic stem cell transplant, or gene therapy — to the subtype and whether the central nervous system is involved.

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Neurofibromatosis type 1 and type 2

A fellowship approach to neurofibromatosis type 1 and type 2: recognise the child with multiple cafe-au-lait macules and freckling as NF1 until proven otherwise, confirm clinically with the NIH criteria and molecularly with NF1 sequencing, build multidisciplinary surveillance around optic glioma, plexiform neurofibroma and learning difficulty, and separate NF2 entirely as a chromosome-22 disorder of bilateral vestibular schwannomas and meningiomas managed in a specialist tumour clinic.

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Noonan syndrome and RASopathies

A fellowship approach to Noonan syndrome and the RASopathies: recognise the shared facio-cardio-cutaneous phenotype produced by gain-of-function germline variants in the RAS/MAPK pathway, distinguish Noonan syndrome from Noonan syndrome with multiple lentigines, Costello syndrome, cardio-facio-cutaneous syndrome, and neurofibromatosis type 1 by gene and cardiac profile, and apply a genotype-aware surveillance schedule anchored by an early echocardiogram.

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Organic acidaemias

A fellowship approach to the organic acidaemias: recognise the high-anion-gap metabolic acidosis with ketosis that distinguishes them from the urea cycle disorders, treat on suspicion with calorie loading, carnitine and toxin removal before the enzyme diagnosis returns, distinguish the cofactor-responsive subtypes, and lock in long-term protein-restricted diet, transplantation, and an emergency sick-day plan.

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Peroxisomal disorders

A fellowship approach to the peroxisomal disorders: split them at the bedside into the peroxisome biogenesis disorders (the Zellweger spectrum — a dysmorphic, hypotonic neonate with hepatomegaly, seizures and chondrodysplasia punctata) and the single-enzyme deficiencies (X-linked adrenoleukodystrophy, Refsum disease, rhizomelic chondrodysplasia punctata), confirm with a plasma very-long-chain fatty acid and phytanic acid panel, and match the therapy — haemopoietic stem cell transplant for cerebral X-ALD, cholic acid for the Zellweger spectrum, phytanic-acid restriction for Refsum — to the disorder.

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Prader-Willi and Angelman syndromes

A fellowship approach to Prader-Willi and Angelman syndromes: recognise the reciprocal imprinting errors at 15q11-q13, confirm the diagnosis with methylation analysis, and build syndrome-specific multidisciplinary management — growth hormone and behavioural support for PWS, anticonvulsant and communication strategies for AS — combined with imprinting-aware cascade genetic counselling.

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Prenatal diagnosis and reproductive genetics

Fellowship guide to prenatal diagnosis and reproductive genetics: screening versus diagnostic genetic testing, first-trimester combined screening and cell-free DNA, chorionic villus sampling and amniocentesis with contemporary procedure-related risk, chromosomal microarray versus karyotype, prenatal exome and genome sequencing, variant interpretation, Mendelian and empirical recurrence risk, expanded carrier screening, preimplantation genetic testing, non-invasive prenatal diagnosis, multidisciplinary coordination, and regional programme differences.

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Skeletal dysplasias

A fellowship approach to the skeletal dysplasias: recognise the disproportionate child and the lethal short-limbed newborn, group the disorders by molecular pathway (FGFR3, type II collagen, type I collagen, skeletal ciliopathies), confirm with a skeletal survey and targeted molecular testing, and match the therapy — vosoritide for achondroplasia, bisphosphonates for osteogenesis imperfecta — to the diagnosis while running surveillance for the lethal complications of foramen magnum compression and recurrent fracture.

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Syndromic craniosynostosis and craniofacial disorders

A fellowship approach to syndromic craniosynostosis and the genetic craniofacial disorders: recognise that an abnormal head shape with midface hypoplasia, exorbitism or a limb anomaly is syndromic until proven otherwise, name the big six syndromes by their gene (FGFR2 for Crouzon, Apert and Pfeiffer; FGFR3 p.Pro250Arg for Muenke; TWIST1/TCF12 for Saethre-Chotzen; EFNB1 for craniofrontonasal; RAB23/MEGF8 for Carpenter), confirm the diagnosis with skull imaging and targeted genetic testing, secure the airway, the exposed eye and raised intracranial pressure before any cosmetic plan, and coordinate an age-based multidisciplinary craniofacial team through to adult transition.

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Tuberous sclerosis complex

A fellowship approach to tuberous sclerosis complex: recognise the infant with hypomelanotic macules and infantile spasms or the fetus with a cardiac rhabdomyoma as having TSC, confirm with the 2012 international consensus criteria and TSC1/TSC2 testing, explain the hamartin-tuberin-Rheb-mTORC1 mechanism, build organ-by-organ surveillance, and offer everolimus for growing subependymal giant cell astrocytoma and refractory epilepsy.

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Turner syndrome

A fellowship approach to Turner syndrome: recognise the complete or partial loss of one X chromosome as the most common sex chromosome aneuploidy in females, confirm the diagnosis with a karyotype, and build lifelong multidisciplinary surveillance around short stature, gonadal dysgenesis, cardiovascular risk, and the neurocognitive profile — because early growth-hormone therapy, timed oestrogen replacement, and aortic imaging change both the trajectory and the survival of the girl you are looking after.

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Urea-cycle disorders and hyperammonaemia

A fellowship approach to the urea cycle disorders: recognise hyperammonaemia as a time-critical metabolic emergency that mimics sepsis in the neonate and presents with bizarre behaviour or coma in the older child, treat on suspicion with calorie loading, nitrogen scavengers and dialysis before the enzyme diagnosis returns, confirm with plasma amino acids and urinary orotic acid, and lock in long-term protein-restricted medical and — for severe forms — transplant-based management.

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Williams syndrome

A fellowship approach to Williams syndrome: recognise the multisystem pattern of a 7q11.23 microdeletion (distinctive facies, supravalvular aortic stenosis and elastin arteriopathy, infantile hypercalcaemia, the hypersocial personality and Williams cognitive profile), confirm the deletion with chromosomal microarray, stage the cardiovascular disease as the leading cause of mortality, and run an age-based multidisciplinary surveillance plan anchored to the AAP 2020 health-supervision clinical report.

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ABCDE assessment and stabilisation of the acutely ill child

A fellowship approach to the systematic ABCDE assessment and immediate stabilisation of the acutely ill child. Treat each life threat as it is found, reassess from A after every action, use age- and weight-appropriate oxygen, ventilation, fluid, glucose and seizure interventions, escalate before local support is exceeded, and hand over safely.

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Airway assessment and basic airway management

Fellowship guide to paediatric airway assessment and basic airway management: how the child's airway differs from the adult's, recognising the threatened and the failing airway at the bedside, head tilt-chin lift and jaw thrust, sizing and selecting oropharyngeal and nasopharyngeal airways, and effective two-person bag-valve-mask ventilation, with escalation triggers to a definitive airway.

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Altered conscious state in children

A fellowship approach to the child with an altered conscious state. Secure the airway with oxygen and ventilation, screen level of consciousness with AVPU and convert any response below Alert to an age-adapted Glasgow Coma Scale, check a bedside glucose immediately and correct a dangerous low now, treat an ongoing convulsion at five minutes, and keep infection, raised intracranial pressure, toxin, metabolic and safeguarding causes open while you escalate.

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Burns assessment, resuscitation and safeguarding

A fellowship approach to the burned child inside an organised burn-care system. Stop the burning process and cool with running water for 20 minutes within 3 hours of injury, estimate percent total body surface area with an age-adjusted Lund and Browder chart, recognise the threatened airway and inhalation injury, start modified-Parkland fluid resuscitation at or above 10 percent TBSA and titrate to urine output, run safeguarding in parallel, apply the burns-centre referral criteria, and hand over safely.

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Button-battery and magnet ingestion

A fellowship approach to the child with suspected button-battery or magnet ingestion. Treat any oesophageal button battery as a time-critical emergency requiring endoscopic removal within two hours, recognise the mechanism of alkaline liquefaction at the negative pole and the risk of delayed life-threatening fistula and perforation, give honey or sucralfate as a bridge in the eligible child older than twelve months who can swallow while awaiting removal, manage two or more magnets as a high-risk situation because attracting magnets across bowel walls cause fistula, obstruction and perforation, and run safeguarding and prevention in parallel.

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Cardiogenic and obstructive shock

Fellowship guide to paediatric cardiogenic and obstructive shock: recognising the low cardiac output state from pump failure versus mechanical obstruction, the distinguishing bedside signs of cardiac tamponade (Beck triad, pulsus paradoxus) and tension pneumothorax, the cautious fluid and inotrope strategy for cardiogenic shock, the emergency needle decompression and pericardiocentesis that reverse obstructive shock, and the ANZ, AHA and European guideline differences.

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Cardiorespiratory arrest and post-arrest care

Fellowship guide to paediatric cardiorespiratory arrest and post-arrest care: recognising the deteriorating child and the arrest, the high-quality CPR and defibrillation pathway to return of spontaneous circulation, and the post-arrest bundle of targeted temperature management, normoxia and normocarbia, haemodynamic and glucose control, seizure detection and delayed multimodal prognostication, with the ANZ, AHA and European guideline differences.

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Cardiotoxic and psychotropic medication poisoning

A fellowship approach to the child or adolescent with cardiotoxic and psychotropic medication poisoning: read the ECG and the toxidrome first, lead an ABCDE primary survey with continuous ECG monitoring and bedside glucose, give hypertonic sodium bicarbonate for tricyclic antidepressant cardiotoxicity with a widened QRS, start high-dose insulin euglycaemic therapy for severe beta-blocker and calcium channel blocker overdose, distinguish calcium channel blocker hyperglycaemia from beta-blocker presentation, manage antipsychotic QT prolongation, torsades and neuroleptic malignant syndrome, reserve intravenous lipid emulsion and extracorporeal support for refractory cases, and call the Poisons Information Centre and a toxicologist early.

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Care after death, unexpected child death and family support

Fellowship guide to care after a child's death and the unexpected child death: distinguishing expected from unexpected death, confirming death and the certification and coronial referral rules, breaking bad news with SPIKES, family time and memory-making, the SUDI and SUDIC definitions and the triple risk model of SIDS, the AAP 2022 safe-sleep recommendations, the multi-agency SUDI response with a joint paediatrician-and-police home visit, bereavement follow-up and sibling support, team welfare and child death review, with the ANZ, UK and North American differences.

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Difficult paediatric airway and emergency front-of-neck access

Fellowship guide to the difficult paediatric airway and emergency front-of-neck access: why the child's airway is anatomically and physiologically unforgiving, how to anticipate and recognise difficulty, the recognise-oxygenate-escalate-rescue sequence from a best-attempt laryngoscopy through early help and supraglottic-airway rescue to the rare emergency front-of-neck access, and the ANZ, UK and North American guideline differences.

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Envenomation and marine bites

Fellowship guide to envenomation and marine bites in children: pressure-immobilisation first aid for snakes and funnel-web spiders, venom-induced consumption coagulopathy and neurotoxicity, Australian snake antivenom dosing, funnel-web and redback spider envenomation, box jellyfish and Irukandji syndromes, and hot-water first aid for stingray and stonefish injuries.

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Fluid bolus therapy and vasoactive support

A fellowship approach to fluid bolus therapy and vasoactive support in the shocked child. Give 10 to 20 mL per kilogram of isotonic crystalloid in aliquots with reassessment after each, stop for overload or no benefit, escalate to adrenaline or noradrenaline for fluid-refractory shock, and keep the first-hour fluid total as a ceiling rather than a target. The FEAST trial anchors why fluid strategy must stay population-specific.

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Heat illness, hypothermia and environmental emergencies

Fellowship guide to heat illness, accidental environmental hypothermia and the principal environmental emergencies in children: the heat-illness spectrum and the cold-water-immersion cooling target, the Swiss hypothermia staging and the rewarming ladder with the hypothermic-arrest defibrillation rules, acute mountain illness with the Lake Louise score and the descent-first rule for high-altitude cerebral and pulmonary oedema, and the lightning reverse-triage and electrical-injury principles.

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Humane restraint and behavioural support in emergency care

A fellowship approach to the child or young person with acute behavioural disturbance in the emergency department. Run a primary survey and treat medical causes first, lead verbal de-escalation and environmental modification, offer oral medication with consent before any injection, escalate to parenteral rapid tranquillisation only when oral fails or is unsafe, reserve physical restraint for grave and imminent danger with minimum force and minimum duration by a trained team, monitor every sedated child for respiratory depression, QTc prolongation and oversedation, and debrief the child, family and team afterwards.

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Hydrocarbon, caustic and household chemical exposure

A fellowship approach to paediatric hydrocarbon, caustic and household chemical exposure. First identify the product. A hydrocarbon (petroleum distillate) threatens by aspiration, so never induce emesis, never lavage, and observe for six hours. A caustic agent threatens by corrosive injury, so keep nil by mouth, never neutralise, and arrange early endoscopy within twenty-four hours. Corticosteroids and prophylactic antibiotics are not routine. Call the poisons information centre early and tailor every rule to the product and the local protocol.

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Hypovolaemic and haemorrhagic shock

A fellowship approach to hypovolaemic and haemorrhagic shock in children. Recognise compensated shock before hypotension, control catastrophic bleeding first, resuscitate with aliquots of crystalloid for non-haemorrhagic loss and with blood products and damage control resuscitation for haemorrhage, give tranexamic acid within three hours of injury, run a paediatric massive transfusion protocol, prevent the lethal triad, and escalate early to surgical and critical-care support.

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Initial stabilisation of major paediatric head injury

A fellowship approach to the initial stabilisation of a child with major traumatic brain injury. Run the primary survey with cervical spine protection, intubate for GCS of 8 or below, oxygenate and ventilate to normocapnia, avoid hypotension with isotonic fluid, treat raised intracranial pressure with hyperosmolar therapy and 30-degree head-up positioning, give early seizure prophylaxis, obtain urgent CT, and escalate to neurosurgery and retrieval before local support is exceeded.

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Iron, salicylate and toxic alcohol poisoning

A fellowship approach to the child who has ingested iron, salicylate or a toxic alcohol: recognise the shared high-anion-gap metabolic acidosis and the poison-specific signature (the four-stage corrosive course and radiopaque tablets of iron, the mixed respiratory alkalosis plus anion-gap acidosis and tinnitus of salicylate, the dual anion-gap plus osmolal-gap with visual or renal-crystal clues of methanol and ethylene glycol), give the correct weight-based antidote (intravenous desferrioxamine 15 mg per kg per hour for iron, urinary alkalinisation to urine pH 7.5 to 8.0 for salicylate, intravenous fomepizole 15 mg per kg loading for toxic alcohols), decontaminate by poison, and avoid the three lethal traps of latent-phase reassurance, salicylate intubation without maintained hypocapnia, and waiting for toxic-alcohol levels before fomepizole.

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Major trauma and paediatric trauma systems

A fellowship approach to the injured child within an organised paediatric trauma system. Run a trauma primary survey that controls catastrophic haemorrhage first and protects the cervical spine, lead a structured trauma team with defined roles, use weight-based fluid and early blood for haemorrhagic shock, avoid the lethal triad, apply paediatric imaging decision rules, escalate to a paediatric trauma centre before local support is exceeded, and reassess after every intervention.

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Mechanical ventilation principles in children

Fellowship guide to mechanical ventilation principles in children: why a child is intubated, how the ventilator delivers a breath, how the modes differ in what they control and what they let the patient do, and the lung-protective strategy that sets low tidal volume, limited plateau pressure, optimised PEEP and permissive hypercapnia that now governs the paralysed diseased lung. Covers the settings a candidate must be able to justify, the weaning and liberation approach including spontaneous breathing trials and post-extubation non-invasive support, sedation and the difficulty of translating adult liberation protocols to children, ventilator-associated pneumonia prevention, and the way every choice is judged against the type of respiratory failure in front of you.

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Oesophageal and gastrointestinal foreign-body ingestion

A fellowship approach to the child who has swallowed a foreign body. The single decision that changes everything is whether a button battery or a complete oesophageal obstruction is lodged in the oesophagus, because both demand emergency endoscopic removal within two hours. Use a plain anteroposterior chest and abdominal radiograph with a lateral view to identify batteries and magnets, apply NASPGHAN and ESPGHAN urgency categories for every other object, observe blunt gastric objects that are below threshold size, and consult early for sharp, long, multiple-magnet and button-battery ingestions.

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Opioid, sedative and recreational-drug toxicity

A fellowship approach to the child or adolescent with opioid, sedative or recreational-drug toxicity: recognise the toxidrome from the bedside pattern, lead an ABCDE primary survey with oxygen, ventilation, glucose and access, titrate naloxone to effective ventilation rather than full wakefulness, reserve flumazenil for the narrow isolated-benzodiazepine case because it can precipitate seizures, manage sympathomimetic and serotonergic toxicity with benzodiazepines and cooling, correct ethanol-induced hypoglycaemia early, and call senior help and the Poisons Information Centre in parallel.

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Oxygen, high-flow and non-invasive respiratory support

A fellowship approach to oxygen and non-invasive respiratory support in children: choose the right device for the right problem, dose high-flow nasal cannula by weight, set CPAP and BiPAP pressures correctly, know what each mode does physiologically, recognise when support is failing, and escalate to intubation without delay.

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Paediatric basic and advanced life support

Fellowship guide to paediatric basic and advanced life support: the BLS sequence, high-quality chest compressions, the airway and ventilation ladder, defibrillation at 4 J per kilogram, adrenaline at 10 micrograms per kilogram, reversible causes, and post-arrest care.

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Paracetamol poisoning

A fellowship approach to paediatric paracetamol poisoning: take a focused time-of-ingestion history, plot a single acute ingestion on the Rumack-Matthew nomogram at four hours using the 150 mg per litre treatment line, give activated charcoal early when indicated, and start intravenous N-acetylcysteine when the level is on or above the treatment line, when the ingestion is staggered or of unknown time, or when hepatotoxicity is already present. Give NAC empirically when in doubt, watch the ALT and the coagulation trend, and escalate to a liver unit the moment King's College criteria are met.

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Poisoned child: structured assessment and decontamination

A fellowship approach to the poisoned child. Resuscitate with ABCDE and treat life-threatening toxin effects first, then take a structured ingestion history, recognise the toxidrome from vital signs, pupils and mental state, and call the Poisons Information Centre early. Give activated charcoal 1 g/kg within the first hour only when the airway is safe and the toxin is adsorbable; reserve whole bowel irrigation for iron, lithium, sustained-release and packet ingestions, and enhanced elimination for the few toxins it helps. Most children need observation and supportive care, and safeguarding runs in parallel for intentional and non-accidental exposure.

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Rapid sequence intubation in children

A fellowship approach to rapid sequence intubation in children: prepare a team and equipment, preoxygenate to a child's shorter safe apnoea time, give a weight-based induction agent and neuromuscular blocker in rapid succession, size the endotracheal tube by the age formulae (uncuffed equals age over four plus four; cuffed equals age over four plus 3.5), confirm placement with exhaled carbon dioxide, and avoid the pitfalls of desaturation, bradycardia and cardiovascular collapse.

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Retrieval, transport and interfacility stabilisation

A fellowship approach to moving a critically ill or injured child between facilities. Treat retrieval as a system that brings intensive care to the child before the child is moved, stabilise the airway, breathing and circulation in full before departure, run a structured referral and handover, choose the right mode of transport and escort for the child and the weather, manage the hostile physics of altitude, vibration and cold, monitor continuously, and rehearse the contingency for deterioration in flight.

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Septic shock resuscitation and vasoactive support

A fellowship approach to resuscitating paediatric septic shock: recognise the failing circulation early, restore perfusion with reassessed crystalloid aliquots, give broad-spectrum antibiotics within the first hour, and escalate to adrenaline for cold shock or noradrenaline for warm shock as the first-line vasoactive agent when shock is fluid refractory. Treat every step as a reassessment loop, watch for fluid accumulation, and call for critical-care help before local support is exceeded.

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Shock in children: physiology and classification

A fellowship approach to the physiology and classification of shock in children. Shock is inadequate delivery or use of oxygen and substrate at the mitochondrion, not a blood pressure number. Children compensate with tachycardia and vasoconstriction and maintain blood pressure until late, so recognise compensated shock from the whole child, watch the trend, and never wait for hypotension. Classify by haemodynamic phenotype as hypovolaemic, distributive, cardiogenic or obstructive, and grade severity as compensated, decompensated or irreversibly failing.

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Submersion injury and hypothermia

Fellowship guide to submersion injury (drowning) and hypothermia in children: the van Beeck definition, the Szpilman severity stratification, the asphyxial and cold-water pathways, the rescue-breath-first and rewarming ladders, hypothermic cardiac arrest ('warm and dead'), prognostic factors, and drowning prevention.

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Abdominal radiograph and acute imaging decisions

Fellowship guide to the abdominal radiograph and the acute paediatric imaging decision. Covers when an abdominal radiograph answers the question (suspected perforation, obstruction, constipation burden, and the ingested foreign body or button battery) and when it does not, the low diagnostic yield of the radiograph in non-specific abdominal pain, the ALARA principle and the cancer-risk evidence that underpins it, the ultrasound-first pathway for appendicitis and intussusception, the role of the upper gastrointestinal contrast study for malrotation and midgut volvulus, and the careful, lowest-dose use of computed tomography when ultrasound is equivocal and the child is unstable or complex. Reproduces the radiographic signs of free air, obstruction, the intussusception target sign, and neonatal pneumatosis, and the regional guidelines that govern the choices.

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Abscess drainage and minor procedures

Fellowship guide to abscess drainage and minor surgical procedures in children. Covers the bedside decision between a drainable cutaneous abscess, cellulitis and a necrotising soft tissue infection that must never be loosely drained; the loop drainage technique and its superiority over classical incision and drainage with packing in larger abscesses; the safe maximum doses of plain lidocaine (3 mg/kg) and lidocaine with adrenaline (7 mg/kg) and of bupivacaine (2 mg/kg); the indications for adjuvant antibiotics after drainage and the empiric choice of cephalexin, clindamycin or trimethoprim-sulfamethoxazole for suspected MRSA; the red flags of necrotising fasciitis that mandate urgent surgical referral; and the common minor procedures of paediatrics including paronychia drainage, ingrown toenail wedge resection with phenolisation, foreign body removal and suture removal timing, with their analgesia, technique and aftercare.

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Airway suction, oxygen devices and nebuliser technique

Fellowship guide to three linked bedside skills: clearing a child's airway by suction, choosing and applying the right oxygen delivery device to a target saturation, and setting up a nebuliser so the drug actually reaches the lung. Covers device classification and FiO2, the entrainment principle and aerosol physics, suction technique and complications, the evidence for high-flow nasal cannula, and the choice between a spacer with a metered-dose inhaler and a nebuliser.

medium

Artificial intelligence and clinical decision support in paediatrics

A fellowship approach to artificial intelligence (AI) and clinical decision support (CDS) in paediatrics. Sort the tools into four classes — prediction and early warning (deterioration, sepsis, PICU transfer), diagnosis and image interpretation (radiograph, retinopathy of prematurity, skull fracture), rule-based decision support (drug interaction, dosing, allergy) and generative or triage tools — and distinguish a trained predictive model from a rule-based alert. Hold the validation ladder in working memory: internal cross-validation, external validation in a different paediatric population, and a prospective silent trial, with external validation as the gate that prevents harm. Run the failure model: bias and non-representation, data leakage, overfitting, the black box, automation bias and alert fatigue. Know that sensitivity and specificity are not fixed but shift with prevalence and threshold, and that the clinician remains accountable for every output.

high

Audiology and hearing-test interpretation

Fellowship guide to paediatric hearing-test interpretation. Covers reading the pure-tone audiogram (axes, symbols, air versus bone conduction, the air-bone gap, the pure-tone average) and the paediatric degree-of-loss thresholds normal at or under 15 dB HL through slight, mild, moderate, moderately severe, severe and profound; the Jerger tympanogram types A, B, C, As and Ad using admittance, peak pressure and ear canal volume, and why the 1000 Hz probe tone is preferred under six months; otoacoustic emissions as a test of cochlear outer hair cell function; the auditory brainstem response as a test of the whole pathway to the brainstem; the two-stage newborn screen with OAE then automated ABR and the 1-3-6 early hearing detection and intervention milestones; the age-appropriate behavioural tests; and the patterns that separate otitis media with effusion, congenital cytomegalovirus-related loss and auditory neuropathy spectrum disorder, with the ANZ, UK and North American screening and guideline differences.

high

Bag-mask ventilation and basic airway adjuncts

Fellowship guide to the two skills that stand between a hypoxic child and a cardiac arrest: ventilating through a face mask, and holding a blocked airway open with an adjunct. Covers manual ventilation device classification, one- and two-person technique, ventilation rates for rescue breathing and arrest, oropharyngeal and nasopharyngeal airway sizing and insertion, the laryngeal mask airway as a rescue device, the paediatric difficult-mask-ventilation predictors, gastric insufflation, and the neonatal T-piece resuscitator.

high

Blood gas, electrolyte and acid-base interpretation

A fellowship approach to blood gas, electrolyte and acid-base interpretation in children covering the five-step systematic method (pH, PaCO2, HCO3, compensation, anion gap), the normal paediatric arterial values of pH 7.35 to 7.45, PaCO2 35 to 45 mmHg and bicarbonate 22 to 26 mmol per litre, the anion gap as sodium minus chloride plus bicarbonate with a normal range of 8 to 12 mmol per litre, the compensation rules including Winter's formula of expected PaCO2 equals 1.5 times bicarbonate plus 8 plus or minus 2 for metabolic acidosis, the choice between arterial, venous and capillary samples with venous pH and bicarbonate closely matching arterial values, the high anion gap metabolic acidosis of diabetic ketoacidosis defined by pH below 7.3 and bicarbonate below 15, the hypochloraemic hypokalaemic metabolic alkalosis of pyloric stenosis, the dysnatraemias and their slow correction rates of no more than 8 to 10 mmol per litre per day, and the use of isotonic maintenance fluids to prevent hospital-acquired hyponatraemia.

medium

Bone-marrow aspiration and biopsy principles

A fellowship approach to bone marrow aspiration and biopsy in children covering the principle that aspirate and trephine are two complementary samples taken at one sitting (the aspirate for cells in suspension — morphology, flow cytometry, cytogenetics, molecular and culture; the trephine core for cellularity, architecture and infiltration), the posterior superior iliac spine as the standard paediatric site and the reasons the sternum is avoided in young children, the manual Jamshidi and Salah needles and the powered OnControl drill, the stepwise procedure of positioning and landmark, asepsis and local anaesthetic infiltration to the periosteum with lidocaine one per cent three milligrams per kilogram plain or seven milligrams per kilogram with adrenaline, aspirating the first pull for morphology and cytogenetics then taking a trephine core from a new track, the meaning of a dry tap and the need for a trephine, the complications of pain bleeding infection and retropneumoperitoneum, and the staging and risk-stratification decisions that rest on a correctly handled first pull.

high

Central venous and arterial access in children

A fellowship approach to central venous and arterial access in children: choose the site by indication and bleeding risk, use ultrasound to identify the target vessel and its companion artery, run the Seldinger sequence (needle, guidewire, dilator, catheter), aim the central catheter tip at the cavoatrial junction, and prevent the complications of arterial puncture, pneumothorax, haematoma, thrombosis and central line-associated bloodstream infection with a full sterile insertion bundle and a daily review of line necessity.

high

Chest decompression and intercostal drain insertion

A fellowship approach to chest decompression and intercostal drain insertion in children covering tension pneumothorax as a clinical diagnosis requiring immediate needle decompression at the second intercostal space mid-clavicular line or the fourth or fifth intercostal space at the anterior axillary line within the safe triangle, the safe triangle boundaries (anterior border lateral edge of pectoralis major, posterior border lateral edge of latissimus dorsi, inferior border the fifth intercostal space at the nipple line, apex at the base of the axilla), the rule of inserting above the rib below to avoid the neurovascular bundle that runs in the costal groove along the inferior border of the rib above, the stepwise blunt-dissection drain insertion technique, drain-size selection by content (small-bore 8 to 14 French pigtail for air, medium 16 to 24 French for fluid and empyema, large-bore 28 to 36 French for blood), the underwater seal with the tube tip two centimetres below the water line, the lidocaine 1 per cent maximum three milligrams per kilogram dose, the never-clamp-a-bubbling-drain rule, the complications of bleeding from the intercostal vessels, re-expansion pulmonary oedema, and wrong-side insertion, and the special scenarios of the ventilated neonate, adolescent spontaneous pneumothorax, and complicated parapneumonic empyema with intrapleural fibrinolytics.

high

Chest radiograph interpretation in children

Fellowship guide to interpreting the paediatric chest radiograph. Covers why the child's chest film differs from the adult's — the thymus that reshapes the mediastinum, the cartilaginous skeleton, the projection and inspiration that change everything — the structured technical-quality check that must precede any reading, the ABCDEFGH systematic approach applied zone by zone, the normal cardiothoracic ratio and how rotation and poor inspiration falsely enlarge the heart, the neonatal chest film with its lines and tubes, the radiographic signs of pneumonia, foreign-body aspiration, heart failure and the common pitfalls, and the radiation-aware ALARA principle that governs when a film is justified at all.

high

Defibrillation, cardioversion and transcutaneous pacing

A fellowship approach to delivering an electric shock or an external pacing stimulus to a child's heart, covering the critical distinction between unsynchronised defibrillation for pulseless ventricular fibrillation and pulseless ventricular tachycardia at 4 joules per kilogram, synchronised cardioversion for a perfusing tachyarrhythmia such as supraventricular tachycardia at 1 joule per kilogram escalating to 2 joules per kilogram, and transcutaneous pacing for symptomatic bradycardia from complete heart block. The page teaches the energy doses, the pad positions (anterolateral and anteroposterior), automated external defibrillator use with attenuated paediatric pads in the under-eight-year-old, the sync function that prevents an R-on-T shock, capture thresholds and analgesia for pacing, and the complications of skin burns, myocardial injury and failure to capture. Every dose is anchored to the 2020 American Heart Association Pediatric Advanced Life Support guidance, the 2021 European Resuscitation Council Paediatric Life Support guidelines, and APLS.

high

Developmental, cognitive and behavioural assessment tools

A fellowship approach to the developmental, cognitive and behavioural assessment tools used across childhood, built on the single principle that surveillance, screening and diagnostic assessment are three different acts answering three different questions. Surveillance is the longitudinal, opinion-based monitoring done at every health visit. Screening is a brief, standardised tool applied to the whole population at scheduled ages to find the child who needs a closer look. Diagnostic assessment is the lengthy, trained-administered evaluation that confirms and quantifies a disorder. Hold the schedule of developmental screen at nine, 18 and 30 months and autism screen at 18 and 24 months, layered on surveillance at every visit. Know the broadband developmental screens (Ages and Stages Questionnaires, Parents' Evaluation of Developmental Status, Denver II), the gold-standard cognitive tools (Bayley, Griffiths, Wechsler), the autism screen (M-CHAT-R/F, CHAT) and the behavioural scales (Strengths and Difficulties Questionnaire, Child Behavior Checklist, Vanderbilt, Conners). Hold the psychometric model: standard score mean 100, standard deviation 15, a score of 70 or below two standard deviations below the mean; developmental quotient equals developmental age divided by chronological age times 100. A positive screen is never a diagnosis; low prevalence lowers positive predictive value, so diagnostic confirmation always follows. Always check hearing and vision, because sensory impairment is the reversible mimic, and escalate regression or loss of any skill to urgent diagnostic referral.

high

Echocardiography fundamentals for general paediatricians

Fellowship guide to echocardiography fundamentals for the general paediatrician. Covers what each echo modality shows (two-dimensional anatomy, M-mode dimensions, colour and spectral Doppler flow and gradients), the standard paediatric imaging windows and the comprehensive transthoracic study, Z-score normalisation against body size, the high-yield indications (pathological murmur, cyanosis, heart failure, syncope with red flags), the modified Bernoulli equation and what a valve gradient means, how to read a paediatric echo report systematically, when a focused point-of-care cardiac ultrasound answers a binary question, the echo features of duct-dependent critical congenital heart disease and its prostaglandin resuscitation, and the boundary between the general paediatrician's competence and the paediatric cardiologist's.

high

Electrocardiogram acquisition and interpretation in children

Fellowship guide to electrocardiogram acquisition and interpretation in children. Covers the technical principles of 12-lead acquisition and electrode placement in an uncooperative infant, the age-specific normal intervals for heart rate, PR, QRS duration and axis, the right ventricular dominance of the newborn that resolves through childhood, the Bazett and alternative QTc formulae and the age-specific prolonged-QTc thresholds, the structured systematic interpretation sequence, and the high-yield abnormal patterns of long QT syndrome, pre-excitation, chamber hypertrophy, AV block and the juvenile T-wave pattern.

high

Endotracheal intubation and emergency airway equipment

A fellowship approach to endotracheal intubation and emergency airway equipment in children covering the indication (respiratory failure, loss of airway reflexes, severe shock, cardiac arrest), the age-based tube sizing formulas (uncuffed internal diameter equals age divided by 4 plus 4, cuffed equals age divided by 4 plus 3.5, depth at the lips equals age divided by 2 plus 12), the straight Miller blade for infants versus the curved Macintosh blade for older children, the infant airway anatomy that drives technique, the seven-step rapid sequence intubation procedure, the role of video laryngoscopy, waveform capnography as the standard for confirming tracheal placement, and the prevention of hypoxia, oesophageal intubation, right main bronchus intubation and post-extubation stridor.

high

Gastrostomy, tracheostomy and central-line troubleshooting

A fellowship approach to troubleshooting the three devices a technology-dependent child lives with — the gastrostomy, the tracheostomy and the central venous catheter. Recognise and resolve the common failure modes: the leaking or buried gastrostomy and the dislodged tube in an immature tract; the obstructed or decannulated tracheostomy run through the National Tracheostomy Safety Project algorithm; and the occluded, broken or infected central line managed with the right lock — sterile water and warm flush, a thrombolytic dwell for a clot, and an immediate clamp-and-repair for a fracture.

high

Genetic and metabolic test selection

Fellowship guide to choosing the right genetic and metabolic test in a child, owned from the requester's side of the form rather than the laboratory's side of the bench. Covers the resolution ladder from karyotype through chromosomal microarray to whole-exome and whole-genome sequencing, the diagnostic yields of each platform in developmental delay, congenital anomalies, autism and the critically ill infant, the design and interpretation of newborn bloodspot screening by tandem mass spectrometry, the metabolic test panel — plasma amino acids, urine organic acids, acylcarnitines, lactate, transferrin isoforms and very-long-chain fatty acids — and how to take consent, request a trio, interpret a variant of uncertain significance, manage an incidental secondary finding, and apply the ACMG, HGSA, RCPCH and regional newborn screening programmes to real children.

high

Intraosseous access

A fellowship approach to intraosseous access in children covering the indication (failed intravenous access within 60 to 90 seconds in shock, arrest or status epilepticus), why the marrow cavity is a non-collapsible vein, the proximal tibial landmark (flat anteromedial surface one to two centimetres below the tibial tuberosity), device and needle-set selection by weight (EZ-IO 15 mm pink for 3 to 39 kg, 25 mm blue for 40 kg and over, 45 mm yellow for the adolescent or oedematous child), the stepwise insertion technique, confirmation, drug and fluid administration at intravenous doses, the preservative-free lidocaine 0.5 milligram per kilogram dose for infusion pain in the conscious child, the complications of extravasation and compartment syndrome, removal within 24 hours, and the neonatal and pre-hospital scenarios.

high

Joint aspiration

Fellowship guide to joint aspiration (arthrocentesis) in infants and children. Covers the indications, the single biggest question of septic arthritis versus transient synovitis, the Kocher and Caird predictors (fever above 38.5°C, refusal to bear weight, ESR above 40, white cell count above 12,000 and CRP above 20), the relative contraindications of overlying cellulitis and uncorrected coagulopathy, why the deep paediatric hip is aspirated under ultrasound guidance, the synovial fluid cell-count categories that separate septic from inflammatory from non-inflammatory effusions, the sterile technique and landmarks for the knee, hip, ankle and shoulder, the local anaesthetic infiltration and its safe dose, and the common and serious complications including infection seeding and bleeding.

high

Lumbar puncture in infants and children

Fellowship guide to lumbar puncture in infants and children. Covers the indications, the absolute contraindications of raised intracranial pressure, coagulopathy, overlying skin infection and the unstable child, the indications for CT before LP, why the infant spinal cord ends at L3 and the safe interspaces this dictates, the lateral decubitus and sitting positions and why opening pressure is reliable only in a calm child in the lateral decubitus position, the atraumatic pencil-point needle and its reduction of post-dural puncture headache, the normal CSF values and the traumatic-tap correction, the topical, local and procedural-sedation analgesia options, the common and serious complications, and the ANZ, UK and North American guideline differences on antibiotics-first in suspected meningitis.

medium

Medical devices, digital health and remote monitoring

A fellowship approach to selecting, deploying and remotely interpreting paediatric medical devices, wearables and digital-health tools. Sort devices into four classes — implantable or long-term, wearable or on-body, home monitoring and telehealth platforms — and distinguish a regulated medical-grade device from a consumer wellness product. Hold the two highest-yield sensor physiologies in working memory: the continuous glucose monitor (interstitial glucose with a five-to-fifteen-minute plasma lag) and the pulse oximeter (light absorption biased by dark skin pigmentation and poor perfusion). Run the ambulatory glucose profile targets from ISPAD 2024, recognise the equity and accuracy failures of pulse oximetry, and deploy a device only after the clinical question, the age validation, the thresholds and the escalation pathway are agreed with the family.

high

Nasogastric tube insertion and verification

Fellowship guide to inserting and verifying a nasogastric (NG) tube in a child of any age, from the preterm neonate to the adolescent. Covers selecting the tube size by age, measuring the insertion length, the gentle age-adapted insertion technique, and confirming gastric position by aspirate pH testing at a threshold of 5.5 or less, escalating to a radiograph when the pH is above 5.5 or no aspirate can be obtained. Names and rejects the deprecated methods (the whoosh test, the bubbling test, litmus paper and auscultation alone), defends why feeding or medicating through an unverified tube is a Never Event, and recognises the complications of misplacement (respiratory intubation, pneumothorax, pleural feed) and of traumatic insertion (pharyngo-oesophageal perforation in neonates, intracranial misplacement). Includes ANZ, UK, US and Canada guidance.

high

Neuroimaging selection and radiation-aware practice

Fellowship guide to choosing between CT, MRI, cranial ultrasound and skull radiograph in infants and children, and to the radiation-aware principles that govern that choice. Covers why CT uses ionising radiation and MRI does not, why the paediatric brain carries a measurably higher lifetime attributable cancer risk per millisievert with the Brenner, Pearce and Meulepas cohort estimates, the ALARA principle and its four levers, the PECARN paediatric head injury prediction rules reproduced verbatim for the under-two and two-and-over arms, the indications for urgent neuroimaging in seizures, stroke, shunt malfunction, raised intracranial pressure and suspected abusive head trauma, the MRI safety issues in children including sedation and gadolinium, the regional guideline differences (NICE, PECARN, Canadian, RCH Melbourne, RCPCH), and how to counsel a parent accurately about the absolute and relative radiation risk of a single head CT.

high

Paediatric ultrasound and point-of-care ultrasound

A fellowship approach to paediatric ultrasound and point-of-care ultrasound covering probe selection and the frequency-to-depth trade-off, the lung ultrasound artefact repertoire (A-lines, B-lines, lung sliding, the lung point, pleural effusion and consolidation), the BLUE protocol decision tree for acute respiratory failure, an eight-zone lung scan, the focused assessment with sonography in trauma (FAST) and its limited sensitivity in children, abdominal applications (intussusception target sign and pyloric stenosis measurement), ultrasound-guided vascular access and the EPIC trial, focus-assessed cardiac ultrasound in shock, neonatal lung ultrasound patterns, the no-ionising-radiation and ALARA acoustic safety principle, and image acquisition principles of depth, gain, focus and probe choice.

high

Paediatric venepuncture and peripheral intravenous access

A fellowship approach to paediatric venepuncture and peripheral intravenous access: choose a site by age (dorsal hand veins first, then antecubital fossa, forearm and great saphenous at the ankle), select a cannula gauge by age and indication (24G neonate and infant, 22G infant and small child, 20G older child, 18G adolescent or rapid bolus), apply a systematic comfort bundle (topical anaesthesia at the correct lead time, oral sucrose, distraction, comfort positioning and a single calm operator), use ultrasound-guided access for the difficult-access child, and escalate to intraosseous access when peripheral attempts fail in an emergency.

high

Point-of-care glucose, ketone and urinalysis testing

Fellowship guide to the three core paediatric point-of-care tests. Covers the capillary blood glucose meter and its known inaccuracy in the neonate from the high haematocrit and the galactose or maltose interference with the glucose dehydrogenase strips, the rule to confirm any critical value with a laboratory plasma glucose, the blood beta-hydroxybutyrate ketone meter as the preferred measure over the urine acetoacetate in diabetic ketoacidosis with the ISPAD thresholds of greater than three millimoles per litre for the diagnosis and the fall that tracks the resolution, and the urine dipstick with the leukocyte esterase and the nitrite performance, the lower sensitivity of the nitrite in the young infant, and the rule that the dipstick screens while the culture confirms the urinary tract infection.

high

Procedural consent, preparation and child-life support

Fellowship-level approach to what wraps around every paediatric procedure: valid informed consent and parental permission, the Appelbaum capacity framework, the AAP four-element assent standard and the doctrine of emergency necessity; the structured pre-procedure preparation conversation by developmental age; the evidence-based roles of child-life specialists, distraction, comfort positioning and parental presence; the bedside comfort bundle of topical anaesthesia, oral sucrose as absolute volume up to 2 mL, breastfeeding and non-nutritive sucking; the recognition and stepwise management of procedural distress and needle fear; and the documentation and quality measures that make the practice defensible across ANZ, UK and North American guidelines.

high

Procedural pain: topical anaesthesia, preparation, distraction and non-pharmacological support

Fellowship guide to managing procedural pain in infants and children with a multi-modal comfort bundle. Covers why untreated procedural pain is harmful and ethical fail, the four layers of the comfort bundle (preparation and child life, topical anaesthesia, sweet taste and breastfeeding, distraction and comfort positioning), the agents and their timings (EMLA lidocaine-prilocaine 60 minutes and its methaemoglobinaemia risk in infants under three months, amethocaine 4% gel 30 to 45 minutes, liposomal lidocaine 4%, oral sucrose 24% at 0.1 to 2 mL given two minutes before and never as mL per kg, breastfeeding during the procedure), how each works (sodium-channel blockade in skin nociceptors, endogenous opioid and dopamine activation by sweet taste, gate-control and attentional modulation by distraction), the age- and procedure-specific approach from the neonate to the needle-phobic adolescent, the avoidance of forceful hold-down restraint, the HELPinKIDS and Cochrane evidence base, and the ANZ, UK and North American guideline differences. Woven throughout is the principle that comfort is a standard of care layered around every needle and painful procedure, not an optional extra.

high

Radiation protection and imaging stewardship

Fellowship guide to radiation protection and imaging stewardship in children — the discipline of getting the right image, at the right time, with the lowest radiation, and only when it changes management. Covers the three pillars of radiological protection (justification, optimisation, dose limitation) and why dose limits do not apply to patients, the linear-no-threshold model and the Brenner, Pearce, Meulepas and EPI-CT risk cohorts, the dose quantities used to measure and benchmark CT and fluoroscopy (CTDIvol, DLP, SSDE, KAP, reference air kerma) and diagnostic reference levels set at the 75th percentile, the practical optimisation levers in paediatric computed tomography, the modern phasing-out of gonadal shielding, the Image Gently, Image Wisely and Choosing Wisely stewardship programmes, the substitution of ultrasound and MRI to remove ionising radiation entirely, the justification and consent conversation with families, and the regional regulatory frameworks (ICRP, IAEA, ARPANSA, IRMER, ACR).

high

Safe paediatric procedural sedation

A fellowship approach to procedural sedation and analgesia in children, covering the continuum of sedation depth from minimal through moderate and deep sedation to general anaesthesia, the paediatric airway and ventilatory physiology that makes children vulnerable, the pre-sedation assessment (ASA physical status, airway, fasting and weight), the mandatory monitoring and rescue equipment, and the exact doses of ketamine (intravenous 1 to 1.5 milligrams per kilogram, intramuscular 4 to 5 milligrams per kilogram) and nitrous oxide 50 percent in oxygen. The page teaches the evidence that fasting status does not substitute for monitoring, the early detection of hypoventilation by capnography, the prevention and management of adverse events such as vomiting, emergence phenomena, laryngospasm and apnoea, the reversal agents naloxone and flumazenil, and the recovery and discharge criteria using the modified Aldrete score.

high

Simple laceration repair and wound management

A fellowship approach to simple laceration repair and wound management in children covering wound assessment (mechanism, depth, contamination, neurovascular and tendon status, tetanus, and non-accidental injury), painless preparation with LET (lidocaine four percent, epinephrine one in two thousand, tetracaine half percent) applied for twenty to thirty minutes, the safe local anaesthetic maximum doses (lidocaine three milligrams per kilogram plain or seven milligrams per kilogram with adrenaline, bupivacaine two milligrams per kilogram), tap water irrigation equal to sterile saline, the four closure methods (tissue adhesive, sutures, adhesive strips, staples) with selection by tension and site, suture size by body region, suture removal timing, bite wound prophylaxis with amoxicillin-clavulanate, and the family-centred approach to a frightened child.

high

Suprapubic aspiration and urinary catheterisation

Fellowship guide to suprapubic aspiration and urethral catheterisation in infants and children. Covers the four urine collection methods and their contamination rates, the anatomical landmark of one to two centimetres above the pubic symphysis in the midline for the suprapubic aspiration, the role of the point-of-care bladder ultrasound in raising the success rate, the paediatric catheter sizing of a 6 to 8 French feeding tube for an infant and an 8 to 10 French catheter for an older child, the aseptic no-touch technique, the management of the failed tap, and the catheter-associated urinary tract infection prevention bundle in which the dwell time is the single strongest modifiable risk factor.

high

Umbilical venous and arterial catheterisation

A fellowship approach to umbilical venous and arterial catheterisation in newborns covering the two vessel types and their courses, the high and low umbilical arterial catheter positions with high between T6 and T9 preferred over low at L3 to L4, the umbilical venous catheter target at T8 to T9 at the diaphragm, the Shukla birth-weight depth formula with umbilical arterial catheter length equal to three times birth weight in kilograms plus nine and umbilical venous catheter length equal to half that value plus one, catheter sizing of three point five French under 1500 grams and five French over 1500 grams, dwell limits of five days for the arterial line and fourteen days for the venous line, and the recognition and prevention of complications including malposition, portal vein and aortic thrombosis, lower-limb ischaemia, necrotising enterocolitis and line sepsis.

medium

Abdominal wall and umbilical disorders

Fellowship guide to abdominal wall and umbilical disorders in children, built around the rule that gastroschisis sits to the right of a normally inserted cord with bare bowel and no sac, while an omphalocele sits in the midline with its contents covered by a sac and carries chromosomal and cardiac associations. The page covers the embryology of the two wall defects, the surgical versus expectant management of umbilical and inguinal herniae, the salt or silver nitrate treatment of the umbilical granuloma, and the red flag of omphalitis progressing to necrotising fasciitis.

high

Acute abdominal pain in children

Fellowship guide to acute abdominal pain in children: the disciplined emergency-department approach that separates the surgical abdomen (appendicitis, intussusception, malrotation with volvulus, and the adolescent torsions) from common medical mimics, the migration pattern and pain pathway, the age-based differential, the Pediatric Appendicitis Score and ultrasound-first imaging, resuscitation with early analgesia and antibiotics, enema reduction of intussusception, and the safety-netting that catches the deteriorating child.

high

Acute gastroenteritis and infectious diarrhoea

Fellowship guide to acute gastroenteritis and infectious diarrhoea in children: the commonest reason a child becomes acutely dehydrated, and the condition in which getting rehydration right saves lives while over-investigation and needless drugs do harm. The page covers the viral, bacterial and parasitic causes and the split between watery and bloody diarrhoea, the mechanism by which fluid is lost and the reason oral rehydration solution works through the intact sodium-glucose co-transporter, the disciplined clinical assessment of dehydration, the evidence that oral rehydration therapy beats intravenous fluids for most children, and the layered management of rehydration, early feeding, zinc, ondansetron and the narrow indications for antibiotics, with rotavirus vaccine as prevention.

high

Acute liver failure

Fellowship guide to paediatric acute liver failure: the PALF diagnostic criteria in which encephalopathy is not required unlike adults, the age-dependent aetiology, the use of N-acetylcysteine including for non-acetaminophen causes, the critical point that the adult King's College Criteria are not validated in children, and the early pathway to liver transplant assessment.

high

Acute vomiting in infants and children

Fellowship guide to acute vomiting in infants and children: the bilious-vomiting surgical emergency, the age-based differential from malrotation and pyloric stenosis to gastroenteritis and raised intracranial pressure, the vomiting reflex and its four afferent triggers, clinical dehydration assessment, oral rehydration and the role of ondansetron, the harmful-and-helpful antiemetic decision, and the dangerous non-gastrointestinal mimics of DKA, sepsis and brain tumour.

high

Appendicitis and surgical abdomen

Fellowship guide to appendicitis as the paradigm of the paediatric surgical abdomen, built around the child with periumbilical pain that migrates to the right iliac fossa with anorexia, nausea and localised tenderness. The page covers the obstruct-ischaemia-perforate pathophysiology, the ten-point Pediatric Appendicitis Score, ultrasound as first-line imaging with magnetic resonance imaging as the radiation-sparing second line, resuscitation and analgesia that never delay diagnosis, laparoscopic appendicectomy as the standard against the evolving non-operative antibiotic option chosen by shared decision, and the recognition of the sick surgical abdomen in which a bilious vomit, guarding, a rigid abdomen or a torsed testis must never be missed.

high

Ascites and peritoneal disease

Fellowship guide to ascites and peritoneal disease in children: the serum-ascites albumin gradient as the key diagnostic tool separating portal hypertension from non-portal causes, the spontaneous bacterial peritonitis polymorphonuclear threshold of 250 per cubic millimetre, the stepwise ascites management with sodium restriction, diuretics, large-volume paracentesis with albumin replacement and transjugular shunting, and the paediatric peritoneal conditions of chylous ascites, tuberculous peritonitis and meconium peritonitis.

high

Bilious vomiting and intestinal obstruction

Fellowship guide to bilious vomiting and intestinal obstruction in children, built around the one rule that green vomiting in a neonate is malrotation with midgut volvulus until proven otherwise. The page covers the high versus low obstruction split, the anatomy that makes a narrow mesenteric base twist, the resuscitation and urgent imaging that precede the Ladd procedure, and the differential from duodenal atresia and meconium ileus to Hirschsprung disease and intussusception.

high

Breastfeeding medicine and lactation support

Fellowship guide to breastfeeding medicine and lactation support: the care of the breastfeeding mother-infant dyad from the physiology of prolactin-driven milk synthesis and the oxytocin let-down reflex to the WHO recommendation of exclusive breastfeeding for about six months and continued breastfeeding to two years and beyond. The page covers the infant and maternal benefits, the few true contraindications, the disciplined assessment of latch and milk transfer with WHO growth standards, and the layered management of the common problems of engorgement, the mastitis spectrum, nipple trauma and perceived low supply. It addresses the safe use of medications in the lactating mother, the support of the late-preterm and preterm infant with pasteurised donor human milk, relactation, the Baby-Friendly Hospital Initiative and the equity gap for Indigenous, migrant and disadvantaged families.

high

Chronic and recurrent abdominal pain

Fellowship guide to chronic and recurrent abdominal pain in children: the Rome IV functional abdominal pain disorders (functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain-NOS), the brain-gut mechanism of visceral hypersensitivity, the alarm features that separate functional from organic disease, a targeted rather than shotgun investigation strategy, and stepwise biopsychosocial management from explanation and reassurance through cognitive behavioural therapy, gut-directed hypnotherapy, and selective pharmacology.

high

Chronic liver disease, cirrhosis and portal hypertension

Fellowship guide to chronic liver disease, cirrhosis and portal hypertension in children: the prehepatic, intrahepatic and posthepatic classification, biliary atresia as the paradigmatic paediatric cause, the pathophysiology of the hyperdynamic splanchnic circulation, variceal bleeding prophylaxis and acute management, ascites and spontaneous bacterial peritonitis with the 250 PMN threshold, hepatopulmonary syndrome and portopulmonary hypertension, and the PELD score for transplant listing.

high

Coeliac disease

Fellowship guide to coeliac disease in children: the immune-mediated small-bowel enteropathy triggered by gluten in genetically susceptible people, the classic and non-classic presentations from the wasted toddler with a distended abdomen to the adolescent with short stature or refractory iron-deficiency anaemia, the HLA-DQ2 and DQ8 genetic background, the immunoglobulin A anti-tissue-transglutaminase-first serological workup with total immunoglobulin A to exclude deficiency, the Marsh histology, the ESPGHAN 2020 no-biopsy pathway requiring a titre at or above ten times the upper limit of normal plus positive endomysial antibody on a separate sample, the gluten-on-board rule, and the lifelong strict gluten-free diet with dietitian support and monitoring.

high

Constipation and faecal incontinence

Fellowship guide to childhood constipation and faecal incontinence: the Rome IV diagnosis of functional constipation, the withholding vicious cycle that drives megarectum and overflow soiling, the red flags that flag Hirschsprung disease and other organic causes, and the disimpaction-then-maintenance polyethylene glycol regimen with behavioural support that underpins evidence-based management.

high

Dysphagia and oesophageal disorders

Fellowship guide to dysphagia and the oesophageal disorders of childhood: the child who cannot move food safely from mouth to stomach, whether because the transfer of the bolus from the pharynx fails or because its transport down the oesophagus is blocked or uncoordinated. The page separates oropharyngeal from oesophageal dysphagia and structural from motility disease, and works through the two examined oesophageal conditions in depth — eosinophilic oesophagitis, the Th2 allergic disease that scars the oesophagus and impacts food, and achalasia, the loss of inhibitory myenteric neurons that leaves the lower oesophageal sphincter unable to relax. It covers gastro-oesophageal reflux, oesophageal atresia and its dysmotility, caustic and peptic strictures, and the emergencies of button battery and food bolus impaction, then the investigations (videofluoroscopy, endoscopy with biopsy, high-resolution manometry, pH-impedance) and the layered management from proton pump inhibitors and swallowed steroids through dupilumab, pneumatic dilation, Heller myotomy and peroral endoscopic myotomy.

high

Enteral feeding tubes and home enteral nutrition

Fellowship guide to paediatric enteral feeding tubes and home enteral nutrition: the child with cerebral palsy who cannot swallow safely and needs a gastrostomy, the short-term nasogastric tube verified by gastric aspirate pH 5.5 or below, the percutaneous endoscopic gastrostomy and the low-profile balloon button, the post-pyloric jejunostomy for reflux and aspiration, the complications of granulation tissue, buried bumper syndrome, tube migration and stoma infection, blenderised versus commercial feeds, and the home enteral nutrition programme of caregiver training, supplies, monitoring and the emergency plan.

high

Feeding assessment and paediatric dysphagia

Fellowship guide to feeding assessment and paediatric dysphagia: the child who coughs, chokes or turns blue with feeds, the wet-voice and prolonged mealtimes of oropharyngeal dysphagia, the four phases of swallowing and where each can fail, the high-risk child with cerebral palsy or airway anomaly, why aspiration is often silent in neurodisability, the bedside clinical feeding evaluation followed by the videofluoroscopic swallow study and fibreoptic endoscopic evaluation of swallowing, the penetration-aspiration scale, the IDDSI texture ladder, the Eating and Drinking Ability Classification System, and the multidisciplinary plan from texture modification and positioning to enteral feeding.

high

Food protein-induced enterocolitis and enteropathy

Fellowship guide to food protein-induced enterocolitis syndrome (FPIES): a non-IgE-mediated food allergy of infancy in which a trigger protein produces delayed, repetitive vomiting one to four hours after ingestion with lethargy, pallor and watery diarrhoea, the 2017 international consensus diagnostic criteria that separate acute from chronic FPIES, the distinction from sepsis and surgical abdomen, the absence of any validated diagnostic test and the central role of supervised oral food challenge, the resuscitation of the acute reaction with intravenous fluids and ondansetron, and the avoidance diet, the action plan and the natural history of tolerance that most children outgrow.

high

Formula feeding and complementary feeding

Fellowship guide to formula feeding and complementary feeding: the classification and compositional standard for infant formula, why cow's milk is unsuitable before twelve months, the developmental and physiological reasons solids begin at around six months, safe formula preparation and the approximate 150 mL per kg daily volume, the texture and allergen ladder from iron-rich first foods to family meals, the never-before-twelve-months hazards of honey, added salt and sugar, whole cow's milk and choking foods, and the ESPGHAN, WHO, NHMRC and AAP regional guidance informed by the LEAP and EAT early-allergen trials.

high

Functional abdominal pain and irritable bowel syndrome

Fellowship guide to paediatric functional abdominal pain and irritable bowel syndrome as disorders of gut-brain interaction: the Rome IV criteria that define functional abdominal pain-NOS and the IBS subtypes (IBS-C, IBS-D, IBS-M, IBS-U), the visceral hypersensitivity mechanism, the alarm features that separate functional from organic disease, a targeted rather than exhaustive workup, and stepwise biopsychosocial management from explanation and reassurance through cognitive behavioural therapy, gut-directed hypnotherapy, low-FODMAP diet, peppermint oil, and selective pharmacology.

high

Gastro-oesophageal reflux and reflux disease

Fellowship guide to paediatric gastro-oesophageal reflux and reflux disease — how to separate the physiologic reflux of the happy spitter from the disease that harms, the transient-sphincter-relaxation pathophysiology, the conservative-first stepwise ladder that keeps children off unnecessary acid suppression, and the red flags that turn reflux into a surgical or allergic emergency.

high

Gastrointestinal bleeding

Fellowship guide to gastrointestinal bleeding in children, built around the upper versus lower split at the ligament of Treitz and the way the differential shifts with age. The page works from haematemesis, coffee-ground vomit, melaena and haematochezia through resuscitation, the Apt test, Meckel scan and endoscopy, and the age-anchored causes from swallowed maternal blood and necrotising enterocolitis in the neonate to intussusception and Meckel diverticulum in the infant, juvenile polyps and varices in the child, and inflammatory bowel disease in the adolescent.

high

Hirschsprung disease

Fellowship guide to Hirschsprung disease, built around the rule that a term neonate who has not passed meconium within 48 hours has a functional obstruction until proven otherwise. The page covers the embryology of failed neural crest cell migration that leaves a non-relaxing aganglionic distal bowel, the suction rectal biopsy with calretinin staining that confirms the diagnosis, the levelling biopsy and three pull-through operations (Swenson, Soave, Duhamel), and the recognition and aggressive treatment of Hirschsprung-associated enterocolitis as the leading cause of death.

high

Inflammatory bowel disease

Fellowship guide to inflammatory bowel disease in children and adolescents: the ESPGHAN revised Porto criteria for diagnosis, the distinction between Crohn disease and ulcerative colitis, the growth-centred clinical presentation, a pan-endoscopy diagnostic strategy, the paediatric activity indices (PCDAI and PUCAI), induction with exclusive enteral nutrition and corticosteroids, maintenance with immunomodulators and anti-TNF biologics, and the evidence-based management of acute severe colitis.

high

Intussusception

Fellowship guide to intussusception in children, built around the single rule that a previously well infant with intermittent colicky screaming, vomiting and a sausage-shaped mass has intussusception until proven otherwise. The page covers the idiopathic-versus-pathological-lead-point split, the telescoping mechanism that drags the mesentery and ischaemes the bowel, the bedside ultrasound target sign, the resuscitation that precedes imaging, and the air enema as first-line reduction with surgery reserved for failure, peritonitis and pathological lead points.

high

Liver transplantation in children

Fellowship guide to liver transplantation in children: the indications with biliary atresia dominant, graft types including living-donor and split grafts, the Paediatric End-stage Liver Disease score for deceased-donor allocation, tacrolimus-anchored maintenance immunosuppression, acute cellular rejection diagnosed on biopsy and treated with high-dose corticosteroid, and the long-term complications of hepatic artery thrombosis, post-transplant lymphoproliferative disorder and non-adherence.

high

Malnutrition: nutritional rehabilitation and monitoring

Fellowship guide to acute malnutrition and its nutritional rehabilitation in children. The page covers the recognition of severe and moderate acute malnutrition by weight-for-height z-score, mid-upper arm circumference and bilateral pitting oedema; the split between complicated and uncomplicated SAM that sends a child to inpatient stabilisation or outpatient ready-to-use therapeutic food; the World Health Organization phased rehabilitation from F-75 stabilisation through transition to F-100 catch-up feeding; the mechanism and prevention of refeeding syndrome through phosphate, potassium and magnesium monitoring and thiamine; the use of ReSoMal rather than standard oral rehydration solution; the rational use of antibiotics; and a discharge and follow-up plan that prevents relapse.

high

Malrotation and volvulus

Fellowship guide to intestinal malrotation and midgut volvulus, the one rotational anomaly that turns a well neonate into a surgical catastrophe within hours. The page follows the embryology that builds the narrow mesenteric stalk, the bilious vomiting that demands an upper gastrointestinal contrast study, the whirlpool and corkscrew signs, and the Ladd procedure that untwists the volvulus, divides the bands and widens the base so the midgut cannot twist again.

high

Micronutrient deficiencies

Fellowship guide to micronutrient deficiencies in children, the so-called hidden hunger: the iron-deficient toddler with pallor, pica and faltering growth screened at twelve months, the exclusively breastfed infant of a vegan mother with vitamin B12 deficiency and developmental regression, the dark-skinned or covered adolescent with vitamin D deficiency and rickets, the malnourished or malabsorbing child with zinc and vitamin A deficiency and impaired immunity, the framework of inadequate intake, malabsorption, increased losses and increased needs, the laboratory confirmation with haemoglobin, ferritin, 25-hydroxyvitamin D and vitamin B12, and the region-aware prevention with supplementation, fortification and dietary diversification.

high

Non-alcoholic fatty liver disease in children

Fellowship guide to paediatric fatty liver disease, now named metabolic dysfunction-associated steatotic liver disease (MASLD): the multisociety 2023 nomenclature and the steatosis-plus-cardiometabolic-criteria definition, the insulin-resistance and PNPLA3-driven pathophysiology, the distinctive paediatric zone-1 histology, the NASPGHAN 2017 screening strategy with the sex-specific alanine aminotransferase upper limits of 22 units per litre for girls and 26 for boys from age nine to eleven, family-based lifestyle therapy as the cornerstone, the limited role of vitamin E shown in the TONIC trial, and the cardiovascular morbidity that dominates long-term outcome.

high

Normal nutritional requirements across childhood

Fellowship guide to normal nutritional requirements across childhood, covering the age-specific energy, protein, fat and micronutrient needs that sustain growth, with the ESPGHAN, WHO and AAP reference values and how to deliver them.

high

Nutritional management of chronic disease

Fellowship guide to the nutritional management of chronic disease in children: the cystic fibrosis child who needs high calorie, high fat intake with pancreatic enzymes and fat-soluble vitamins, the chronic kidney disease child on a controlled phosphate and potassium diet with careful protein and growth hormone support, the Crohn disease child induced into remission with exclusive enteral nutrition, the cardiac infant with a large shunt who needs one hundred and fifty kilocalories per kilogram to grow, and the oncology child whose chemotherapy strips appetite and muscle, all unified by the four mechanisms of increased demand, decreased intake, nutrient loss and dietary restriction and the assess, screen, support and monitor pathway.

high

Oesophagitis, caustic ingestion and oesophageal injury

Fellowship guide to paediatric oesophagitis and oesophageal injury, built around the button-battery emergency: the reflux, eosinophilic, infective and pill causes of oesophagitis; the liquefactive alkali versus coagulative acid mechanism of caustic ingestion with the Zargar endoscopic grading; and the lithium coin-cell button battery that generates hydroxide at its negative pole and burns through the oesophageal wall within two hours, with honey and sucralfate as the pre-removal mitigations, emergent endoscopic removal, and the aorto-oesophageal fistula that can exsanguinate a child days after the battery is out.

high

Paediatric feeding disorder: nutritional and gastrointestinal management

Fellowship guide to paediatric feeding disorder and its nutritional and gastrointestinal management: the child whose oral intake is impaired across the four domains of medical, nutritional, feeding skill and psychosocial dysfunction; the Goday consensus definition built on the WHO ICF framework; prevalence of around one in thirty-seven children under five; the PFD-versus-ARFID distinction between an organ-based feeding disorder and a DSM-5 psychiatric eating disorder; the gastrointestinal drivers of reflux, constipation and eosinophilic oesophagitis; the stepped multidisciplinary plan from medical optimisation and behavioural intervention to oral nutritional support and enteral feeding; the intensive multidisciplinary program evidence; tube dependency and weaning; and the ESPGHAN gastrostomy guidance.

high

Pancreatitis and pancreatic disorders

Fellowship guide to pancreatitis and pancreatic disorders in children: the NASPGHAN classification and two-of-three diagnostic criteria for acute pancreatitis, the premature intracellular trypsin activation pathophysiology, the three paediatric risk-factor domains of toxic-metabolic, genetic and obstructive causes, the INSPPIRE definitions separating acute from acute recurrent and chronic pancreatitis, early aggressive hydration and the shift to early enteral feeding, the management of pain and complications, pancreatic exocrine insufficiency diagnosed by faecal elastase and treated with pancreatic enzyme replacement, hereditary PRSS1 pancreatitis and its cancer risk, autoimmune pancreatitis, traumatic pancreatitis, and total pancreatectomy with islet autotransplantation.

high

Parenteral nutrition and refeeding syndrome

Fellowship guide to prescribing parenteral nutrition safely in children and to preventing refeeding syndrome when nutrition is restarted after starvation. The page covers the rule that the gut should be fed first and parenteral nutrition reserved for when it cannot, the four parenteral streams of glucose given as a glucose infusion rate, amino acids, lipid and electrolytes with trace elements, how to build the bag to an infant target of around 90 to 120 kcal per kilogram per day, the complications of metabolic disturbance, catheter sepsis and intestinal failure-associated liver disease, and the refeeding principle that a starved child restarted on nutrition needs thiamine, conservative starting calories, and correction and monitoring of phosphate, potassium and magnesium.

medium

Peptic disease and Helicobacter pylori

A fellowship approach to peptic disease and Helicobacter pylori in children: separate primary H. pylori-associated ulceration from NSAID and stress-related injury and from functional dyspepsia, understand why test-and-treat is rejected in paediatrics, diagnose with endoscopy and biopsy plus susceptibility testing, deliver susceptibility-guided eradication, and confirm cure non-invasively at least four weeks later.

high

Persistent and chronic diarrhoea

Fellowship guide to persistent and chronic diarrhoea in children: the duration definitions that separate it from acute gastroenteritis, the osmotic, secretory, inflammatory and dysmotility mechanisms, the age-based causes from congenital diarrhoea and cow's milk protein allergy in infancy through toddler's diarrhoea to coeliac disease and inflammatory bowel disease in later childhood, the stool-osmotic-gap and fasting test, the coeliac serology and faecal calprotectin workup, and the management priorities of rehydration, nutritional rehabilitation, zinc and cause-specific therapy.

medium

Polyps and inherited gastrointestinal cancer syndromes

Fellowship guide to gastrointestinal polyps in children: distinguishing the benign isolated juvenile polyp from the inherited cancer syndromes juvenile polyposis, familial adenomatous polyposis, Peutz-Jeghers syndrome and MUTYH-associated polyposis, with the genes, histology, cancer risks, red-flag cutaneous clues, and the surveillance and prophylactic surgery that prevent early colorectal and extraintestinal cancer.

high

Short-bowel syndrome and intestinal failure

Fellowship guide to short-bowel syndrome and intestinal failure in children, built around the rule that the remaining anatomy matters more than the residual length: an intact colon and ileocaecal valve is the strongest predictor that a child will one day feed entirely by mouth. The page covers how massive small-bowel resection from necrotising enterocolitis, volvulus or atresia produces malabsorption, how the remnant gut adapts under the drive of enteral feeding and glucagon-like peptide 2, how to manage parenteral nutrition, advance feeds and balance the sodium-hungry high-output stoma, when to add teduglutide at 0.05 milligrams per kilogram subcutaneously once daily, when to offer serial transverse enteroplasty, and how to recognise and prevent intestinal failure-associated liver disease and central-line bloodstream infection.

high

Viral, autoimmune and metabolic hepatitis

Fellowship guide to hepatitis in children across viral, autoimmune and metabolic causes: the faecal-oral acute viruses hepatitis A and E that never become chronic, the parenteral and perinatal chronic viruses hepatitis B, C and D with their serological panels and phases, the birth-dose vaccine and hepatitis B immunoglobulin within twelve hours that prevents perinatal chronicity of ninety per cent, the direct-acting antiviral era for hepatitis C with sustained virologic response above ninety-five per cent, the simplified and revised International Autoimmune Hepatitis Group scoring systems and the type 1 and type 2 antibody profiles treated with prednisolone and azathioprine, the Leipzig score and Kayser-Fleischer ring of Wilson disease with ceruloplasmin under zero point two grams per litre and urinary copper over forty micrograms, and the PiZZ phenotype and PAS-positive diastase-resistant globules of alpha-1-antitrypsin deficiency managed supportively with transplant for end-stage liver disease.

high

Aboriginal and Torres Strait Islander child health

Fellowship-level culturally safe care for Aboriginal and Torres Strait Islander children: structural inequities, ACCHO partnership, ear lung skin and post-strep pathways, developmental vulnerability, racism as a health exposure, and regional distinctions from other Indigenous health systems.

high

Adolescent preventive health care

A fellowship approach to adolescent preventive care: time alone, conditional confidentiality, HEADSS/HEEADSSS psychosocial assessment, integrated screening, anticipatory guidance, immunisation review, red-flag safety action, follow-up and transition across ANZ, UK, US and Canada.

high

Air pollution, tobacco smoke and vaping exposure

Fellowship-level approach to childhood air pollution, tobacco smoke and vaping exposure: ambient and household pollutants, second- and third-hand smoke, youth e-cigarettes, mechanisms, counselling, acute EVALI-type presentations, and regional practice differences.

medium

Cardiovascular risk screening in childhood

Fellowship approach to childhood cardiovascular risk screening: blood pressure technique and staging, lipid screening including the universal-versus-selective debate, obesity-related risk, familial hypercholesterolemia clues, staged work-up, lifestyle first-line care, referral triggers and regional guideline differences.

high

Catch-up immunisation and uncertain vaccination history

Fellowship approach to reconstructing vaccination history, classifying valid versus invalid doses, building age-banded catch-up plans, using serology selectively, and documenting registers across ANZ, UK, US and Canadian practice.

high

Childcare attendance, exclusion and infection prevention

Fellowship-level approach to infection risk in group childcare, evidence-based exclusion and return-to-care decisions, centre infection prevention, outbreak response, special populations, and regional operational guidance differences.

high

Childhood injury prevention and anticipatory guidance

Fellowship-level childhood injury prevention and anticipatory guidance: Haddon energy model, age-banded hazards, passive versus active strategies, office-based counselling evidence, modern household toxins, safeguarding interface, and regional practice differences.

medium

Climate change, heat and child health

Fellowship-level approach to climate-driven heat risk in children: thermoregulation, heat-illness spectrum, cool-first resuscitation, sports and school prevention, equity, and multi-board anticipatory guidance.

medium

Community needs assessment and child-health advocacy

Fellowship guide to community needs assessment and child-health advocacy: define the community, gather mixed data, map assets, prioritise with partners, act at patient-to-policy levels, evaluate equity outcomes, and keep acute social crises on the resuscitation pathway.

high

Developmental and behavioural screening

Fellowship guide to developmental and behavioural screening in preventive paediatrics: key-age general screens, autism-specific two-stage pathways, early emotional-behavioural screening, interpretation, closed-loop referral, equity and exam defence — cross-linked to surveillance technique without cloning it.

high

Drowning prevention and water safety

Fellowship-level drowning prevention and water safety: WHO definition, age-specific hazards, layered prevention (supervision, barriers, flotation, swim skills, CPR readiness), bath and pool counselling, open-water and boating risk, immediate response after submersion, and regional practice differences.

high

Environmental health and children's exposure risks

Fellowship-level hub on paediatric environmental health: why children are uniquely vulnerable, structured environmental history, major exposure domains, primary prevention, targeted testing, PEHSU and public-health pathways, and regional practice differences — without duplicating leaf detail on lead, air pollution or climate heat.

medium

Global child health and sustainable paediatric care

Fellowship-level approach to global child health and sustainable paediatric care: under-5 and neonatal mortality metrics and SDG 3.2, major preventable causes, continuum-of-care packages including IMCI and essential newborn care, care of newly arrived children, and climate-smart low-carbon clinical practice.

high

Housing insecurity, food insecurity and child health

Fellowship-level approach to childhood food and housing insecurity: definitions and USDA severity, Hunger Vital Sign screening, multi-domain housing risk, medical sequelae, clinic-to-community management, safeguarding boundaries, and regional programme differences.

high

Immunisation principles and national schedule comparison

Fellowship guide to immunisation principles and national schedule comparison: vaccine platforms, valid doses, herd immunity, visit algorithms, birth-to-adolescent architecture, and ANZ/UK/US/Canada programme differences without duplicating catch-up, AEFI or hesitancy chapters.

high

Indigenous child health and culturally safe care

Fellowship-level framework for Indigenous child health equity and culturally safe paediatric care: definitions, colonisation and racism as structural drivers, clinical patterns without stereotyping, partnership with community-controlled services, bedside practice, and regional frames across ANZ, Canada, the US and the UK.

high

Infant health supervision: 3 to 6 months

Fellowship guide to the 3–6 month health-supervision window: growth and feeding, evidence-informed milestones, safe sleep and tummy time, head shape, maternal mood screening, injury prevention, immunisation-ready visits, red flags and regional schedule differences.

high

Infant health supervision: 6 to 12 months

Fellowship guide to 6-, 9- and 12-month infant health supervision: growth, developmental surveillance, complementary feeding and iron, safe sleep, injury prevention, oral health, targeted screens, family psychosocial care and conversion of a well visit to acute care.

high

Infant health supervision: birth to 3 months

Fellowship-level health supervision from hospital discharge through 3 months: visit structure, growth and feeding, examination, newborn screening loop-closure, immunisation, safe sleep, maternal mental health, red-flag triage and region-aware anticipatory guidance.

high

Lead exposure and poisoning prevention

Fellowship-level approach to childhood lead exposure and poisoning prevention: no-safe-level principle, sources, screening and venous confirmation, CDC blood lead reference value, source removal, nutrition and development support, chelation thresholds, and regional practice differences.

high

Māori child health, Te Tiriti and culturally safe care

Fellowship-level approach to Māori child health in Aotearoa New Zealand: Te Tiriti-informed practice, cultural safety versus competence theatre, Hui Process and Meihana-style engagement, equity pathways for SUDI, immunisation, ear health, skin infection and rheumatic fever, and regional contrasts with other indigenous frameworks.

high

Newborn bloodspot screening for inherited metabolic disease and follow-up

Fellowship guide to dried bloodspot newborn screening: valid collection, result states, critical positives in well neonates, CH PKU MCADD galactosaemia CAH CF SCID pathways, incomplete cards, family counselling and regional panel differences.

high

Newborn hearing screening

Fellowship guide to universal newborn hearing screening: OAE and AABR pathways, pass versus refer counselling, 1-3-6 EHDI clocks, high-risk and NICU strategies, late-onset loss after a pass, congenital CMV interfaces, incomplete screens, equity and regional programme differences.

high

Newborn preventive care and screening

Fellowship guide to the newborn preventive package: physical examination, dried bloodspot screening, universal hearing screening, critical congenital heart disease pulse-oximetry, vitamin K, jaundice and DDH risk pathways, incomplete screens, family communication and regional programme differences.

high

Passenger, bicycle, pedestrian and firearm safety

Fellowship-level anticipatory guidance for child passenger restraints, bicycle helmets, pedestrian safety and firearm safe storage: staged transitions, mechanism-based counselling, equity, acute injury response, and ANZ/UK/US practice differences.

medium

Population health, epidemiology and prevention in paediatrics

Fellowship foundation on population health, epidemiology and prevention in paediatrics: defining populations and outcomes, incidence and risk measures, primary secondary tertiary prevention, Rose population strategy, Haddon matrix, life-course and social determinants, herd immunity concepts, equity metrics, and bedside-to-system action without duplicating screening, injury, housing or immunisation schedule leaves.

high

Preschool health supervision

Fellowship approach to preschool (about 3–5 years) health supervision: growth and BMI, school-readiness surveillance, vision and hearing gates, oral health and fluoride, immunisation review, behaviour sleep and media, injury prevention, equity and safeguarding, with regional schedule differences and safety-netting.

high

Preventive paediatrics and the well-child visit

Fellowship hub on preventive paediatrics and the well-child visit: visit architecture, Bright Futures/periodicity principles, growth and development, screening, immunisation integration, anticipatory guidance, social determinants, safety, equity redesign, and when to convert a well visit to acute or safeguarding care.

high

Rural, regional and remote child-health inequities

Fellowship guide to rural, regional and remote child-health inequities: remoteness classification, workforce and distance mechanisms, paediatric readiness, telehealth and retrieval decisions, medical-home models, farm and water injury prevention, and ANZ/UK/US/Canada system differences.

high

Safe sleep and sudden unexpected death prevention

Fellowship-level approach to safe infant sleep counselling and sudden unexpected death prevention: definitions, triple-risk model, modifiable hazards, AAP-aligned core rules, equity, NICU transition, unexpected death response, and regional practice differences.

high

School health and school-based care

Fellowship guide to school health and school-based care: school nursing and SBHC models, executable chronic-disease and emergency plans, return-to-learn after concussion, infection and sports outbreak principles, confidential adolescent care, and clinic–school coordination.

high

School-age health supervision

Fellowship guide to school-age health supervision: well-visit structure, growth and BMI, vision hearing BP and oral screens, sleep media activity guidance, school function, safeguarding gates and regional preventive frameworks.

high

Screening test principles in children

Fellowship guide to screening test principles in children: programme criteria, sensitivity specificity and PPV in low prevalence, false-positive harm, two-step pathways, consent, net benefit, and ANZ/UK/US/Canada governance differences without duplicating bloodspot, hearing or developmental tool chapters.

medium

Sun protection and skin cancer prevention

Fellowship-level approach to childhood sun protection and skin-cancer prevention: UV biology, age-banded counselling, layered photoprotection, indoor tanning, vitamin D balance, high-risk phenotypes, and regional practice differences.

high

Toddler health supervision: 1 to 3 years

Fellowship approach to toddler (12–36 months) health supervision: growth trajectories, developmental surveillance and autism screening, injury and oral-health anticipatory guidance, feeding and sleep, iron and lead risk assessment, positive discipline, equity and safeguarding, with regional schedule differences.

high

Vaccine contraindications, precautions and adverse events

A fellowship approach to paediatric vaccine safety: true contraindications versus precautions and false contraindications; live-vaccine rules in immunocompromise and pregnancy; AEFI recognition including anaphylaxis, intussusception and ITP; bedside screening; resuscitation; reporting; and regional guidance across ANZ, UK, US and Canada.

high

Vaccine hesitancy and risk communication

Fellowship approach to vaccine hesitancy as a continuum, SAGE confidence–complacency–convenience assessment, evidence-based clinic communication, motivational interviewing, ethical response to delay and refusal, documentation and regional programme context.

high

Absence, focal and generalised epilepsies

A fellowship approach to absence, focal and generalised epilepsies: the child with staring spells whose EEG shows three-per-second spike-and-wave, the teenager whose morning jerks declare juvenile myoclonic epilepsy, and the ILAE 2017 framework that turns a seizure description into a syndrome, an aetiology, and a matched first-choice medicine.

high

Acute disseminated encephalomyelitis and demyelinating disease

A fellowship approach to the child with a first central nervous system demyelinating event. Recognise acute disseminated encephalomyelitis by the mandatory encephalopathy that separates it from the monofocal clinically isolated syndromes, then drive a unified antibody-led pathway that distinguishes the four entities a general paediatrician must tell apart - ADEM, myelin-oligodendrocyte-glycoprotein antibody-associated disease, paediatric multiple sclerosis, and neuromyelitis optica spectrum disorder - on serum MOG-IgG, aquaporin-4 IgG, MRI patterns, and the cerebrospinal fluid. Treat the acute event early with high-dose corticosteroids, step to intravenous immunoglobulin or plasma exchange when steroid-refractory, and match long-term therapy to the confirmed diagnosis, because the wrong maintenance drug - a multiple-sclerosis disease-modifying therapy given for neuromyelitis optica - can worsen the disease.

high

Acute neuromuscular respiratory failure

Fellowship guide to acute neuromuscular respiratory failure in children. Covers the respiratory pump from brainstem to diaphragm and bulbar muscles, the two mechanisms of failure, hypercapnic pump failure and hypoxaemic bulbar aspiration, the bedside forced vital capacity, maximum inspiratory pressure, and maximum expiratory pressure monitoring with the Lawn twenty-thirty-forty thresholds and the Durand and Sharshar predictors of ventilation, the differential across the motor unit from anterior horn cell to muscle including spinal muscular atrophy, Guillain-Barre syndrome, myasthenia gravis, infant botulism, and Duchenne muscular dystrophy, the airway decision between non-invasive ventilation when bulbar function is intact and intubation for bulbar weakness, the avoidance of suxamethonium and use of rocuronium one milligram per kilogram, cough augmentation with mechanical insufflation-exsufflation, and the disease-specific and long-term ventilation decisions.

high

Antiseizure medicines: selection, adverse effects and monitoring

A fellowship approach to antiseizure medicines in children: selecting the syndrome-matched first-choice drug, anticipating and monitoring the adverse effects that determine whether a child stays on treatment, and applying the valproate pregnancy prevention programme, the lamotrigine slow-titration rule, and the carbamazepine-worsens-absence contraindication.

high

Ataxia in children

Fellowship guide to ataxia in children: separating the common, benign post-infectious acute cerebellar ataxia from the dangerous posterior fossa tumour and the progressive hereditary causes such as Friedreich ataxia, the gait and bedside examination that localises cerebellar from sensory ataxia, the red-flag screen that drives urgent neuroimaging, and the genetic and multidisciplinary management of chronic progressive ataxia including omaveloxolone for Friedreich ataxia.

high

Autoimmune encephalitis

Fellowship guide to autoimmune encephalitis in children. Covers the Graus 2016 diagnostic tiers of possible, probable, and definite disease with the specific anti-NMDA receptor criteria, the distinction between cell-surface antibody syndromes that respond to immunotherapy and intracellular onconeural syndromes that often do not, the pathophysiology of antibody-mediated NMDA receptor internalisation versus cytotoxic T-cell injury, the staged presentation from prodrome through psychiatric change to seizures, movement disorder, and dysautonomia, the first-line immunotherapy ladder of methylprednisolone, intravenous immunoglobulin, and plasma exchange and the second-line ladder of rituximab and cyclophosphamide at ten to fourteen days, the ovarian teratoma association and the search for and removal of occult tumours, the extreme delta brush EEG pattern and CSF pleocytosis, the Titulaer outcome data on early treatment and second-line therapy, and the prolonged multidisciplinary recovery with cognitive and school reintegration.

high

Brain death, death by neurological criteria and organ donation

Fellowship guide to brain death, death by neurological criteria and organ donation in children. Covers the irreversible cessation of all function of the entire brain including the brainstem, the difference between circulatory and neurological death and the whole-brain versus brainstem concept, the catastrophic prerequisites of a known irreversible cause with confounders corrected including normothermia of a core temperature at least 36 degrees Celsius and a blood pressure normal for age, the bedside examination of coma with absent brainstem reflexes, the apnoea test positive when there is no respiratory effort and the PaCO2 reaches at least 60 mmHg or rises by at least 20 mmHg from baseline, the two clinical evaluations performed by independent senior clinicians separated by an observation period of 48 hours for term neonates up to 30 days and 24 hours for infants and children, the ancillary tests of cerebral angiography and nuclear brain scan and transcranial Doppler and EEG, the declaration of death and the donation after brain death pathway with donor management, and the ANZICS, AAN and World Brain Death Project evidence on regional practice.

high

Cerebral vascular malformations

Fellowship guide to cerebral vascular malformations in children. Covers the classification into high-flow arteriovenous malformation, vein of Galen aneurysmal malformation, low-flow cavernous malformation, and the developmental venous anomaly, the epidemiology with haemorrhage as the dominant paediatric presentation, the pathophysiology of the arteriovenous shunt versus thin-walled caverns versus the midline venous sac, the clinical presentation from a sudden intracerebral haemorrhage in the older child to neonatal high-output cardiac failure, the urgent MRI with MRA and MRV imaging pathway, the Bicetre neonatal evaluation score for vein of Galen, the Spetzler-Martin grade for arteriovenous malformation, the management of multidisciplinary treatment with microsurgery, embolisation and stereotactic radiosurgery, the transarterial embolisation of vein of Galen malformation, the surgical resection of symptomatic cavernoma, the familial CCM gene, and the long-term angiographic follow-up.

high

Concussion and mild traumatic brain injury

Fellowship guide to concussion and mild traumatic brain injury in children and adolescents. Covers the consensus definition of concussion as a traumatically induced functional brain injury with rapid-onset short-lived impairment, the distinction from moderate and severe traumatic brain injury by a Glasgow Coma Scale of 13 to 15, the PECARN and CATCH clinical decision rules that safely reduce computed tomography in minor head injury, the Amsterdam 2022 consensus pathway of 24 to 48 hours of relative rest followed by graduated return to learn before return to sport, the Child SCAT5 and Child SCAT6 multimodal assessment, the natural recovery trajectory with most children symptom-free within four weeks, the predictors of persistent post-concussion symptoms, and the active rehabilitation of the child whose symptoms do not resolve.

high

Congenital myopathies and muscular dystrophies

Fellowship guide to congenital myopathies and muscular dystrophies in children. Covers the division into the dystrophic congenital muscular dystrophies and the structurally disordered congenital myopathies, the merosin-deficient LAMA2 form with its white matter changes and raised creatine kinase, the collagen VI spectrum of Ullrich and Bethlem with contractures and distal hyperlaxity, the dystroglycanopathies of Walker-Warburg and muscle-eye-brain disease with cobblestone lissencephaly and eye malformations, the LMNA and SEPN1 and titin forms, the congenital myopathies of central core disease with ryanodine receptor RYR1 mutations and malignant hyperthermia risk, nemaline myopathy with its rod bodies, and centronuclear myotubular myopathy with neonatal respiratory failure, the creatine kinase as the first fork, the brain and eye examination, the muscle biopsy findings of cores and rods and central nuclei, the multigene panel replacing biopsy, and the multidisciplinary management of respiratory support, nutrition, contractures, scoliosis, and rehabilitation.

high

Developmental regression and neurodegeneration

A fellowship approach to the child who loses previously acquired developmental milestones. Recognise regression as a red flag, distinguish true progressive neurodegeneration from plateau and static loss, read the tempo and bedside pattern to generate a structured differential (epileptic encephalopathies, genetic and syndromic neurodegeneration, leukodystrophies, neurodegeneration with brain iron accumulation, and the acquired and treatable mimics - autoimmune encephalitis, subacute sclerosing panencephalitis, autistic regression, Rett syndrome), and drive a tiered neuro-investigation anchored on the developmental history, brain MRI, EEG and genomic sequencing - never accepting a degenerative label until the treatable causes have been actively excluded.

high

Duchenne and Becker muscular dystrophy

Fellowship guide to Duchenne and Becker muscular dystrophy. Covers the X-linked recessive dystrophinopathies from the loss of dystrophin and the reading-frame hypothesis, through the boy with delayed motor milestones, calf pseudohypertrophy, Gowers sign, and a creatine kinase above 10,000, to the genetic confirmation by multiplex ligation-dependent probe amplification, the glucocorticoid backbone of prednisolone 0.75 mg per kg per day or deflazacort 0.9 mg per kg per day started at the motor plateau, the cardiac surveillance with angiotensin-converting-enzyme inhibition and eplerenone, the respiratory surveillance with spirometry and non-invasive ventilation, and the precision therapies of exon-skipping and AAV micro-dystrophin gene therapy.

high

Epilepsy syndromes by age

Fellowship guide to the paediatric epilepsy syndromes organised along the developmental timeline, built on the ILAE 2022 Task Force nosology. The page teaches how a syndrome — the cluster of seizure type, EEG signature, age of onset and developmental context — points to a cause, a prognosis and a single best treatment. It walks the neonatal channelopathies through infantile spasms and Dravet syndrome to the self-limited focal epilepsies, childhood and juvenile absence epilepsies, Lennox-Gastaut syndrome and juvenile myoclonic epilepsy, and stresses syndrome-directed antiseizure medicine selection and the drugs that worsen specific syndromes.

high

Febrile seizures

Fellowship guide to febrile seizures: the age-locked definition (6 months to 5 years with fever, no CNS infection, no prior afebrile seizure), the simple-versus-complex split that drives every decision, the reassuring prognosis, the acute termination of a prolonged convulsion with a benzodiazepine, the case against routine antiepileptic prophylaxis and against antipyretics as prevention, the lumbar-puncture thresholds of the 2011 AAP guideline, and the FEBSTAT evidence linking febrile status epilepticus to hippocampal injury.

high

First seizure and seizure mimics

Fellowship guide to the child who presents after a possible first seizure: the first question is not what caused it but whether it was a seizure at all, because syncope, breath-holding spells, parasomnias and psychogenic non-epileptic events account for a large share of referrals and are harmed by antiseizure drugs. For a true first unprovoked seizure the work turns to seizure type by the 2017 ILAE classification, a focused cause search (EEG, neuroimaging, bloods), an honest recurrence-risk conversation, and the decision of whether to start daily treatment or wait — while never forgetting that an ongoing convulsion of five minutes or more is status epilepticus and needs a benzodiazepine now.

high

Guillain-Barré syndrome and acute flaccid paralysis

Fellowship guide to Guillain-Barre syndrome and acute flaccid paralysis in children. Covers the Brighton and Asbury Cornblath diagnostic criteria with the albuminocytological dissociation in the cerebrospinal fluid, the subtypes AIDP, AMAN, AMSAN, the Miller Fisher syndrome, and Bickerstaff brainstem encephalitis with their anti-ganglioside antibody associations, the molecular mimicry by which Campylobacter jejuni lipo-oligosaccharide provokes cross-reactive antibodies against GM1, GD1a, and GQ1b with macrophage-mediated demyelination and axonal injury, the ascending symmetrical areflexic presentation and the paediatric differences of pain and refusal to walk, the acute flaccid paralysis differential including transverse myelitis, acute flaccid myelitis, and tick paralysis, the bedside respiratory monitoring with forced vital capacity thresholds under twenty millilitres per kilogram for intensive care, the first-line intravenous immunoglobulin two grams per kilogram over two to five days and plasma exchange as alternative, the lack of benefit of corticosteroids, the Erasmus scores for ventilation and outcome, and the paediatric recovery course.

high

Headache and migraine in children

Fellowship guide to headache and migraine in children: the ICHD-3 criteria that separate migraine from tension-type headache, the primary-versus-secondary decision driven by the SNNOOP red flags, the acute abortive pathway built around ibuprofen and paracetamol with a triptan for moderate-to-severe attacks, the prophylaxis ladder that begins with lifestyle and cognitive behavioural therapy and confronts the CHAMP trial finding that amitriptyline and topiramate are no better than placebo, and the trap of medication-overuse headache.

high

Hydrocephalus and shunt emergencies

Fellowship guide to paediatric hydrocephalus and shunt emergencies. Covers the Rekate functional classification of hydrocephalus by the site of cerebrospinal fluid obstruction and overproduction, the cerebrospinal fluid pathway from choroid plexus to arachnoid granulations, the age-specific presentation of raised intracranial pressure from the bulging fontanelle and sunset sign in the infant to the early-morning headache and Cushing triad in the older child, the shunt series of skull, chest, and abdomen radiographs that traces the catheter from ventricle to peritoneum, the shunt tap that measures pressure and sends cerebrospinal fluid for culture, the hyperosmolar bridge to theatre with mannitol and hypertonic saline, the distinction of shunt malfunction from overdrainage, slit ventricle syndrome, and infection, the Hydrocephalus Clinical Research Network protocol that cut shunt infection, and the endoscopic third ventriculostomy and ETV Success Score work of Warf and Kulkarni as the non-shunt alternative.

high

Hypoxic-ischaemic brain injury

Fellowship guide to hypoxic-ischaemic brain injury in the infant and child beyond the neonatal period. Covers the primary versus secondary injury split, the causes from drowning and asphyxia to cardiac disease and sepsis, the ischaemia-reperfusion cascade, the THAPCA out-of-hospital and in-hospital trials and the Bayesian reanalysis, the targeted temperature management protocol at 32 to 34 degrees or 36 to 37.5 degrees with rewarming at no more than 0.5 degrees per hour, the neurocritical care bundle of normoxia, normocapnia, normotension, normoglycaemia, and normothermia, the high rate of non-convulsive seizures on continuous EEG, the multimodal neuroprognostication deferred to at least 72 hours, and the care of the child with pre-existing neurodisability.

high

Infantile spasms and developmental epileptic encephalopathy

A fellowship approach to infantile spasms (West syndrome) and the developmental and epileptic encephalopathies: recognise the triad of clustered epileptic spasms, hypsarrhythmia and developmental regression as a neurodevelopmental emergency, confirm with a sleep EEG and MRI brain, classify the cause across the ILAE aetiology categories with tuberous sclerosis as the leading identifiable cause, and start vigabatrin first-line when the cause is TSC and hormonal therapy (high-dose ACTH or oral prednisolone) first-line otherwise, because aetiology and the speed of spasm cessation drive developmental outcome.

high

Moderate and severe traumatic brain injury

Fellowship guide to moderate and severe traumatic brain injury in children. Covers the Glasgow Coma Scale severity bands of mild 13 to 15, moderate 9 to 12, and severe 3 to 8 with the paediatric verbal modification, the Monro-Kellie doctrine and the cerebral perfusion pressure equation, the primary versus secondary brain injury cascade from hypotension and hypoxia to herniation, the structured primary survey with cervical spine immobilisation and intubation for GCS 8 or less, computed tomography and intracranial pressure monitoring, the Brain Trauma Foundation pediatric guideline threshold of treating intracranial pressure over 20 mmHg while keeping cerebral perfusion pressure at least 40 mmHg, the stepwise ladder from head elevation and sedation through 3 percent saline and mannitol to barbiturate coma and decompressive craniectomy, the Hutchison hypothermia trial and the DECRA decompressive craniectomy trial, the recognition of Cushing triad and uncal herniation, and the neurorehabilitation and developmental follow-up.

high

Movement disorders, dystonia and chorea

Fellowship guide to paediatric movement disorders. Defines the hyperkinetic movements of chorea, dystonia, myoclonus, tics and tremor against the hypokinetic pole of parkinsonism, applies the Albanese 2013 two-axis dystonia classification and the Sanger 2003 childhood hypertonia framework, traces the basal ganglia direct and indirect pathway mechanism of dyskinesia, and works through Sydenham chorea as a major Jones criterion needing secondary penicillin prophylaxis, dopa-responsive dystonia and its dramatic levodopa response, Wilson disease screening, glutaric aciduria type 1, Lesch-Nyhan, the iatrogenic acute dystonic reversal with an anticholinergic, the status dystonicus escalation ladder from trigger control through oral drugs to sedation and intrathecal baclofen or deep brain stimulation, the dystonic cerebral palsy ladder of trihexyphenidyl, botulinum toxin, intrathecal baclofen and selective dorsal rhizotomy, the PANDAS and PANS controversy, regional rheumatic fever differences, and the family communication and long-term functional outlook.

high

Myasthenia gravis and neuromuscular junction disorders

Fellowship guide to myasthenia gravis and the neuromuscular junction disorders of childhood. Covers the fatigable, fluctuating weakness of autoimmune myasthenia gravis with the acetylcholine receptor, muscle-specific kinase, and LRP4 antibody subtypes and their clinical signatures, the complement-mediated destruction of the postsynaptic junctional folds, the myasthenia gravis Foundation of America clinical classification, the bedside fatiguability manoeuvres, the ice pack test, the single-fibre and repetitive nerve stimulation neurophysiology, and the antibody panels. Details pyridostigmine dosing, corticosteroid initiation with its transient worsening, steroid-sparing agents, intravenous immunoglobulin and plasma exchange for crisis, thymectomy after the MGTX trial, and eculizumab for refractory disease. Distinguishes the congenital myasthenic syndromes by gene and by subtype-specific treatment including the subtypes where pyridostigmine worsens the disease, the maternal antibody syndromes of transient neonatal myasthenia and fetal acetylcholine receptor inactivation, the presynaptic Lambert-Eaton myasthenic syndrome and botulism, and the myasthenic crisis with the forced vital capacity thresholds for intensive care.

high

Neural tube defects and spinal dysraphism

Fellowship guide to paediatric neural tube defects and spinal dysraphism. Covers the open and closed spectrum from anencephaly and myelomeningocele to spina bifida occulta and the occult dysraphic states, the periconceptional folic acid prophylaxis at 400 micrograms for the general population and 4 milligrams for the high-risk woman, the maternal serum alpha-fetoprotein and fetal ultrasound that make the prenatal diagnosis, the Chiari II malformation and the near-universal hydrocephalus of myelomeningocele, the Management of Myelomeningocele Study that established prenatal repair before 26 weeks, the cutaneous stigmata of occult dysraphism that prompt spinal imaging, the low-lying conus and the thickened filum of tethered cord syndrome, the clean intermittent catheterisation and anticholinergic management of the neurogenic bladder, and the latex-free environment that prevents sensitisation from birth.

high

Neurodegenerative and leukodystrophy disorders

A fellowship approach to the child with an inherited neurodegenerative white-matter disorder. Read the brain MRI pattern - the symmetric confluent change of metachromatic leukodystrophy, the contrast-enhancing parieto-occipital lesion of cerebral X-linked adrenoleukodystrophy, the tigrid stripes, the diffuse hypomyelination of Pelizaeus-Merzbacher, the vanishing white matter of eIF2B disease, the anterior-temporal cysts of megalencephalic leukoencephalopathy, and the calcification and atrophy of Aicardi-Goutieres - to generate a mechanism-based differential across the lysosomal, peroxisomal, hypomyelinating and astrocytopathic groups, and to drive a tiered workup anchored on MRI, biochemistry and genomic sequencing that identifies the disorders whose only therapy window closes before symptoms begin - the cerebral adrenoleukodystrophy that needs urgent transplant and the presymptomatic metachromatic leukodystrophy and Krabbe disease that newborn screening now lets us treat.

high

Neurogenetic conditions and precision diagnosis

Fellowship guide to precision diagnosis in paediatric neurogenetic disease. Covers the diagnostic odyssey and why tiered genomic testing ends it, the test ladder from chromosomal microarray through trio exome and genome sequencing with their diagnostic yields around fifteen to forty per cent, rapid whole-genome sequencing in the acutely ill infant that returns an answer in days, phenotype-driven deep phenotyping against genome-first reverse phenotyping, the American College of Medical Genetics five-tier variant classification framework and the management of the variant of uncertain significance, the inheritance patterns with de novo dominant change dominant in sporadic severe neurodevelopmental disease, and the treatable conditions unlocked by a molecular diagnosis including glucose transporter one deficiency and the ketogenic diet, creatine transporter deficiency and creatine, pyridoxine-dependent epilepsy, dopa-responsive dystonia, biotinidase deficiency, Wilson disease, and the gene-modifying therapies for spinal muscular atrophy and Duchenne muscular dystrophy, with genetic counselling, periodic reanalysis, and regional practice.

high

Neurological examination across childhood

A fellowship approach to the neurological examination from the newborn to the adolescent: hold a single constant framework — mental state, cranial nerves, motor, sensory, cerebellar and gait, and development — while adapting the technique to age and cooperation; read tone, reflexes, posture and movement through the lens of corticospinal maturation; use the Hammersmith Infant Neurological Examination and General Movements Assessment to detect cerebral palsy early; and separate the benign and transient from the red-flag findings that demand urgent imaging.

high

Neurorehabilitation and acquired brain injury

Fellowship guide to neurorehabilitation after acquired brain injury in children. Covers the definition of acquired brain injury as brain damage sustained after a period of normal development from trauma, stroke, infection, anoxia, or tumour, and the World Health Organization International Classification of Functioning framework of body structure, activity, and participation. Explains neuroplasticity and the recovery curve, the multidisciplinary goal-directed approach, the motor interventions of constraint-induced movement therapy and bimanual therapy, the spasticity management ladder from physiotherapy and oral baclofen through botulinum toxin-A and casting to intrathecal baclofen and selective dorsal rhizotomy, and the cognitive rehabilitation and return to school strategies. Reviews the predictors of outcome, the late-emerging executive and behavioural deficits, the Cochrane and meta-analysis evidence for upper limb therapies, and the botulinum and cognitive rehabilitation systematic reviews.

high

Non-epileptic events and functional seizures

Fellowship guide to the child or adolescent whose episodes look like epilepsy but are not: non-epileptic events, and within them the high-stakes entity of functional (dissociative) seizures. The single most important message is that functional seizures are real and involuntary, that antiseizure drugs do not work, and that the correct path is a positive diagnosis by video-electroencephalogram, an honest explanation, supervised withdrawal of unnecessary medication, and cognitive behavioural therapy. The page covers the semiology that distinguishes a functional seizure from an epileptic one and from the physiological mimics, the coexistence of epilepsy in a substantial minority, the management of an acute flurry in the emergency department without escalating sedation, and the safeguarding lens that any clinician must hold over the adolescent carrying this diagnosis.

high

Paediatric stroke and cerebral sinovenous thrombosis

Fellowship guide to paediatric stroke and cerebral sinovenous thrombosis. Covers the classification of childhood cerebrovascular disease into arterial ischaemic stroke, cerebral sinovenous thrombosis, and haemorrhagic stroke, the epidemiology with arteriopathy as the dominant cause and recurrence driver, the pathophysiology of arterial occlusion versus venous outflow obstruction, the clinical presentation of sudden focal deficit in the older child and seizures in the infant, the urgent MRI and MRA and MRV imaging pathway, the acute management of supportive care with antithrombotic therapy for ischaemic stroke and anticoagulation for sinovenous thrombosis, the Thrombolysis in Pediatric Stroke trial and why thrombolysis is not routine in children, the focal cerebral arteriopathy and Moyamoya subtypes, secondary prevention with aspirin, and the rehabilitation and recurrence follow-up.

high

Pain, feeding and respiratory care in severe neurodisability

Fellowship guide to the three threats that dominate the life of a child with severe neurodisability: persistent pain, feeding failure, and respiratory compromise. Covers the population at GMFCS level four or five with severe cerebral palsy and neurodegenerative conditions, pain assessment in non-verbal children using the revised FLACC the Paediatric Pain Profile and the Non-communicating Children's Pain Checklist with a search for treatable sources such as hip dislocation reflux constipation and fracture, the stepwise analgesic and gabapentinoid approach, oromotor dysfunction and the eating and drinking ability classification with videofluoroscopic swallow assessment and the role of gastrostomy and reflux management, and the respiratory pathway of weak cough and sialorrhoea and aspiration and sleep-disordered breathing leading to recurrent chest infection and respiratory failure with secretion control airway clearance glycopyrrolate and non-invasive ventilation, built on the American Academy of Pediatrics pain clinical report and the Australia New Zealand cerebral palsy respiratory consensus statement.

high

Peripheral neuropathies

Fellowship guide to peripheral neuropathies in children covering the inherited and acquired polyneuropathies. Details Charcot-Marie-Tooth disease subtypes CMT1A with PMP22 duplication, CMT1B with MPZ, CMT2A with MFN2, CMTX1 with GJB1 connexin 32, and HNPP with PMP22 deletion, the clinical phenotype of distal wasting with pes cavus and foot drop, the nerve conduction study distinction between demyelinating under thirty-eight metres per second and axonal patterns, the paediatric CMT clinical practice guideline of Yiu 2022, the acquired neuropathies including chronic inflammatory demyelinating polyradiculoneuropathy with its greater than eight weeks criterion and treatment with intravenous immunoglobulin and corticosteroids, diabetic neuropathy in youth, chemotherapy-induced and vincristine neuropathy that can unmask Charcot-Marie-Tooth disease, and the multidisciplinary management with orthotics, physiotherapy, foot surgery, pain control, and genetic counselling.

high

Secondary headache and raised intracranial pressure

Fellowship guide to the child whose headache may be secondary: the central task is not to diagnose the headache but to exclude a dangerous cause, using a red-flag screen that separates the small minority with raised intracranial pressure from the large majority with a benign primary headache. The two syndromes that dominate the exam are idiopathic intracranial hypertension, defined by the Friedman 2013 revised criteria of papilloedema with normal neuroimaging and cerebrospinal fluid and an elevated opening pressure, and the brain tumour, whose HeadSmart symptom cluster of morning headache, vomiting and behavioural change is the key to early diagnosis. The single error that fails children is reassuring a progressive or morning headache with vomiting, because headache alone is a late and unreliable sign of a tumour.

high

Sleep disorders with neurological disease

Fellowship guide to sleep disorders with neurological disease: the four-cluster framework of dyssomnias, sleep-disordered breathing, parasomnias, and sleep-related movement disorders, the bidirectional mechanism linking sleep to seizures, cognition, behaviour, and tone, the high-yield case-finding history and validated questionnaires, the targeted investigation pathway from polysomnography to the multiple sleep latency test and cerebrospinal fluid orexin, the stepped management built on sleep hygiene and behavioural therapy with melatonin, iron, airway support, and ventilation, and the evidence base for melatonin in autism and intravenous ferric carboxymaltose in restless legs syndrome.

high

Spasticity, dystonia and tone management

Fellowship guide to spasticity, dystonia and tone management in children, centred on cerebral palsy. Covers the Sanger classification of hypertonia into velocity-dependent spasticity and action-induced dystonia with the mixed picture common in cerebral palsy, the goal-directed principle that tone is treated only when it limits function comfort or care, the Modified Tardieu and Modified Ashworth scales and the Gross Motor Function Classification System from GMFCS I to V, the four core modalities of focal botulinum toxin type A with its non-interchangeable products and twelve-week re-injection interval, oral baclofen as a GABA-B agonist that must not be stopped abruptly, intrathecal baclofen with a screening bolus and the medical-emergency withdrawal syndrome, selective dorsal rhizotomy for the ambulant spastic diplegic child, the dystonia pathway from trihexyphenidyl to GPi deep brain stimulation, and the multidisciplinary prevention of contracture hip subluxation scoliosis and pain.

high

Spinal cord compression and transverse myelitis

A fellowship approach to the child with an acute or subacute spinal cord syndrome. The first act is to recognise that a new back pain with a neurological deficit is a cord emergency until an emergency whole-spine MRI proves otherwise, and to separate the two great threats to the cord - a structural compressive lesion (tumour, epidural abscess, disc, haematoma) that is a surgical emergency from an intrinsic inflammatory transverse myelitis (idiopathic, neuromyelitis optica spectrum disorder, myelin-oligodendrocyte-glycoprotein antibody-associated disease, multiple sclerosis, post-infectious) that is a medical emergency. Treat the compressive lesion with dexamethasone and surgical decompression within twenty-four to forty-eight hours, plus radiotherapy or antibiotics as indicated, and treat the inflammatory lesion with high-dose intravenous methylprednisolone escalating to intravenous immunoglobulin or plasma exchange. Ambulation at presentation is the single strongest predictor of outcome, so the emergency MRI is never delayed while workup tests return.

high

Spinal muscular atrophy

Fellowship guide to spinal muscular atrophy in children. Covers the autosomal recessive SMN1 deletion on chromosome 5q13 with the inverse relationship to SMN2 copy number and the exon 7 splicing defect that depletes survival motor neuron protein and causes anterior horn cell degeneration, the five SMA types from the lethal type 0 and the Werdnig-Hoffmann type 1 to the milder type 3 and adult type 4, the clinical picture of severe symmetric proximal hypotonia and areflexia with tongue fasciculations and paradoxical breathing but preserved intellect, the genetic diagnosis by SMN1 deletion testing and SMN2 copy number, the three disease-modifying therapies nusinersen the intrathecal antisense oligonucleotide risdiplam the oral small molecule and onasemnogene abeparvovec the AAV9 gene therapy, the ENDEAR CHERISH FIREFISH SUNFISH NURTURE and STR1VE trial evidence, newborn screening and presymptomatic treatment, and the multidisciplinary respiratory nutritional and orthopaedic care.

high

Status epilepticus

Fellowship guide to status epilepticus in children. Covers the ILAE operational definition with the t1 and t2 time points, the classification into early, established, and refractory phases, the time-dependent pharmacodynamic shift of GABA-A receptor internalisation and glutamate receptor recruitment that erodes benzodiazepine efficacy, the APLS stepwise pathway from first-line benzodiazepines through second-line levetiracetam or fosphenytoin to refractory rapid sequence intubation and continuous infusion, the ConSEPT, EcLiPSE, and ESETT trials comparing levetiracetam with phenytoin across the age range, the reversible causes including hypoglycaemia and electrolyte disturbance, the role of continuous EEG after paralysis, and new-onset refractory status epilepticus.

high

Tics and Tourette syndrome

Fellowship guide to tics and Tourette syndrome: the DSM-5 spectrum from provisional to persistent tic disorder to Tourette disorder, the defining phenomenology of premonitory urge and suppressibility with waxing and waning, the cortico-striato-thalamo-cortical mechanism and the shared genetics with attention-deficit or hyperactivity disorder and obsessive-compulsive disorder, the high-yield comorbidity screen that drives most of the impairment, the stepped management built on Comprehensive Behavioural Intervention for Tics with alpha-2 agonists and antipsychotics, and the favourable prognosis that tics peak around 10 to 12 years and improve through adolescence.

high

Transition and advance care planning in neurodisability

Fellowship guide to transition and advance care planning in young people with neurodisability. Covers the planned process of health care transition from paediatric to adult services built on the Got Transition Six Core Elements and the NICE framework, the assessment of transition readiness with tools such as the TRAQ and Ready Steady Go, the named transition coordinator and the transfer by age eighteen to twenty-one, the dangerous transition gap with loss to follow-up and deterioration, and the parallel practice of paediatric advance care planning covering goals of care ceiling of treatment resuscitation decisions and preferred place of care for children with severe life-limiting neurodisability such as cerebral palsy and neurodegenerative disease.

high

Abusive head trauma

Fellowship guide to abusive head trauma in infants and young children: the inflicted shaking-with-or-without-impact mechanism, the clinical picture of encephalopathy with subdural and retinal haemorrhage, the PediBIRN screen and Maguire discriminating features, the imaging and skeletal-survey workup, safeguarding from minute zero, the medical mimics and the triad debate, and the ANZ, UK and US guideline differences.

high

Caregiver-fabricated or induced illness

Fellowship guide to caregiver-fabricated or induced illness (FII): the modern child-centred definition that replaced Munchausen syndrome by proxy, the three caregiver behaviours of fabrication falsification and induction, the three mechanisms of harm through direct injury iatrogenic burden and developmental distortion, the RCPCH alerting features, the separation from perplexing presentations and genuine rare disease, the multi-agency safeguarding response that never confronts the suspected caregiver alone, and a closed-loop long-term plan with sibling protection across ANZ UK US and Canada.

high

Child maltreatment recognition and response

Fellowship hub on recognising and responding to child maltreatment across all forms (physical, sexual, emotional, neglect, fabricated or induced illness): global epidemiology and the under-detection gap, the toxic-stress / adverse-childhood-experiences cascade and its buffering adult, presenting patterns and sentinel injuries, the TEN-4-FBCP bruising rule, mimics and differentials, the trauma-informed examination with a body map, the workup (skeletal survey, neuroimaging, ophthalmology, coagulation, STI screen), the parallel recognition-to-response bundle (stabilise, document, report, refer, safeguard), prevention of re-injury, and ANZ/UK/US/Canada guideline structure.

high

Child sexual abuse and assault assessment

A fellowship approach to the medical assessment of a child or adolescent who may have been sexually abused or assaulted: deciding the tempo from acute to non-acute, conducting the trauma-informed forensic history and ano-genital examination, interpreting normal and abnormal findings against the Adams consensus, ordering the right investigations within the correct time windows, assembling the acute management bundle, and discharging the safeguarding, reporting and follow-up duties.

high

Children in out-of-home care and foster care

A fellowship approach to health care for children living in out-of-home (foster, kinship, residential) care: classification of placement and legal status; the heavy cumulative mental-health, developmental, attachment, growth, immunisation, dental and sensory burden and its toxic-stress mechanism; a trauma-informed initial and comprehensive health assessment on entry to care; consent-authority and conditional confidentiality when the state may hold parental responsibility; management of developmental, behavioural, educational and growth needs; permanency and transition planning — across ANZ, UK, US and Canada.

high

Expert reports and court evidence in child protection

Fellowship-level guide to expert reports and court evidence in child protection: the paediatrician's distinct roles as witness of fact, professional witness and expert witness; how to structure a defensible expert report; the standards of certainty (balance of probabilities, reasonable medical certainty); how to prepare for and survive cross-examination; the duty owed to the court above any instructing party; and the personal impacts of giving evidence.

high

Female genital mutilation or cutting

A fellowship approach to recognising and managing female genital mutilation or cutting in children and adolescents: understanding the WHO Type I–IV classification and why every type performed on a minor is child abuse, identifying the at-risk girl through history and community risk, conducting a trauma-informed and culturally safe examination, managing the acute and lifelong complications from urinary retention to obstetric fistula, arranging deinfibulation and reconstructive care, and fulfilling the mandatory-reporting and safeguarding duties that fall on every paediatrician.

high

Homelessness and housing instability

Fellowship-level guide to homelessness and housing instability as a paediatric health problem: the housing continuum from stable to crisis, the toxic-stress mechanism that embeds harm biologically, the five domains of clustered morbidity (physical, growth and nutrition, developmental and educational, mental and behavioural, and access and continuity), the screening-to-housing pathway, the portable summary that protects continuity, and the paediatrician's role as screener, treater, linker and housing advocate.

high

Inflicted abdominal and thoracic injury

Fellowship-level coverage of inflicted abdominal and thoracic injury: the hidden high-specificity patterns (posterior rib fractures, duodenal and pancreatic injury), why delay and an inconsistent story matter, the AST/ALT and lipase occult-injury screen, trauma-team care running in parallel with safeguarding, and ANZ/UK/US practice differences.

high

Inflicted burns and scalds

Fellowship guide to inflicted burns and scalds: pattern-based recognition of non-accidental thermal injury (immersion stocking-glove scalds, sharp demarcation, contact burns on hidden sites), the BuRN-Tool decision rule, co-existing injury assessment, the mandatory safeguarding pathway, and primary prevention with the SafeTea programme.

high

Inflicted fractures and other non-accidental musculoskeletal injury

Fellowship guide to inflicted (non-accidental) musculoskeletal injury: the high-specificity fracture patterns — classic metaphyseal lesion, posterior rib, scapular, spinous and sternal fractures — alongside the moderate- and low-specificity patterns; the shearing and lever biomechanics (Tsai finite-element; Lonergan radiologic-pathologic correlation); the AAP and ACR skeletal-survey protocol with the mandatory follow-up survey; the bone-fragility and rickets differentials; and the safeguarding-first, multi-domain assessment in which no single fracture is pathognomonic and specificity outranks sensitivity — across ANZ, UK, US and Canada.

high

Intimate partner violence and its impact on children

Fellowship topic on intimate partner violence (IPV) and its impact on children: the four pathways of exposure (direct witness, auditory, aftermath, coercive control), global prevalence and the 30 to 70 percent co-occurrence with child maltreatment, the toxic-stress / HPA-axis cascade that makes witnessing violence an adverse childhood experience with a dose-response to adult disease, the heterogeneous presenting patterns (externalizing, internalizing, somatic, developmental, direct co-victimization), the differential from ADHD, ODD, ASD and anxiety, trauma-informed enquiry and validated screening (HARK, HITS), the immediate safety assessment with lethal-means restriction, the child-protection reporting threshold, referral of the non-offending parent to IPV services without blame, trauma-focused therapy (TF-CBT), the buffering-adult recovery model, and ANZ/UK/US/Canada guideline differences.

high

Intra-oral injury and occult trauma

Fellowship guide to inflicted intra-oral injury and occult trauma in suspected child physical abuse: recognise the sentinel oral signs (torn labial frenum, lip laceration, palatal petechiae, dental trauma), distinguish inflicted from accidental using history consistency and the TEN-4 FACES-B bruising rule, actively screen for occult fractures (skeletal survey under 24 months, repeat at 2 weeks), retinal haemorrhages (dilated ophthalmology), intracranial injury (CT then MRI), and occult abdominal injury (AST/ALT over 80 IU/L triggering CT), cite Maguire and Kemp systematic reviews, Pierce TEN-4 validation, Lindberg transaminase utility, AAP and ACR imaging guidance, and execute the safeguarding pathway with mandatory reporting without discharging the child.

medium

Kinship care, adoption and permanency health assessments

Fellowship-level guide to the health assessment of children in kinship care, foster care, adoption and other permanency placements: the staged, repeatable assessment schedule, the developmental-trauma mechanism behind the high health burden, consent and guardianship in statutory care, and the specific needs of Aboriginal and Torres Strait Islander children governed by the Child Placement Principle.

high

Mandatory reporting and jurisdictional child-protection frameworks

Fellowship-level guide to mandatory reporting and jurisdictional child-protection frameworks: who must report, the reasonable-belief threshold, how obligations vary across ANZ, UK, US and Canadian jurisdictions, barriers and enablers to reporting, and the defensible bedside sequence from recognition through documentation to notification.

high

Medical neglect and refusal of care

Fellowship guide to medical neglect and refusal of care in children — the failure to seek, attend or comply with medically necessary treatment and the active parental refusal of recommended care on religious, ideological or personal grounds. Covers the Diekema harm-principle threshold for state intervention, the best-interests standard, the four classic refusal scenarios (vaccines, vitamin K, blood transfusion for Jehovah's Witness families, cancer chemotherapy), the mature-minor doctrine and contested adolescent refusals, a stepped engagement-to-escalation management plan that negotiates first and escalates to court orders when the harm threshold is met, and the regional legal frameworks across ANZ, UK, US and Canada.

high

Multidisciplinary child-protection case conference

Fellowship-level guide to the multidisciplinary child-protection case conference: the statutory forum where agencies share information, assess risk, make decisions about ongoing harm, and agree a coordinated plan. Covers conference types, the paediatrician's preparation and contribution, information-sharing principles, decision-making biases, and the defensible sequence from written report through participation to plan implementation.

high

Neglect and supervisory neglect

Fellowship guide to child neglect and supervisory neglect across the physical, emotional, medical, educational, supervisory and nutritional domains: neglect as an act of omission rather than commission, the most common yet under-recognised form of maltreatment, the developmental and lifelong consequences of chronic unmet need, the supervision-and-injury evidence of Saluja and Morrongiello, a non-judgemental multi-agency assessment that separates neglect from poverty, a stepped plan pairing family support with mandatory reporting when thresholds are met, and a closed-loop reduce-recurrence disposition across ANZ, UK, US and Canada.

high

Online sexual exploitation and image-based abuse

Fellowship-level guide to online sexual exploitation and image-based abuse: online grooming, sextortion, non-consensual intimate image sharing, self-generated sexual content and child sexual abuse material. Covers recognition of behavioural cues, trauma-informed assessment, evidence preservation, the mandatory-reporting and platform-reporting pathway, and the regional safeguarding architecture across ANZ, the UK, the US and Canada.

high

Perplexing presentations and diagnostic uncertainty

Fellowship leaf on the child whose symptoms do not fit known disease — the zone where genuine rare or complex illness, medically unexplained symptoms and somatisation, and caregiver-fabricated or induced illness must be held in balanced consideration. Covers the RCPCH three-level escalation (alerting signs, perplexing presentation, FII), the dual cognitive errors of premature closure and over-investigation, the diagnostic-odyssey literature, the stress-system lens on functional symptoms, the safety-netted multidisciplinary pathway, and the regional guidance structure across ANZ, UK, US and Canada.

high

Photodocumentation and medicolegal evidence

A fellowship-level, exam-exhaustive approach to photodocumentation and medicolegal evidence in suspected child maltreatment: the three-shot rule, body mapping, scale and labelling standards, secure storage and chain of custody, the ethics of clinical photography, the difference between fact and opinion in the court report, and preparation for cross-examination across ANZ, UK, US and Canada.

high

Physical abuse: bruising and sentinel injuries

A fellowship-level, exam-exhaustive approach to inflicted bruising and sentinel injuries: the TEN-4 FACES-L decision rule, the significance of any bruise in a non-mobile infant, patterned and high-specificity injury, the differential (including bleeding disorders), skeletal survey and coagulopathy work-up, mandatory reporting and the safeguarding pathway across ANZ, UK, US and Canada.

high

Poisoning as maltreatment

Fellowship guide to poisoning as a form of child maltreatment — the deliberate administration or withholding of a substance by a caregiver to harm or fabricate illness in a child. Covers non-accidental poisoning and the induced-illness subtype (Munchausen syndrome by proxy / fabricated or induced illness), Rosenberg's defining triad, the common inducing agents (salt, insulin, sedatives, emetics), the bizarre recurrent toxidrome that resolves only on separation, the toxicology and covert-surveillance workup, and a stepped plan that treats the poisoning, secures the child, confirms the diagnosis, and triggers mandatory child-protection action across ANZ, UK, US and Canada.

high

Poverty, food insecurity and social prescribing

A fellowship approach to poverty and food insecurity as the most prevalent risk to child health: how material hardship, food insecurity and housing instability become biology through a toxic-stress cascade; how to screen every family with validated tools (the two-item Hunger Vital Sign and social-needs instruments); how to co-design and deliver a social prescription that connects a family to food, income, housing and welfare support; and how to advocate at the bedside and the policy level — across ANZ, UK, US and Canada.

high

Prevention of child maltreatment and family support

Fellowship topic on preventing child maltreatment and supporting families: the public-health frame of primary, secondary and tertiary prevention; the WHO INSPIRE seven strategies and the Strengthening Families protective factors; why prevention works biologically through the toxic-stress cascade and the buffering adult; risk and protective factors and the prevention paradox; the prevention opportunity at every child contact; the stepped universal-to-intensive pathway of evidence-based interventions (Nurse-Family Partnership, Triple P, school-based sexual-abuse prevention, economic strengthening); recurrence prevention after a sentinel injury or substantiated harm; Indigenous, rural, refugee, disability and socioeconomic-disadvantage prevention; what does not work and the controversies; and ANZ/UK/US/Canada policy structure.

high

Psychological and emotional abuse

A fellowship approach to psychological and emotional abuse of children: a sustained pattern of caregiver behaviour — spurning, terrorizing, isolating, exploiting, denying responsiveness, or mental-health neglect — that conveys the child is worthless, unloved, endangered, or valued only in meeting another's needs. Recognise that it leaves no mark yet is as harmful as physical or sexual abuse, assess the pattern and its developmental impact, exclude or find concurrent maltreatment, and act through a stepped, trauma-informed, jurisdiction-specific safeguarding pathway across ANZ, UK, US and Canada.

high

Refugee, asylum-seeking and newly arrived children

A fellowship approach to health care for refugee, asylum-seeking and newly arrived children: classification of migration status and stage of journey; the heavy cumulative infectious-disease, immunisation, mental-health, nutrition, growth, developmental, dental and sensory burden and its forced-displacement toxic-stress mechanism; a trauma-informed, interpreter-mediated on-arrival health assessment; guardianship and consent authority and conditional confidentiality, especially for unaccompanied or separated children; stepwise catch-up screening and management; the harm of immigration detention; and advocacy across ANZ, UK, US and Canada.

high

Sexually transmitted infections and child sexual abuse

A fellowship approach to sexually transmitted infections (STIs) in the context of child sexual abuse: a trauma-informed, forensic-aware evaluation in which an STI is read as a graded marker of sexual contact rather than a routine infection, with age- and pathogen-specific interpretation of NAAT results, targeted forensic sample collection within the evidence window, STI and HIV post-exposure prophylaxis, mandated reporting across jurisdictions, and multidisciplinary safety planning for ANZ, UK, US and Canada.

high

Strangulation, suffocation and asphyxial injury

Fellowship guide to strangulation, suffocation and asphyxial injury in infants and children: the three mechanisms (neck compression, airway oronasal occlusion, chest restriction) and their shared endpoint of cerebral hypoxia; the infant-vulnerability anatomy and the petechial-haemorrhage reality check; recognition of the collapsed child in a sleep or hazard space, the resuscitation and scene-preservation response, the safe-sleep ABCs and product-hazard prevention, the hardest forensic question of accidental overlay versus inflicted suffocation, and the ANZ, UK and US guideline and reporting differences.

high

Trafficking, exploitation and forced marriage

Fellowship-level guide to trafficking, exploitation and forced marriage in children: recognising the hidden signs of labour and sexual exploitation and forced marriage, understanding vulnerability and control, the trauma-informed bedside response, mandatory reporting and National Referral Mechanism referral, and the long tail of physical, sexual and mental-health harm.

high

Trauma-informed examination and forensic documentation

A fellowship approach to performing a trauma-informed medical examination of a child who may have been maltreated and to documenting the findings so the record is contemporaneous, objective and court-admissible: setting the tempo and the environment, running a single trained forensic interview, conducting the consented and chaperoned examination, capturing photo-documentation, maintaining chain of custody, separating fact from opinion, and handing the whole bundle to the safeguarding and reporting systems that act on it.

medium

Youth justice and detained young people

Fellowship-level guide to the health of justice-involved and detained young people: the concentration of neurodisability, mental illness, trauma and substance use behind the gate; the equivalence-of-care principle; the entry-screening pathway; safeguarding, consent and confidentiality in custody; the post-release mortality spike; and the paediatrician's advocacy role across the community-to-detention-to-release arc.

high

Acid-base disorders in children

Fellowship guide to acid-base disorders in children: a systematic six-step approach to any blood gas, the anion gap and its albumin correction, Winters formula for the expected pCO2 in metabolic acidosis, the delta gap for mixed disorders, and the compensation rules for each of the four primary disorders, anchored in diabetic ketoacidosis as the commonest high anion gap metabolic acidosis, diarrhoea and renal tubular acidosis as the normal anion gap acidoses, chloride-responsive metabolic alkalosis, and the respiratory acidoses and alkaloses of bronchiolitis, asthma and hyperventilation.

high

Acute kidney injury

Fellowship guide to paediatric acute kidney injury: the KDIGO definition and three-stage classification using creatinine and urine output criteria, the pre-renal, intrinsic and post-renal framework with acute tubular necrosis the leading intrinsic cause in critically ill children, the staged emergency management of hyperkalaemia and fluid overload, the indications and modality choice for renal replacement therapy, and the long-term risk of chronic kidney disease that now mandates nephrology follow-up after every significant AKI episode.

high

Acute nephritic syndrome and glomerulonephritis

Fellowship guide to the acute nephritic syndrome in children: the tetrad of haematuria, proteinuria, oedema and hypertension driven by glomerular inflammation, the serum-complement split that separates post-streptococcal glomerulonephritis from C3 glomerulopathy, lupus and IgA disease, the rapidly progressive crescentic course that demands urgent biopsy and immunosuppression, and supportive care (fluid and salt restriction, loop diuretic, antihypertensive, penicillin eradication) with the red flags that escalate to paediatric intensive care and dialysis.

high

Antenatal hydronephrosis and postnatal evaluation

Fellowship guide to antenatal hydronephrosis and postnatal evaluation. Covers the definition and the Society for Fetal Urology grading system and the Urinary Tract Dilation classification system, the anteroposterior renal pelvic diameter thresholds at the 28-week gestational cutoff, the critical timing of the first postnatal ultrasound at days 5 to 7 to avoid the false negative of neonatal dehydration, the investigation pathway of ultrasound, MCUG, DMSA, and MAG3, the risk stratification that separates transient physiologic dilatation from obstructive uropathy and reflux, the role of prophylactic antibiotics, and the long-term surveillance for the chronic kidney disease risk that the underlying congenital anomaly carries.

high

Calcium, magnesium and phosphate disorders

Fellowship guide to disorders of calcium, magnesium and phosphate in children: corrected calcium and ionised fractions, neonatal early and late hypocalcaemia, hypoparathyroidism and DiGeorge syndrome, vitamin D deficiency rickets, hypercalcaemia with immobilisation and Williams syndrome, hypomagnesaemia as the cause of refractory hypocalcaemia and hypokalaemia, refeeding hypophosphataemia, X-linked hypophosphataemic rickets with excess FGF23, tumour lysis hyperphosphataemia with hypocalcaemia, and the emergency doses of intravenous calcium gluconate and magnesium sulfate.

high

Chronic kidney disease and progression

Fellowship guide to chronic kidney disease and its progression in children: the KDIGO definition (kidney abnormalities or low GFR for over three months), the GFR G1 to G5 and albuminuria A1 to A3 staging grid that drives risk and referral, why congenital CAKUT dominates paediatric causes, the hyperfiltration vicious cycle that makes CKD self-amplifying, the nephroprotective bundle of blood-pressure control below the 50th percentile with ACE inhibitors or ARBs, and the longitudinal management of growth failure, anaemia, acidosis and mineral-bone disease that lets a child reach transplantation in the best possible condition.

high

Congenital anomalies of the kidney and urinary tract

Fellowship guide to congenital anomalies of the kidney and urinary tract, the CAKUT spectrum that accounts for the largest single cause of paediatric end-stage kidney disease. Covers the embryological basis in the ureteric bud and metanephric mesenchyme interaction, the classification into kidney parenchymal anomalies including multicystic dysplastic kidney and renal agenesis, ureteric anomalies, and bladder and urethral anomalies including posterior urethral valves, the antenatal and postnatal investigation pathway using ultrasound, MCUG, DMSA, and MAG3, the management from prophylactic antibiotics to surgical correction and nephrology surveillance, and the long-term risk of chronic kidney disease that every child with CAKUT carries.

high

Dehydration and oral or intravenous rehydration

Fellowship guide to paediatric dehydration and rehydration: the clinical dehydration scale and the WHO and percentage-weight-loss severity bands, the assessment of volume status at the bedside, oral rehydration therapy with reduced-osmolarity oral rehydration solution as the first-line treatment for mild to moderate dehydration, the staged intravenous rehydration protocol with isotonic crystalloid and the slow correction of dysnatraemia, and the prevention of cerebral oedema that dominates the safe management of the severely dehydrated child.

high

Fluid maintenance and deficit replacement

Fellowship guide to prescribing fluids in children: the Holliday-Segar 100/50/20 mL/kg/day rule (the 4/2/1 hourly form) for maintenance water, the 2 to 3 mmol/kg/day sodium and 1 to 2 mmol/kg/day potassium requirement, the switch to isotonic maintenance fluids with dextrose and potassium to prevent hospital-acquired hyponatraemia and hyponatraemic encephalopathy, the percentage method for calculating a dehydration deficit with half replaced over 8 hours and half over 16 hours, and the slow correction of hypernatraemic dehydration at no faster than 0.5 mmol per litre per hour.

high

Haematuria: diagnostic approach

Fellowship guide to the diagnostic approach to haematuria in children, built around the glomerular versus non-glomerular fork. The page works from confirming that red or brown urine really is blood, through the colour clue and red-cell morphology, to an age-anchored differential that runs from renal vein thrombosis in the neonate through post-streptococcal glomerulonephritis, IgA nephropathy, IgA vasculitis nephritis and haemolytic uraemic syndrome in the child to lupus nephritis and Alport syndrome in the adolescent, and on to complement patterns, the indications for renal biopsy and the red flags of hypertension, oedema and an abdominal mass.

high

Haemolytic uraemic syndrome

Fellowship guide to paediatric haemolytic uraemic syndrome: the defining triad of microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury; the distinction between STEC-HUS (approximately 90 percent of cases, following Shiga toxin-producing E. coli) and atypical HUS from complement dysregulation; the critical point that supportive care is the mainstay for STEC-HUS while eculizumab is first-line for aHUS; and the need for long-term renal follow-up in all survivors.

high

Hypokalaemia and hyperkalaemia

Fellowship guide to potassium disorders in children: hypokalaemia as a serum potassium below 3.5 and hyperkalaemia as above 5.5 mmol/L, the three-axis classification of intake, transcellular shift and renal or gut loss, the cardiac membrane electrophysiology behind peaked T waves and U waves, emergency management of hyperkalaemia with calcium gluconate, salbutamol and insulin-dextrose, safe intravenous potassium replacement for hypokalaemia, Bartter and Gitelman syndromes, and hypomagnesaemia as the cause of refractory hypokalaemia.

high

Hyponatraemia and hypernatraemia

Fellowship guide to sodium and water disorders in children: hyponatraemia as a serum sodium below 135 and hypernatraemia as above 145 mmol/L, the volume-status classification of hypo-, eu- and hypervolaemic hyponatraemia and the water-loss versus sodium-gain classification of hypernatraemia, arginine vasopressin and thirst physiology, brain cell volume adaptation and its two failure modes, 3 percent hypertonic saline boluses for severe symptomatic hyponatraemia at a maximum correction of 8 mmol/L in 24 hours to avoid osmotic demyelination, and slow hypernatraemia correction at a maximum of 0.5 mmol/L per hour to avoid cerebral oedema.

high

Hypospadias, cryptorchidism and common male genital disorders

Fellowship guide to hypospadias, cryptorchidism and the common male genital disorders of childhood. Covers the ectopic ventral urethral meatus and the hooded prepuce of hypospadias with its distal to proximal classification, the failure of testicular descent in cryptorchidism with the orchidopexy window of 6 to 18 months, the testicular dysgenesis syndrome that links the two, the absolute rule against circumcision in hypospadias, the distinction of the retractile from the truly undescended testis, the physiological from the pathological phimosis, and the communicating hydrocele and inguinal hernia that share a patent processus vaginalis, together with the urgent disorder-of-sex-development workup for the boy with bilateral non-palpable testes.

high

IgA nephropathy and IgA vasculitis nephritis

Fellowship guide to IgA nephropathy and IgA vasculitis nephritis: the most common primary glomerulonephritis worldwide, defined by dominant mesangial IgA deposition and classified by the Oxford MEST-C score; IgA vasculitis as the most common childhood vasculitis whose renal lesion is histologically identical; the shared multi-hit pathogenesis centred on galactose-deficient IgA1; the distinction of synpharyngitic haematuria from post-infectious glomerulonephritis by normal C3 and a short latency; and the treatment ladder from ACE inhibitor or ARB supportive care to corticosteroids, targeted-release budesonide, and immunosuppression for crescentic disease.

high

Inherited tubulopathies

Fellowship guide to the four archetypal inherited tubulopathies of childhood: Bartter syndrome (thick ascending limb, hypercalciuria, antenatal polyhydramnios), Gitelman syndrome (distal convoluted tubule, hypomagnesaemia and hypocalciuria), Fanconi syndrome (generalised proximal tubular failure with glycosuria, phosphaturia and proximal RTA), and Liddle syndrome (collecting duct ENaC gain-of-function with hypertension and suppressed renin and aldosterone). The blood pressure and the renin/aldosterone axis separate Liddle from the salt-losing trio, and the urine calcium and serum magnesium separate Bartter from Gitelman.

high

Kidney replacement therapy and dialysis in children

Fellowship guide to kidney replacement therapy in children: the four modalities of peritoneal dialysis, haemodialysis, continuous renal replacement therapy, and kidney transplantation; the AEIOU indications for urgent dialysis in acute kidney injury; why peritoneal dialysis is preferred in infants and small children while continuous renal replacement therapy suits the haemodynamically unstable child in intensive care; and why transplantation remains the gold standard for end-stage kidney disease.

high

Kidney transplantation in children

Fellowship guide to paediatric kidney transplantation: why a transplanted kidney is the treatment of choice over lifelong dialysis for a child with end-stage kidney disease; the living-donor versus deceased-donor and preemptive versus dialysis-first classifications that predict graft survival; the standard tacrolimus, mycophenolate and steroid maintenance regimen with therapeutic drug monitoring; the distinction between T-cell-mediated and antibody-mediated rejection and how each is treated; and the leading threats to long-term graft survival including non-adherence in adolescence and chronic antibody-mediated rejection.

high

Lupus nephritis and systemic disease

Fellowship guide to paediatric lupus nephritis: the six-class ISN/RPS 2003 classification (I minimal mesangial through VI advanced sclerosing), why Class IV diffuse proliferative dominates childhood disease, the immune-complex pathophysiology behind the full-house immunofluorescence pattern, and the induction-maintenance treatment paradigm built on mycophenolate mofetil or low-dose cyclophosphamide with glucocorticoids, treat-to-target proteinuria goals, and hydroxychloroquine for every patient.

high

Nephrolithiasis and nephrocalcinosis

Fellowship guide to paediatric nephrolithiasis (stones in the collecting system) and nephrocalcinosis (calcium deposits in the renal parenchyma), the rising incidence of childhood stone disease, hypercalciuria as the commonest metabolic risk factor, the stone-composition and nephrocalcinosis-cause classification, the supersaturation-and-inhibitor pathophysiology, the abdominal pain and haematuria presentation, the ultrasound-first imaging strategy, the acute analgesia and hydration pathway, medical expulsive therapy with tamsulosin for distal ureteric stones, the ESWL, ureteroscopy and PCNL surgical ladder, and prevention through fluids, diet, thiazides and potassium citrate.

high

Neurogenic bladder and dysfunctional voiding

Fellowship guide to the neurogenic bladder and the dysfunctional voiding spectrum in children. Covers the neurological control of micturition and how a cord lesion such as spina bifida produces a hostile high-pressure bladder that threatens the upper tracts, the distinction from functional overactive bladder and dysfunctional voiding, the role of video-urodynamics, and the stepwise management from clean intermittent catheterisation and anticholinergics through intravesical botulinum toxin to bladder augmentation and a continent catheterisable channel, with the explicit goal of protecting renal function.

high

Nocturnal enuresis

Fellowship guide to nocturnal enuresis (bedwetting) in children: the International Children's Continence Society definition of involuntary voiding during sleep from age five, the split into monosymptomatic versus non-monosymptomatic and primary versus secondary, the three pathophysiological mechanisms of reduced arousal, nocturnal polyuria from inadequate vasopressin and reduced bladder capacity, the clinical assessment built on the voiding diary and urinalysis, first-line therapy with the enuresis alarm or desmopressin at 200 to 400 micrograms orally or 120 to 360 micrograms sublingually with mandatory evening fluid restriction, combination therapy for partial responders, and the red flags that reclassify the problem as organic or neurological disease.

high

Oedema and nephrotic syndrome

Fellowship guide to oedema and nephrotic syndrome in children: the KDIGO 2021 definition built on oedema, nephrotic-range proteinuria and hypoalbuminaemia, the rule that minimal change disease dominates under ten years and responds to steroids in about ninety per cent, the initial prednisolone 60 mg/m2/day regimen capped at 60 mg/day and not prolonged beyond twelve weeks, the steroid-response classification that separates steroid-sensitive from steroid-resistant disease, and the three life-threatening complications — infection, thromboembolism and acute kidney injury — that kill children with nephrotic syndrome, not the proteinuria itself.

high

Oliguria, anuria and urinary obstruction

Fellowship guide to oliguria, anuria and urinary obstruction in children: the urine output thresholds that define oliguria and anuria, the pre-renal, renal and post-renal framework with post-renal obstruction the focus, the pathophysiology of obstructive nephropathy where raised hydrostatic pressure collapses filtration, the emergency decompression of the urinary tract by catheter or nephrostomy, and the diagnosis and fluid management of post-obstructive diuresis that follows relief of a chronic obstruction.

high

Polycystic kidney disease and inherited nephropathies

Fellowship guide to polycystic kidney disease and inherited nephropathies in children: the neonatal-onset ARPKD driven by PKHD1 and fibrocystin with bilateral enlarged echogenic kidneys and congenital hepatic fibrosis, the later-presenting ADPKD from PKD1 or PKD2 encoding polycystin with height-adjusted total kidney volume guiding tolvaptan therapy, Alport syndrome with its type IV collagen defect causing progressive haematuric nephropathy with sensorineural hearing loss and the ACE-inhibitor-at-diagnosis strategy, and nephronophthisis as the autosomal recessive ciliopathy causing tubulointerstitial fibrosis with disproportionate anaemia and ESKD in childhood.

high

Polyuria and polydipsia

Fellowship guide to the diagnostic approach to a child with polyuria and polydipsia, beginning with a blood glucose to exclude osmotic diuresis from diabetes mellitus, then a urine osmolality to split the water diuresis of diabetes insipidus from a solute diuresis, the three-way split of the water diuresis into central diabetes insipidus (arginine vasopressin deficiency), nephrogenic diabetes insipidus (arginine vasopressin resistance) and primary polydipsia, the serum sodium pointer, the vasopressin-aquaporin-2 axis, the water deprivation test with desmopressin response and the copeptin-based approach, the management of hypernatraemic dehydration with slow sodium correction, desmopressin for central disease, and a low-solute diet with thiazide for nephrogenic disease.

high

Post-infectious glomerulonephritis

Fellowship guide to post-infectious glomerulonephritis (PSGN): the classic acute nephritic syndrome that follows group A streptococcal pharyngitis by one to three weeks or skin infection by three to six weeks, defined by smoky haematuria, oedema, and hypertension with a low C3 and normal C4 that recovers within eight weeks; the immune-complex and complement pathophysiology with subepithelial humps; the supportive management of fluid restriction, diuretics, and antihypertensives plus streptococcal eradication; and the excellent prognosis in children, with the atypical features that mandate renal biopsy.

high

Posterior urethral valves

Fellowship guide to posterior urethral valves, the most common cause of lower urinary tract obstruction in male infants. Covers the Young classification of valve leaflets in the male posterior urethra, the back-pressure pathophysiology from the obstructed bladder through bilateral hydronephrosis and renal dysplasia to oligohydramnios and the Potter sequence, the antenatal and postnatal presentation, the micturating cystourethrogram as the diagnostic gold standard, the immediate catheter decompression and endoscopic valve ablation, the valve-bladder management with urodynamics and clean intermittent catheterisation, and the life-long chronic kidney disease surveillance driven by the nadir creatinine.

high

Proteinuria: diagnostic approach

Fellowship guide to the diagnostic approach to proteinuria in children and adolescents. The page frames the central rule that protects the child: confirm proteinuria on two to three repeat first-morning urine samples before labelling the child, quantify it with the spot urine protein-to-creatinine ratio and albumin-to-creatinine ratio, separate the benign transient and orthostatic patterns from persistent pathological proteinuria, and assess blood pressure, renal function, urinalysis and a renal ultrasound before deciding between benign monitoring and paediatric nephrology referral. It holds the exact paediatric thresholds, the KDIGO albuminuria categories, the dipstick limitation that it detects albumin and misses tubular and overflow proteins, and the red-flag pairings that demand urgent nephrology.

high

Renal tubular acidosis

Fellowship guide to renal tubular acidosis in children: a normal anion gap (hyperchloraemic) metabolic acidosis from impaired renal acid-base handling, classified into distal (type 1) with hypokalaemia and nephrocalcinosis, proximal (type 2) with bicarbonate wasting and Fanconi syndrome, and type 4 with hypoaldosteronism and hyperkalaemia, the urine anion gap as a surrogate for urinary ammonium, and alkali therapy that differs in dose between distal (1 to 4 mEq per kg per day) and proximal (10 to 20 mEq per kg per day) RTA.

high

Scrotal pain and testicular torsion

Fellowship guide to scrotal pain and testicular torsion in boys. Covers the bell-clapper deformity and intravaginal torsion, the 6-hour salvage window, the TWIST score for the acute scrotum, the differentiation of torsion from torsion of the appendix testis and acute epididymitis, the role of colour Doppler ultrasound, immediate surgical exploration with detorsion and bilateral orchidopexy, manual detorsion as a bridge, the extravaginal perinatal form, intermittent torsion, and the fertility and medicolegal consequences of a missed diagnosis.

high

Urinalysis, renal function and paediatric kidney assessment

A fellowship approach to paediatric kidney assessment at the bedside: how to collect and interpret urine, read the dipstick and microscopy, estimate glomerular filtration rate with the bedside Schwartz equation, stage chronic kidney disease, and combine urine and blood data into a safe plan from neonate to transition.

high

Vesicoureteric reflux

Fellowship guide to vesicoureteric reflux, the retrograde flow of urine from the bladder into the upper urinary tract that is the most common urological abnormality in children. Covers the International Reflux Study grading system from grade I to grade V, the pathophysiology of an incompetent ureterovesical junction with a short intramural tunnel, the role of the micturating cystourethrogram in diagnosis, the natural history of spontaneous resolution skewed toward low-grade reflux, the RIVUR trial evidence on antimicrobial prophylaxis, the management ladder from observation through continuous antibiotic prophylaxis to endoscopic injection and ureteric reimplantation, the critical modifier of bladder and bowel dysfunction, and the long-term risk of reflux nephropathy with renal scarring, hypertension, and chronic kidney disease.

high

Vulvovaginal and common prepubertal gynaecological disorders

Fellowship guide to the three common prepubertal gynaecological disorders: vulvovaginitis, labial adhesions, and lichen sclerosus. Covers the hypo-oestrogenic prepubertal vulval environment with its thin mucosa and neutral pH that predispose to nonspecific irritant vulvovaginitis as the commonest complaint, the fusion of the labia minora in labial adhesions that peaks between three months and six years and usually resolves at puberty, and the porcelain-white sclerotic plaques of lichen sclerosus treated with an ultra-potent topical corticosteroid, together with the red flags of vaginal foreign body, sexual abuse, and prepubertal bleeding that must never be missed.

high

Acne vulgaris in adolescents

A fellowship approach to acne vulgaris in the adolescent: the comedones and the papules and the pustules over the sebum-rich skin of the face and the upper back and the chest that mark the androgen-driven pilosebaceous unit, the four drivers of the sebum and the Cutibacterium acnes and the follicular plugging and the inflammation that the treatment targets, the split between the comedonal and the inflammatory disease that frames the topical retinoid and the benzoyl peroxide and the oral doxycycline, the oral isotretinoin for the nodulocystic and the refractory disease with the pregnancy prevention and the lipid and the liver monitoring, the antibiotic stewardship that never prescribes the monotherapy and always pairs the antibiotic with the benzoyl peroxide, and the psychosocial and the scarring burden that the early and the effective treatment prevents.

high

Alopecia and hair disorders in children

Fellowship guide to alopecia and hair disorders in children: the smooth non-scaly bald patch with exclamation-mark hairs of alopecia areata, an organ-specific autoimmune attack on the anagen hair bulb; the diffuse shedding two to three months after a trigger that marks telogen effluvium; the irregular patch of hairs broken to varying lengths that betrays trichotillomania; the hairline thinning of traction alopecia; and the scaly broken stubs and lymphadenopathy of tinea capitis. Bedside confirmation with dermoscopy, the hair pull test, potassium hydroxide microscopy and thyroid and iron studies. The stepwise ladder for alopecia areata from topical and intralesional corticosteroid and topical minoxidil through topical immunotherapy to systemic agents and JAK inhibitors, the habit-reversal and cognitive behavioural therapy that is first-line for trichotillomania, and the trigger removal and reassurance that settle most telogen effluvium.

high

Approach to rash in infants and children

A morphology-first, distribution-aware and red-flag-driven fellowship approach to any rash from the neonate to the adolescent: classify the lesion, map the pattern, weigh age, fever, itch and mucosa, and separate benign and self-limiting eruptions from the emergencies - meningococcaemia, Stevens-Johnson syndrome/toxic epidermal necrolysis, staphylococcal scalded skin syndrome, necrotising fasciitis, Kawasaki disease and neonatal sepsis or herpes simplex.

high

Congenital melanocytic naevi and pigmentary birthmarks

A fellowship approach to the congenital pigmentary birthmarks, built around the single decision that matters: separating the common benign lesion — the dermal melanocytosis, the isolated cafe-au-lait macule, and the small congenital melanocytic naevus — from the high-risk lesion that demands the specialist service. The page covers the size-based classification of the congenital melanocytic naevus (CMN) by the projected adult size, the size-risk relationship that concentrates the melanoma risk in the large and the giant CMN, the postzygotic NRAS mosaicism that produces the CMN and the neurocutaneous melanocytosis as a single neural-crest event, the recognition of the child at risk of the neurocutaneous melanocytosis, the differential of the cafe-au-lait macule of the NF1 and the McCune-Albright, the dermal melanocytosis mistaken for the bruise, and the ash-leaf macule of the tuberous sclerosis, and the surveillance and the management from the observation and the baseline photography to the surgery and the laser.

high

Contact dermatitis

Fellowship guide to contact dermatitis in children: how to tell irritant from allergic disease at the bedside, the common culprits (nickel, fragrances, methylisothiazolinone, neomycin, saliva, wet work), when a recurrent or treatment-resistant eczema is hiding an allergy, the role and reading schedule of patch testing, and how barrier repair, allergen avoidance and potency-matched topical corticosteroids resolve the lesion while preventing the chronic, infected and facially disfiguring complications.

high

Drug eruptions including DRESS and AGEP

Fellowship guide to drug eruptions in children: how to tell the common benign morbilliform rash from the three severe cutaneous adverse reactions (DRESS, AGEP and SJS-TEN) at the bedside, the drugs and the timing that point to each, the role of eosinophilia, hepatitis and HHV-6 reactivation in DRESS, the sterile pinhead pustules and rapid course of AGEP, and the management of stopping the drug, assessing severity, excluding infection and supporting the child.

high

Epidermolysis bullosa and inherited blistering disorders

Inherited epidermolysis bullosa and related mechanobullous disorders are a genetically heterogeneous group in which mutations in structural skin proteins cause fragile skin that blisters after minor friction or trauma; the four major types are EB simplex, junctional EB, dystrophic EB and Kindler EB, classified by the ultrastructural level of blister cleavage and managed with lifelong atraumatic wound care, pain control, nutrition, surgery and multidisciplinary surveillance.

high

Genodermatoses and neurocutaneous skin findings

Fellowship topic on paediatric genodermatoses and neurocutaneous skin findings: the three classic phakomatoses — neurofibromatosis type 1 with its café-au-lait macules, skinfold freckling, neurofibromas and the NIH diagnostic criteria; tuberous sclerosis complex with its hypomelanotic ash-leaf macules, facial angiofibromas, shagreen patch and the major-minor diagnostic criteria; and Sturge-Weber syndrome with its forehead port-wine stain, leptomeningeal angioma and glaucoma. The shared biology is the RAS-MAPK and mTOR signalling pathways — NF1 loss unleashes RAS-MAPK through absent neurofibromin, TSC1 or TSC2 loss drives mTOR overactivation, and a somatic mosaic GNAQ mutation fixes the Sturge-Weber port-wine stain. Management turns on recognising that the skin lesion is the entry point to brain and systemic disease: optic pathway glioma and malignant peripheral nerve sheath tumour surveillance in NF1, vigabatrin for infantile spasms and everolimus for subependymal giant cell astrocytoma in TSC, and seizure, glaucoma and stroke-like-episode care in Sturge-Weber — with ANZ, UK, US and Canada guidance.

high

Impetigo and bacterial skin infection

Fellowship topic on impetigo and bacterial skin infection in children: the non-bullous and bullous forms of impetigo, ecthyma, and the toxin-mediated staphylococcal scalded skin syndrome; the Staphylococcus aureus and group A streptococcal pathophysiology including desmoglein-cleaving exfoliative toxins; the differential of crusted and blistering paediatric rashes; a clinical diagnosis with swabs reserved for atypical or recurrent disease; stepwise topical and oral antibiotic treatment matched to extent and region, with incision-and-drainage-centred management of abscess and community-acquired MRSA; the post-streptococcal glomerulonephritis complication and the skin-strep-versus-throat-strep distinction from rheumatic fever; and ANZ, UK, US and Canada guidance including remote Indigenous endemic disease.

high

Molluscum contagiosum and viral warts

Two of the commonest benign, self-limiting viral skin infections of childhood — molluscum contagiosum (a poxvirus causing pearly umbilicated papules) and viral warts (human papillomavirus causing rough keratotic papules) — both managed by default with expectant care and treated actively only when symptomatic, spreading or bothersome.

medium

Nail disorders in children

Fellowship topic on nail disorders in children: the nail unit anatomy and the site-based diagnostic principle that matrix lesions change nail shape and surface, nail bed lesions change colour and attachment, and nail fold lesions cause swelling and infection; the classification of paediatric nail disorders into normal and developmental variants, traumatic, infectious (acute and chronic paronychia, onychomycosis), inflammatory and skin-disease associated (psoriasis, alopecia areata, lichen planus, trachyonychia), congenital and genetic (congenital malalignment of the great toenail, nail-patella syndrome, pachyonychia congenita), nail tumours (pyogenic granuloma, subungual exostosis, viral warts, longitudinal melanonychia and the nail matrix naevus) and systemic nail signs (clubbing, koilonychia, Beau lines); the confirm-before-treat principle for onychomycosis with mycology before systemic therapy and weight-based terbinafine or itraconazole; the conservative-first management of the ingrown toenail with wedge excision and phenolisation for recurrent disease; the reassurance and topical steroid approach to idiopathic trachyonychia; the recognition that longitudinal melanonychia in a child is usually benign; the red flags for urgent referral; and the ANZ and international dermatology guidance.

high

Nappy dermatitis

A fellowship approach to nappy dermatitis in infants, built around the single decision that matters: separating the common irritant contact dermatitis on convex surfaces with spared folds from the candidal dermatitis that involves the folds and carries satellite lesions, so that the barrier cream and the air exposure are used first and the topical antifungal is added when Candida is present. The page covers the pathophysiology of the moisture-and-faecal-enzyme disruption of the stratum corneum, the Candida albicans overgrowth in the warm occluded fold, the bedside pattern recognition of the two main subtypes, the differential of seborrhoeic dermatitis, atopic dermatitis, allergic contact dermatitis, psoriasis, zinc deficiency, and Langerhans cell histiocytosis, the stepwise management from frequent nappy changes and zinc oxide barrier to clotrimazole or miconazole for the candidal rash and short-course hydrocortisone for the inflamed rash, and the red flag of the rash that does not respond in seven days and demands a broader differential.

high

Neonatal pustular and vesiculobullous eruptions

Fellowship topic on the neonate presenting with a pustule, vesicle or bulla: the benign transient pustular eruptions (erythema toxicum neonatorum, transient neonatal pustular melanosis, neonatal cephalic pustulosis, infantile acropustulosis, eosinophilic pustular folliculitis) distinguished from the dangerous infections (neonatal herpes simplex, staphylococcal scalded skin syndrome, congenital syphilis, neonatal candidiasis) and the inherited blistering diseases (incontinentia pigmenti, epidermolysis bullosa); the eosinophilic-follicular, exfoliative-toxin desmoglein-1, viral-cytopathic, basement-membrane adhesion-defect and mosaic-X-inactivation pathophysiology; the bedside smear and the decision to reassure the well baby or to escalate the ill or atypical baby with a full sepsis workup, herpes simplex PCR, and empiric intravenous aciclovir and antibiotics; and AAP Red Book, NICE, BNFc and ANZ guidance on the aciclovir dose and the genodermatosis referral pathway.

high

Petechiae, purpura and vasculitic rashes

Fellowship topic on the non-blanching rash in children — petechiae, purpura and vasculitic eruptions — framed as a triage problem. The first split is sick versus well: a febrile, toxic child with a rapidly evolving purpuric rash is meningococcal sepsis or purpura fulminans until proven otherwise and needs immediate antibiotics and resuscitation, while a well child with isolated petechiae and a normal examination is most likely immune thrombocytopenia (ITP). Cover the glass-test confirmation of non-blanching, the ISTH disseminated intravascular coagulation score and purpura fulminans, IgA vasculitis (Henoch-Schönlein purpura) with its palpable dependent purpura and mandatory renal follow-up, the haemolytic uraemic syndrome, leukaemia presenting as pancytopenia with blasts rather than isolated thrombocytopenia, and the safeguarding assessment of bruising using the TEN-4 FACES pattern. Diagnostic and triage focus throughout, cross-linking the dedicated sepsis, rash-approach and systemic-disease topics rather than duplicating their full protocols.

high

Psoriasis in children

Fellowship topic on psoriasis in children: the plaque, guttate, scalp, nail, facial and napkin forms and their paediatric-specific presentations; the IL-23 and Th17 and IL-17 immune pathophysiology with HLA-Cw6 genetics, streptococcal and Koebner triggers; the differential from atopic and seborrhoeic dermatitis, tinea and pityriasis rosea; a clinical diagnosis with severity measured by body surface area, PASI and the Children's Dermatology Life Quality Index; stepwise treatment from emollients and potency-matched topical corticosteroid plus calcipotriol through narrowband UVB phototherapy to systemic methotrexate, cyclosporin and acitretin and the biologic agents etanercept, ustekinumab and the IL-17 and IL-23 inhibitors, grounded in the landmark paediatric etanercept trial and the recent biologics network meta-analysis; the obesity, metabolic, juvenile psoriatic arthritis and psychosocial comorbidities; and the ANZ, UK and North American guidance including the joint AAD-NPF paediatric psoriasis guideline.

high

Scabies, lice and infestations

Human ectoparasite infestations of childhood — scabies (Sarcoptes scabiei), head lice (Pediculus humanus capitis), pubic lice and body lice — presenting with characteristic itchy burrows or nits, diagnosed clinically using the 2020 IACS criteria, and managed with permethrin or ivermectin while treating all household contacts on the same day.

high

Seborrhoeic dermatitis and cradle cap

A fellowship approach to seborrhoeic dermatitis and cradle cap (infantile seborrhoeic dermatitis): the greasy yellow scale over the scalp vertex, the face, the flexures, and the nappy area of a well, non-itchy infant in the first three months of life, the absent pruritus as the single decisive feature that separates it from atopic dermatitis alongside the greasy rather than dry scale and the nappy-area involvement atopic dermatitis characteristically spares, the Malassezia-driven pathophysiology on the androgen-stimulated infant sebum, the benign and self-limiting course that clears by six to twelve months on the evidence of the Victoire 2019 Cochrane review with its very low-certainty evidence and the favourable prognosis regardless of intervention, the gentle scalp-care management of an emollient or vegetable oil to soften the scale, gentle brushing, and a mild baby shampoo, the second-line ketoconazole two per cent shampoo and hydrocortisone one per cent for the refractory or extensive case, and the red flags that escalate the management — the generalised erythroderma and desquamation of Leiner disease with its complement C3 or C5 dysfunction, the failure to thrive, and the refractory disease beyond infancy that prompts the immunodeficiency, HIV, and Langerhans cell histiocytosis workup.

high

Skin manifestations of systemic disease

Fellowship topic on cutaneous manifestations of systemic disease in children: the skin as a window to internal disease. Covers the reactive erythemas and panniculitides (erythema nodosum signalling streptococcal infection, sarcoidosis and inflammatory bowel disease; erythema multiforme and mycoplasma-induced rash and mucositis after HSV and Mycoplasma; Gianotti-Crosti papular acrodermatitis as a viral exanthem), the neutrophilic dermatoses (Sweet syndrome and pyoderma gangrenosum linked to inflammatory bowel disease and malignancy), the metabolic and endocrine markers (acanthosis nigricans as insulin resistance and obesity and type 2 diabetes; necrobiosis lipoidica and xanthomas), the gastrointestinal and nutritional dermatoses (dermatitis herpetiformis as the cutaneous face of coeliac disease; acrodermatitis enteropathica as zinc deficiency), the haematological and neoplastic markers (petechiae and purpura in leukaemia and septicaemia, the blueberry muffin neonate), and the neurocutaneous phakomatoses (neurofibromatosis type 1 with its revised diagnostic criteria, tuberous sclerosis complex and the port-wine stain of Sturge-Weber syndrome). Built around recognise, investigate the underlying disease, and refer, grounded in the erythema nodosum and erythema multiforme and acanthosis nigricans reviews, the coeliac disease ESsCD guideline, the dermatitis herpetiformis update, the revised NF1 and updated TSC diagnostic criteria, the port-wine birthmark and Sweet syndrome reviews, the acrodermatitis enteropathica paper and the Gianotti-Crosti review.

high

Stevens-Johnson syndrome and toxic epidermal necrolysis

Fellowship topic on Stevens-Johnson syndrome (SJS), SJS-TEN overlap and toxic epidermal necrolysis (TEN) in children: a severe, usually drug-induced, T-cell-mediated mucocutaneous reaction causing full-thickness epidermal necrosis and detachment, classified by the percentage of body-surface-area detached (under 10, 10 to 30, over 30); the allopurinol, anticonvulsant, sulfonamide and nevirapine culprits and the HLA-B pharmacogenetic associations including HLA-B*15:02 for carbamazepine; the granulysin, Fas-FasL and perforin-granzyme effector mechanisms; the Mycoplasma-induced rash and mucositis syndrome distinct from drug-induced SJS; the differential from staphylococcal scalded skin syndrome where mucosae are spared; SCORTEN severity scoring with its seven risk factors and mortality bands; and management centred on immediate withdrawal of the culprit drug, burn-unit or PICU supportive care, meticulous eye care, and the lack of proven survival benefit for IVIG, cyclosporine and corticosteroids.

high

Tinea and fungal skin infection

Fellowship guide to tinea and fungal skin infection in children: the annular scaly ringworm plaque of tinea corporis with its active advancing border, the prepubertal bald scaly patch of tinea capitis and the boggy inflammatory kerion, the black-dot and ectothrix or endothrix hair invasion, confirmation by potassium hydroxide (KOH) microscopy showing branching septate hyphae and by Wood's lamp green fluorescence for Microsporum, the species-specific oral therapy of tinea capitis with griseofulvin (favoured for Microsporum) versus weight-banded terbinafine (favoured for Trichophyton), the topical treatment of corporis, cruris and pedis, kerion management with an oral antifungal and corticosteroid without incision, household carrier screening and pet source control, and the emerging terbinafine-resistant Trichophyton indotineae.

high

Vascular birthmarks and infantile haemangioma

Fellowship topic on vascular birthmarks and infantile haemangioma: the ISSVA split of vascular anomalies into proliferating tumours (infantile haemangioma, congenital haemangiomas, kaposiform haemangioendothelioma) and structural malformations (capillary, venous, lymphatic, arteriovenous and combined); the GLUT1-positive endothelial-proliferation biology of infantile haemangioma and its proliferate-then-involutive natural history; the segmental-haemangioma syndromes PHACE and LUMBAR and their screening; the GNAQ somatic-mosaic biology of port-wine stain and Sturge-Weber syndrome; propranolol 2 to 3 mg per kg per day as first-line therapy for problematic infantile haemangioma with topical timolol for small superficial lesions; pulsed-dye laser for port-wine stain; the Kasabach-Merritt phenomenon of kaposiform haemangioendothelioma; and ANZ, UK, US and Canada guidance.

high

Acquired hypothyroidism and Hashimoto thyroiditis

**Acquired hypothyroidism** is thyroid-hormone deficiency that develops after a period of normal thyroid function. In iodine-sufficient regions **Hashimoto (chronic lymphocytic) thyroiditis** is by far the commonest cause in children and adolescents: an autoimmune, antibody-mediated destruction of thyroid follicular cells that produces a **goitre**, a rising **TSH** and a falling **free T4**. Presentation is often subtle — **growth slowdown, fatigue, constipation, weight gain and school decline** — so the diagnosis rests on **venous TSH with free T4 and anti-TPO antibodies**. Treatment is **levothyroxine**, weight-based and titrated to a normal TSH; outcome is excellent once replacement begins, with catch-up growth and full cognitive preservation. The skill is recognising the insidious picture, confirming biochemically, screening the associated autoimmune syndromes (Down, Turner, type 1 diabetes, coeliac), and counselling the family on a long but reversible condition.

high

Adrenal insufficiency and adrenal crisis

Fellowship guide to adrenal insufficiency and adrenal crisis in children: the primary-versus-secondary split, autoimmune Addison disease and the salt-wasting crisis, glucocorticoid-withdrawal secondary insufficiency, the cortisol-ACTH-renin work-up, acute resuscitation with fluids and parenteral hydrocortisone, and lifelong replacement with a stress-dose plan.

high

Congenital adrenal hyperplasia

Fellowship guide to congenital adrenal hyperplasia: the cortisol-androgen split, the 21-hydroxylase block, the salt-wasting crisis versus virilisation, the 17-OHP screen and confirmatory work-up, and lifelong hydrocortisone and fludrocortisone replacement with stress dosing.

high

Congenital hypothyroidism

A fellowship approach to congenital hypothyroidism: the newborn-screening-to-treatment pipeline that prevents intellectual disability, the dose and timing of levothyroxine that protects the developing brain (10 to 15 mcg per kg per day, started within the first two weeks), the primary-versus-central classification that explains which babies the TSH screen misses, and the long-term surveillance and permanence reassessment that carries the child into adult endocrine care.

high

Constitutional delay and familial short stature

A fellowship approach to the two commonest normal variants of short stature: recognise familial short stature as a low polygenic height set-point with a normal bone age and constitutional delay of growth and puberty as a slowed hypothalamic-pituitary-gonadal clock with a delayed bone age, separate both from the pathological causes by trajectory and a focused workup, and manage almost all children with reassurance and surveillance while reserving short-course testosterone or oxandrolone for the distressed adolescent and growth hormone only for true deficiency or idiopathic short stature.

high

Cushing syndrome in children

Fellowship guide to Cushing syndrome in children: the growth-arrest hallmark that separates it from simple obesity, the confirm-with-two-tests work-up, the ACTH-dependent versus ACTH-independent split, transsphenoidal surgery for pituitary disease, and the perioperative glucocorticoid replacement that prevents adrenal crisis.

high

Delayed puberty and hypogonadism in adolescents

A fellowship approach to the adolescent whose puberty is late or has stalled: confirm the timing against sex-specific thresholds (no testicular enlargement by 14 in boys, no thelarche by 13 in girls, or a pause over 2 years), split the differential with gonadotrophins into central versus gonadal causes, separate the common and benign constitutional delay of growth and puberty from permanent congenital hypogonadotropic hypogonadism, and treat by reassuring the temporary, inducing puberty in the permanent, and replacing sex steroids for life in primary gonadal failure.

high

Diabetes insipidus and polyuria-polydipsia

Fellowship guide to diabetes insipidus and the polyuria-polydipsia syndrome in children: the vasopressin-water balance axis from hypothalamic osmoreceptor to renal aquaporin-2, the three-way split of central (AVP deficiency) versus nephrogenic (AVP resistance) versus primary polydipsia, the water-deprivation test and the copeptin revolution, and the management divide between desmopressin, thiazide-amiloride-indometacin, and fluid restriction.

high

Diabetic ketoacidosis

A fellowship approach to paediatric diabetic ketoacidosis: recognise the child with hyperglycaemia, ketosis and acidosis who is dehydrated and breathing deeply, diagnose on the triad of glucose over 11 millimoles per litre with venous pH below 7.3 or bicarbonate below 15 and ketonaemia, grade severity by pH and bicarbonate, and deliver the ISPAD-aligned protocol of careful rehydration over 48 hours, insulin at 0.05 to 0.1 units per kilogram per hour started an hour or two after fluids, early potassium replacement, and glucose-guided dextrose — while watching relentlessly for cerebral oedema, the complication that kills, and driving the resolution criteria of a closed anion gap before transition to subcutaneous insulin.

high

Disorders of sex development

A fellowship approach to disorders of sex development: recognise the atypical-genitalia infant, exclude a salt-wasting adrenal crisis before reaching for a label, classify using the 2006 Chicago framework built from karyotype rather than appearance, confirm with a karyotype and a 17-hydroxyprogesterone first, and deliver care through a multidisciplinary team that defers non-consent cosmetic surgery and protects lifelong psychosocial and gonadal health.

high

Endocrine emergencies: integrated approach

Fellowship guide to the integrated approach to paediatric endocrine emergencies: the shared recognition and resuscitation framework that unifies DKA, adrenal crisis, thyroid storm and the sodium-water disorders (SIADH and diabetes insipidus), the bedside triage with glucose, blood gas and electrolytes, the empiric life-saving treatments that cannot wait for confirmatory endocrine tests, and the cross-cutting pitfalls of missed cortisol, missed glucose and missed sodium.

high

Endocrine late effects of cancer treatment

A fellowship approach to the endocrine late effects of childhood cancer treatment: recognise that the survivor who slows on the growth chart, develops central hypothyroidism, adrenal insufficiency, gonadotropin deficiency or paradoxical precocious puberty after cranial irradiation, or primary thyroid dysfunction, gonadal failure, metabolic syndrome and reduced bone density after neck radiation and alkylating chemotherapy, is showing the most common and earliest complications of cure — then risk-stratify by exposure, screen the vulnerable axes with a structured long-term follow-up programme, and replace each deficiency in the correct order with hydrocortisone before thyroxine and sex steroids and recombinant growth hormone only after magnetic resonance imaging excludes recurrence.

high

Growth hormone deficiency and excess

A fellowship approach to disordered growth hormone action: recognise the short child with growth hormone deficiency (short stature crossing centiles, delayed bone age, neonatal hypoglycaemia and midline defects) and the overgrowing child with growth hormone excess (accelerating growth velocity, headache, visual field defect), confirm with IGF-1 and a stimulation test or an oral glucose load, and treat with recombinant growth hormone titrated to IGF-1 for deficiency and transsphenoidal surgery with somatostatin analogue or pegvisomant for excess.

high

Hypercalcaemia and hyperparathyroidism

Fellowship guide to paediatric hypercalcaemia and hyperparathyroidism: the PTH fork that sorts every high calcium, the single test (urine calcium-to-creatinine clearance ratio) that stops you operating on familial hypocalciuric hypercalcaemia, the saline-first acute resuscitation, and the calcitonin-then-bisphosphonate sequence that locks calcium into bone.

high

Hyperthyroidism and Graves disease

A fellowship approach to childhood thyrotoxicosis: confirm the hormone excess with a suppressed TSH and raised free T4, then make Graves disease the leading diagnosis through a positive TSH-receptor antibody, deliver symptom control with a beta-blocker while antithyroid drugs (carbimazole or methimazole first-line) control the gland, hold propylthiouracil for thyroid storm and first-trimester pregnancy because of hepatotoxicity, recognise the transient transplacental neonatal disease, and reach definitive radioactive iodine or surgery for relapse and non-adherence.

high

Hypocalcaemia and hypoparathyroidism

Fellowship guide to hypocalcaemia and hypoparathyroidism in children: the calcium-PTH axis from parathyroid chief cell to bone, kidney and gut, neonatal versus later-onset hypocalcaemia, the PTH-led classification that splits every cause, acute symptomatic tetany and seizure management with IV calcium gluconate, and the long-term trio of oral calcium, calcitriol and PTH 1-34 for refractory disease.

high

Hypoglycaemia in diabetes

A fellowship approach to hypoglycaemia in children and adolescents with diabetes: recognise the autonomic-to-neuroglycopenic slide and the silent nocturnal event as the single greatest barrier to safe intensive therapy, classify severity by the ISPAD/ADA levels, understand why the glucagon and adrenaline counter-regulation fails in type 1 diabetes and produces impaired awareness (HAAF), and deliver the rule of 15 for mild events and glucagon or intravenous dextrose for severe events — then prevent recurrence with continuous glucose monitoring, hybrid closed-loop delivery, structured education, and insulin-adjustment skills.

high

Hypopituitarism and pituitary lesions

Fellowship guide to hypopituitarism and pituitary and hypothalamic lesions in children: the congenital forms (transcription-factor defects, septo-optic dysplasia, pituitary stalk interruption) and the acquired lesions (craniopharyngioma and germinoma), the anterior and posterior hormone deficiencies and the order in which they fail, the dynamic tests that confirm each axis, and the single replacement rule that keeps a child alive — glucocorticoid before thyroxine.

high

Lipid disorders and familial hypercholesterolaemia

Fellowship guide to lipid disorders and familial hypercholesterolaemia: the LDL receptor pathway and its genetic defects, the LDL-C thresholds that flag FH in a child, selective and universal screening, the secondary mimics, the statin-first drug ladder with ezetimibe and PCSK9 inhibitors, apheresis and newer agents for homozygous FH, and cascade screening of relatives.

medium

Monogenic diabetes and neonatal diabetes

Fellowship guide to monogenic diabetes and neonatal diabetes: the single-gene beta-cell defects that masquerade as type 1 or type 2 diabetes, the neonatal diabetes that appears under six months and is almost never autoimmune, the GCK and HNF1A/HNF4A MODY subtypes that change the drug, the KATP channel mutations that switch a child from insulin to an oral sulfonylurea, and the genetic pathway from suspicion to a genotype-matched treatment.

high

Obesity: assessment, complications and treatment

A fellowship approach to childhood obesity as a chronic disease of excess adiposity: BMI-for-age classification with adult crossover, systematic comorbidity screening across six systems, exclusion of secondary and syndromic causes, and staged treatment from lifestyle foundation through anti-obesity pharmacotherapy to metabolic and bariatric surgery, delivered in family-centred, weight-neutral language.

high

Osteoporosis and fragility fractures in children

A fellowship approach to osteoporosis and fragility fractures in children: the ISCD framework that makes a low bone density Z-score only half the diagnosis, the primary-versus-secondary split where the steroid-treated and non-ambulant child dominate, the vertebral fracture that defines osteoporosis on its own, the growing skeleton's peak-bone-mass window, and the weight-based bisphosphonate pathway that now leads with intravenous zoledronic acid.

high

Phaeochromocytoma and endocrine hypertension

Fellowship guide to phaeochromocytoma, paraganglioma and the endocrine causes of hypertension in children: the metanephrines-not-catecholamines diagnostic rule, the high hereditary fraction that makes every child a genetics patient, the alpha-before-beta preoperative trap, and the renin–aldosterone fork that sorts the monogenic mineralocorticoid causes of low-renin hypertension.

high

Precocious puberty

A fellowship approach to precocious puberty: recognise early sexual development as the onset of secondary sexual characteristics before 8 years in girls and before 9 years in boys, split it immediately into central (GnRH-dependent) and peripheral (GnRH-independent) forms plus the normal variants, confirm with bone age and a basal-then-stimulated gonadotropin work-up, and match the treatment to the driver — GnRH analog for central disease, cause-directed therapy for peripheral causes — because accelerated bone maturation and a missed central nervous system lesion are the two preventable harms.

high

Rickets and metabolic bone disease

A fellowship approach to rickets and metabolic bone disease in children: defective mineralisation of growing bone that is almost always preventable, the calcipenic-versus-phosphopenic classification that the biochemistry reveals in seconds, the vitamin D cascade and where it breaks, the symptomatic hypocalcaemic infant who needs intravenous calcium before vitamin D, and the lifelong pathway for hereditary forms such as X-linked hypophosphataemia.

high

Short stature and poor linear growth

Fellowship guide to the short child: position, velocity and proportion drive the differential, from normal variants (familial short stature, constitutional delay) to GH deficiency, hypothyroidism, coeliac disease, syndromes, skeletal dysplasia and psychosocial causes, with a directed investigation pathway and cause-directed therapy including licensed growth-hormone indications.

high

SIADH and disorders of water balance

Fellowship guide to SIADH and disorders of water balance in children: the antidiuretic hormone axis from hypothalamic osmoreceptor to renal aquaporin-2, the volume-status approach to hyponatraemia, the euvolaemic dilutional picture of SIADH versus the dry salt-losing picture of cerebral salt wasting, fluid restriction for chronic disease, hypertonic 3 per cent saline for the seizing child, and the sodium correction rate that must stay under 8 mmol per litre a day to avoid osmotic demyelination.

medium

Tall stature and overgrowth syndromes

A fellowship approach to the tall child: separate the familial and constitutional normal variants from the pathological causes — syndromic overgrowth (Sotos, Beckwith-Wiedemann, Weaver, Simpson-Golabi-Behmel, Tatton-Brown-Rahman), growth-hormone excess, and chromosomal or hormonal delay — using a structured dysmorphology and proportion assessment, targeted genetic testing, and syndrome-specific tumour surveillance.

high

Thyroid nodules, goitre and thyroid cancer

Fellowship guide to paediatric thyroid nodules, goitre and thyroid cancer: recognise the neck mass, risk-stratify with ultrasound (TI-RADS) and FNA (Bethesda), understand the higher childhood malignancy risk and gene-fusion biology, and step through multidisciplinary surgery, risk-adapted radioiodine and surveillance.

high

Type 1 diabetes: diagnosis and initial management

Fellowship guide to the diagnosis and first days of type 1 diabetes in children and adolescents who present without ketoacidosis: the classic symptoms and the diagnostic glucose and HbA1c thresholds, the islet autoantibodies and C-peptide that confirm the autoimmune type and separate it from type 2 and monogenic diabetes, the three-stage model of preclinical to clinical disease, the first subcutaneous basal-bolus insulin regimen, structured family education, and the honeymoon phase. The full ketoacidosis protocol lives on its own leaf.

high

Type 1 diabetes: insulin therapy, technology and ambulatory care

Fellowship guide to ongoing insulin therapy, diabetes technology and ambulatory care in children and adolescents with type 1 diabetes: the insulin pharmacology that drives regimen choice, the basal-bolus and pump pathways, continuous glucose monitoring and hybrid closed-loop systems, sick-day and exercise rules, hypoglycaemia prevention, school care plans, HbA1c targets, and structured transition to adult care.

high

Type 2 diabetes and metabolic syndrome in youth

Fellowship guide to type 2 diabetes and metabolic syndrome in children and adolescents: the insulin-resistance and beta-cell-failure pathophysiology, the acanthosis and metabolic cluster at the bedside, the diagnostic criteria with antibody and C-peptide confirmation, the exclusion of type 1 and monogenic diabetes, the stepwise ladder of lifestyle, metformin, insulin, GLP-1 receptor agonists and SGLT2 inhibitors, and the aggressive comorbidity and complication care that defines the disease as faster and more dangerous than its adult counterpart.

high

Acute and chronic rhinosinusitis

Fellowship topic on acute and chronic rhinosinusitis in children: the term rhinosinusitis because the nasal and sinus mucosa are one continuous lining; the distinction of acute viral from acute bacterial rhinosinusitis by the AAP criteria of persistence beyond ten days, double worsening, and severe onset; the chronic form lasting twelve weeks or more with impaired mucociliary clearance; the Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Moraxella catarrhalis microbiology; the ostial-obstruction pathophysiology and spread through the lamina papyracea to the orbit by the Chandler stages and through the valveless diploic veins to the brain; the orbital complications of preseptal and orbital cellulitis, subperiosteal and orbital abscess and cavernous sinus thrombosis; the intracranial complications of meningitis, epidural and subdural empyema, brain abscess and Pott puffy tumour; the clinical diagnosis, the contrast CT indication, high-dose amoxicillin-clavulanate, saline irrigation and intranasal corticosteroid, and the medical versus surgical threshold for the medial subperiosteal abscess; and ANZ, UK and North American guidance.

high

Acute otitis media

Fellowship guide to acute otitis media (AOM): the acute suppurative inflammation of the middle-ear mucosa behind an intact tympanic membrane, diagnosed from a bulging eardrum or new otorrhea rather than redness alone; the AAP three-part criteria; the Streptococcus pneumoniae, Haemophilus influenzae and Moraxella pathogens and the Eustachian-tube-dysfunction mechanism; severity grading and the age-and-laterality matrix that separates watchful waiting with a safety-net from immediate antibiotics; analgesia for every child; first-line high-dose amoxicillin 90 mg/kg/day twice daily with the penicillin-allergy pathway; the red flags of mastoiditis; recurrent AOM and grommet decisions; and the ANZ, UK and North American guideline differences.

medium

Ankyloglossia and infant feeding

Fellowship topic on ankyloglossia (tongue-tie) and infant feeding — a congenital short, thick or tight lingual frenulum that tethers the underside of the tongue to the floor of the mouth and restricts tongue mobility. Covers the anterior-versus-posterior and structural-versus-functional classification (Coryllos type one to four, Kotlow free-tongue length, the Hazelbaker Assessment Tool for Lingual Frenulum Function and the TABBY picture tool); the biomechanics of the breastfeeding latch and how a restricted tongue fails to cup, elevate and form a peristaltic wave, causing nipple trauma, poor milk transfer, engorgement and mastitis; the estimated four to eleven percent prevalence with male predominance; the bedside and lactation assessment including observing a feed and testing protrusion, elevation, cupping and lateralisation; the principle of skilled lactation support before any decision to divide; the stepwise move through conservative support, validated assessment and frenotomy (sterile scissors or laser division) for the infant whose feeding difficulty persists; the randomised and systematic-review evidence on frenotomy and its limits; the complications of bleeding, oral ulceration and reattachment and the overdiagnosis and underdiagnosis pitfalls; and the regional guidance from NICE interventional procedures guidance one four nine, the AAO-HNS consensus and the Royal Children's Hospital Melbourne.

high

Cleft lip and palate

Fellowship topic on cleft lip and palate: the embryologic origin in the failure of fusion of the frontonasal, maxillary and mandibular processes and of the palatal shelves; the Veau and Kernahan classifications from an isolated cleft lip through a complete bilateral cleft lip and palate; the newborn priorities of feeding with a squeeze bottle or specialised teat and not allowing aspiration or failure to thrive, the near-universal otitis media with effusion from Eustachian tube dysfunction and the role of grommets at palatoplasty; Pierre Robin sequence with micrognathia, glossoptosis and airway obstruction; the staged surgical timeline of primary lip repair around three months by the rule of ten, palatal repair at nine to eighteen months, secondary alveolar bone grafting at nine to eleven years and orthognathic correction in adolescence; nasoalveolar molding in the first weeks; the syndromic associations of Van der Woude, Stickler and 22q11 deletion; and the multidisciplinary cleft team coordinating surgery, orthodontics, speech, audiology, genetics and psychology across childhood.

medium

Congenital ear anomalies and microtia

Fellowship topic on congenital ear anomalies and microtia: the bedside distinction between a deformational ear deformity (soft, structurally complete, moldable in the newborn) and a true malformation or microtia (a tissue deficiency needing reconstruction); the Marx classification from grade I to anotia; the pharyngeal-arch and otic-placode embryology that explains why the outer and middle ear are affected together while the inner ear and sensorineural hearing are usually spared; the syndromic patterns of Treacher Collins, hemifacial microsomia or oculo-auriculo-vertebral spectrum, and branchio-oto-renal; the priority of ABR and early bone-conduction hearing rehabilitation in bilateral aural atresia; the narrow newborn window for ear molding; the autologous and porous-polyethylene reconstruction options staged at six to ten years; and the Jahrsdoerfer CT grading, where a score of seven or more out of ten favours atresiaplasty and a lower score favours a bone-conduction device.

high

Dental caries, enamel disease and oral-health prevention

Fellowship topic on dental caries, developmental enamel disease and oral-health prevention in children. Covers dental caries as the commonest chronic disease of childhood and a biofilm-mediated, sugar-driven, dynamically demineralising disease; the AAPD case-definition of early childhood caries (ECC) and its severe form; the Streptococcus mutans ecological-plaque pathophysiology, the demineralisation-remineralisation cycle and the critical pH of about 5.5 for enamel; the fluoride, diet and dental-home prevention pillars with age-specific fluoride toothpaste guidance, fluoride varnish and silver diamine fluoride; the developmental enamel defects differential of molar-incisor hypomineralisation, amelogenesis imperfecta and fluorosis; the emergency recognition of spreading odontogenic infection; and the ANZ, UK, US and Canadian guidance on community water fluoridation and supervised toothbrushing.

high

Dental trauma and avulsed teeth

Fellowship topic on dental trauma and avulsed teeth in children. Covers traumatic dental injury as a time-critical emergency in which the management in the first minutes at the scene decides whether an avulsed permanent tooth survives; the Andreasen classification of hard-tissue and periodontal-ligament injuries; the periodontal ligament cell-viability pathophysiology that makes extra-alveolar dry time the dominant prognostic factor; the International Association of Dental Traumatology 2020 first-aid and management protocol of finding the tooth, holding it by the crown, rinsing a dirty root for about ten seconds and replanting a permanent tooth immediately or storing it in milk, HBSS or saliva; the rule that primary teeth are never replanted; flexible splinting, root-canal-treatment timing and systemic antibiotics for the replanted tooth; luxation and fracture subtypes; complications of inflammatory and replacement root resorption; the oral-injury link with non-accidental injury; and the safety-net and dental follow-up plan.

high

Drooling, dysphagia and upper-aerodigestive disorders

Fellowship guide to drooling (sialorrhoea), dysphagia and the upper-aerodigestive disorders of childhood; the distinction between anterior drooling (visible, social and skin impact) and posterior drooling (silent, carrying aspiration and recurrent chest infection risk); drooling as a clearance problem of oromotor impairment rather than saliva overproduction; classification of dysphagia into oropharyngeal transfer and oesophageal transport forms; the four swallow phases and where each fails; overt and silent aspiration; the Drooling Severity and Frequency Scale and the clinical swallow evaluation; the roles of videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing; the stepwise drooling ladder from oromotor therapy and positioning through glycopyrrolate (glycopyrronium) and sublingual atropine, botulinum toxin injection of the salivary glands, and surgery; eosinophilic oesophagitis and structural aerodigestive anomalies; and the decisions around gastrostomy and oesophagogastric dissociation in the child with an unsafe swallow.

high

Epistaxis in children

Fellowship topic on epistaxis in children — bleeding from the nasal mucosa, over 90 percent anterior from Little's area (Kiesselbach's plexus) on the anteroinferior septum. Covers the four-artery anatomy that explains anterior vulnerability and the sphenopalatine origin of posterior bleeds; the digital-trauma, dry-air, allergic-rhinitis and upper-respiratory-tract-infection precipitants; the correct first-aid technique (sit upright, lean forward, pinch the soft part of the nose for 10 to 15 minutes) and the common errors of tilting the head back or pinching the bony bridge; the stepwise escalation from first aid through topical vasoconstriction, silver-nitrate cautery (one side of the septum) and nasal packing; the antiseptic-cream and cautery evidence for recurrent disease; and the red flags of bleeding disorder, juvenile nasopharyngeal angiofibroma in the adolescent male, foreign body and non-accidental injury, with ANZ, UK, US and Canadian guidance.

high

Facial swelling and odontogenic infection

Fellowship guide to paediatric facial swelling of dental origin, from a localised periapical abscess through spreading odontogenic cellulitis to Ludwig angina and deep neck space infection: the principle that every spreading odontogenic infection has a source tooth that must be drained or extracted, because antibiotics alone fail without source control; the polymicrobial anaerobic microbiology and the empirical intravenous regimens (ampicillin-sulbactam, clindamycin with metronidazole, ceftriaxone plus metronidazole); the fascial-plane anatomy (buccinator, mylohyoid, submandibular and sublingual spaces) that determines whether pus tracks into the cheek, the floor of mouth or the neck; and the airway-threat red flags of Ludwig angina — bilateral submandibular swelling, woody floor of mouth induration, tongue elevation, drooling and trismus — that make securing the airway the first and most important step.

high

Hearing assessment and childhood hearing loss

Fellowship guide to hearing assessment and childhood hearing loss: how universal newborn hearing screening (AABR and OAE) and the 1-3-6 milestones catch permanent congenital hearing loss, the conductive-versus-sensorineural framework with otitis media with effusion as the commonest acquired cause, the aetiology (genetic including GJB2, congenital CMV as the commonest infective cause, auditory neuropathy spectrum disorder), age-appropriate audiometry and tympanometry, grommet criteria with three months of watchful waiting and the Paradise developmental evidence, hearing aids and cochlear implantation, and the principle that the open critical period makes early identification non-negotiable.

high

Mastoiditis and otogenic complications

Fellowship topic on mastoiditis and otogenic complications in children: acute mastoiditis as the commonest suppurative complication of acute otitis media through the contiguous mastoid air-cell system; coalescent and masked forms; the intratemporal complications from subperiosteal and Bezold abscess through Gradenigo petrositis, facial palsy and labyrinthitis to lateral sinus thrombosis; the intracranial complications of meningitis, extradural and subdural empyema, brain abscess and otitic hydrocephalus; the postauricular swelling and the down-and-out pinna, the Streptococcus pneumoniae, pyogenes, Staphylococcus aureus and Pseudomonas microbiology; the contrast temporal-bone CT findings of coalescence; the intravenous antibiotic regimen and the cortical mastoidectomy, myringotomy and needle-aspiration decisions; and ANZ, UK and North American guidance.

high

Nasal foreign body and button-battery injury

Fellowship topic on nasal foreign body and button-battery injury in children — an object lodged in the nasal cavity of a two-to-five-year-old, most often a benign inert bead, food or toy part presenting with unilateral foul-smelling or blood-stained discharge, with a single time-critical subtype, the button (coin) battery, that must be removed immediately because electrolysis at its negative pole generates hydroxide ions and alkaline liquefactive necrosis dissolves tissue within hours. Covers the common objects and the peak toddler age; the unilateral foul-discharge presentation and the rhinolith sequela; the alkaline-electrolysis, thermal and pressure-necrosis cascade that makes a battery burn the septum; the stepwise removal of inert objects by positive pressure (the parent's kiss) and instruments (alligator forceps for graspable objects, a right-angle hook behind a smooth bead, suction, a Katz extractor); the emergency removal of a button battery without waiting for fasting, cavity irrigation, the emerging role of topical neutralising agents, and ENT referral for burn surveillance; the avoidance of a blind finger sweep; the distinction of a battery from a coin by its step-off edge and double-ring sign; the complications of septal perforation, synechiae and stenosis; and ANZ, UK, US and Canadian guidance.

high

Neck masses in children

Fellowship guide to the paediatric neck mass framed around the two questions that drive every assessment — is this congenital, inflammatory or neoplastic, and where does it sit (midline versus lateral, anterior versus posterior triangle, supraclavicular)? Most cervical masses in children are benign reactive lymph nodes, but the discipline is to never miss the malignant one: a hard, fixed, painless, progressively enlarging node, a node in the supraclavicular fossa or posterior triangle, or a node that persists or grows beyond four to six weeks or fails to respond to antibiotics. The congenital midline mass that moves up with swallowing and tongue protrusion is a thyroglossal duct cyst (Sistrunk procedure); the lateral mass is a branchial cleft cyst until proven otherwise; the soft, transilluminating posterior-triangle mass in an infant is a lymphatic malformation. Suppurative lymphadenitis needs antibiotics covering Staphylococcus aureus and group A streptococcus with incision and drainage if an abscess forms; non-tuberculous mycobacterial lymphadenitis needs surgical excision. Ultrasound is the first-line imaging test because it is radiation-free and tissue-characterising; persistent or suspicious masses need ultrasound-guided biopsy and urgent paediatric oncology referral. The red flags that shift a reassuring node into an emergency are airway compromise, drooling, a rapidly enlarging mass, constitutional B symptoms, and any supraclavicular node.

high

Oral manifestations of systemic disease

Fellowship topic on the oral manifestations of systemic disease in children. Covers the chalky symmetrical dental enamel defects and recurrent aphthae of coeliac disease, the swollen lip and cobblestone buccal mucosa of oral Crohn disease and orofacial granulomatosis, the gingival infiltration and mucosal petechiae of leukaemia, the recurrent ulcers and periodontitis of cyclic neutropenia, the candidiasis and periodontitis of type 1 diabetes and HIV, the Hutchinson teeth and mulberry molars of congenital syphilis, and the premature loss of primary teeth in hypophosphatasia and Papillon-Lefevre syndrome. Builds the fellowship skill of reading an oral sign as a window onto an underlying systemic disease, naming the targeted work-up, and knowing when to refer.

high

Oral ulcers and mucosal disease

Fellowship topic on oral ulcers and mucosal disease in children. Covers primary herpetic gingivostomatitis with early oral aciclovir, recurrent aphthous stomatitis and its deficiency, coeliac and autoinflammatory associations, oral candidiasis and nystatin dosing in infants, hand-foot-and-mouth disease and herpangina, oral mucositis in oncology with WHO grading and prevention, the PFAPA syndrome triad, and benign geographic tongue. Builds the single-most-important skill of distinguishing the common self-limiting ulcer from the one that signals immunodeficiency, cytopenia, Behcet disease or a dehydrating viral gingivitis, with ANZ, UK, US and Canadian guidance.

high

Otitis externa

Fellowship topic on otitis externa — inflammation of the external auditory canal. Covers the acute diffuse (swimmer's ear), furuncular, eczematous, fungal and necrotising (malignant) forms; the cerumen-defence and pH pathophysiology that explains why water and trauma drive Pseudomonas and Staphylococcus overgrowth, and why Pseudomonas invades the skull base in the immunocompromised child; the tragal-tenderness and pain-on-pull bedside signs that separate it from acute otitis media; aural toilet, topical antimicrobial drops and ear-wick stepwise care; and the emergency recognition of necrotising otitis externa with prolonged antipseudomonal therapy, cranial-nerve and skull-base imaging, and ANZ, UK, US and Canadian guidance.

high

Otitis media with effusion and grommet decisions

Fellowship topic on otitis media with effusion (glue ear) and grommet (tympanostomy tube) decisions in children: the definition of OME as non-purulent fluid behind an intact tympanic membrane without acute infective signs, distinct from acute otitis media; the Eustachian tube dysfunction pathophysiology amplified by the short, horizontal, compliant paediatric tube; the natural-history principle that most effusions resolve within three months and that watchful waiting is the first and default management; the tympanogram (type A normal, type B flat effusion, type C negative pressure) and the typical 20 to 30 dB HL conductive hearing loss; the grommet criterion of bilateral OME persisting three months or longer with documented hearing difficulty, and the rule against inserting tubes for a single episode under three months; the at-risk child (Down syndrome, cleft palate, permanent hearing loss, developmental delay) needing earlier referral; the Paradise developmental trials showing no long-term advantage of early tubes and the Cochrane hearing evidence; autoinflation and the limited role of antibiotics, steroids and adenoidectomy; and culturally safe, region-aware care including the high-burden early-severe disease of Aboriginal and Torres Strait Islander children.

high

Pharyngitis, tonsillitis, peritonsillar abscess and deep neck infection

Fellowship guide to paediatric sore throat progressing from viral pharyngitis through group A streptococcal tonsillitis to peritonsillar abscess and deep neck infection: the Centor and McIsaac clinical scoring systems and the principle that children need microbiological confirmation before antibiotics because clinical features alone cannot reliably separate bacterial from viral disease; first-line phenoxymethylpenicillin or amoxicillin for ten days; the drooling, trismus and toxic-child red flags that mark peritonsillar abscess, retropharyngeal abscess and parapharyngeal spread; contrast-enhanced CT of the neck; needle aspiration versus incision and drainage for quinsy; intravenous antibiotics and surgical drainage for deep neck space collections; acute rheumatic fever primary prevention; and the ANZ, UK and North American guideline approaches.

medium

Salivary gland disorders

Fellowship topic on salivary gland disorders in children. Covers mumps and its complications, juvenile recurrent parotitis and sialendoscopy, acute suppurative parotitis with anti-staphylococcal therapy, the simple and plunging ranula, sialolithiasis and neonatal parotitis. Builds the skill of distinguishing the common viral parotitis from the suppurative gland needing antibiotics and the recurrent or cystic lesion needing a different pathway, with ANZ, UK, US and Canadian guidance.

medium

Tinnitus, vertigo and balance disorders in children

Fellowship guide to tinnitus, vertigo and balance disorders in children: separating the common benign causes, benign paroxysmal vertigo of childhood and vestibular migraine, from the acute peripheral vestibular neuritis and the dangerous central mimics, the bedside distinction of peripheral from central nystagmus, the red-flag screen that drives urgent magnetic resonance imaging, and the management built on reassurance, the Epley manoeuvre for positional vertigo, and early vestibular rehabilitation.

high

Acute behavioural disturbance and agitation

A fellowship approach to the acutely behaviourally disturbed or agitated child and adolescent: secure the environment and call help early, apply verbal de-escalation as first-line treatment, climb a stepped least-restrictive ladder from de-escalation to oral then parenteral medication to physical restraint as a last resort, exclude organic causes before and after sedation, and minimise and recover from restraint — grounded in the BETA consensus and the PEAChY trials across ANZ, UK, US and Canada.

high

Anxiety disorders in children and adolescents

Fellowship guide to anxiety disorders in children and adolescents: distinguish the seven DSM-5-TR disorders from normal developmental fear, assess multi-informant with SCARED/SCAS/RCADS, exclude medical mimics and comorbid depression, deliver stepped care from psychoeducation through exposure-based CBT (Coping Cat, FRIENDS) to SSRI (sertraline, fluoxetine), anchored by CAMS, Cochrane 2020 and AACAP Walter 2020 evidence, with activation and suicidality monitoring and adapted care for neurodiverse, Indigenous, refugee and rural youth.

high

Attachment disorders and relational trauma

Fellowship guide to reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) and the wider relational-trauma picture in children: the two-disorder DSM-5-TR and ICD-11 structure built on grossly pathogenic early care, the developmental and caregiving-history assessment, the BEIP, ABC and Child-Parent Psychotherapy evidence, phased relationship-based care with no first-line medication and no coercive holding therapy, and a closed safeguarding and disposition plan across ANZ, UK, US and Canada.

high

Avoidant restrictive food intake disorder

Fellowship approach to avoidant/restrictive food intake disorder (ARFID): a DSM-5-TR/ICD-11 eating disorder of restriction that harms nutrition, growth or function without weight/shape overvaluation. Three driver patterns — sensory, fear/aversive, low appetite/interest. Stepwise care: medical safety, stop coercion, protect nutrition, evidence-based CBT-AR or FBT, escalate with exit plan.

high

Child and adolescent suicide and self-harm assessment

A fellowship approach to assessing suicide risk and self-harm in children and adolescents: distinguishing non-suicidal self-injury from suicidal self-harm; structured risk stratification using ideation, plan, intent, means access and prior attempts; co-building a Stanley-Brown safety plan; means restriction counselling with carers; and disposition matched to dynamic risk across ANZ, UK, US and Canada.

high

Children of parents with mental illness or substance use

Fellowship guide to the child of a parent with mental illness or substance use: a heightened but probabilistic — never deterministic — risk-and-need picture driven by gene-environment interplay, the Rutter / Reiss / Gotlib transmission evidence, the offspring-risk data by parental disorder (Weissman STAR*D-child; Rasic), and stepped two-generational, family-focused care whose non-negotiables are treating the parent, assessing the child in their own right, safeguarding when thresholds are met, and a closed loop — across ANZ, UK, US and Canada.

high

Chronic fatigue and post-viral fatigue syndromes

A fellowship approach to chronic fatigue and post-viral fatigue in children and adolescents: separating post-viral fatigue from CFS/ME, recognising post-exertional malaise as the hallmark, the differential of the tired young person, a validating biopsychosocial assessment, function-first management (energy management, CBT, individualised activity), school reintegration, and the regional divide on graded exercise — across ANZ, UK, US and Canada.

high

Collaborative care with child and adolescent mental-health services

Fellowship guide to collaborative care between the paediatrician and child and adolescent mental-health services (CAMHS): the four models of integration (referral, consultation-liaison / access programs, co-located, fully integrated), why the gap exists and how collaborative care closes it, the stepped-care tiers and who delivers each, multi-agency assessment and information-sharing, the acute-risk warm handoff, routine outcome monitoring, regional service architecture (ANZ Better Access and headspace, UK CAMHS tiers, US MCPAP and Project TEACH), and adaptation for Indigenous, refugee, rural and out-of-home-care youth — anchored by the AACAP 2023 collaborative-care clinical update, the Asarnow 2015 meta-analysis and the Massachusetts child psychiatry access program.

high

Conduct disorder and antisocial behaviour

Fellowship guide to conduct disorder and antisocial behaviour in children: the rights-violation definition, the Moffitt developmental taxonomy, the callous-unemotional specifier, the biopsychosocial coercion-loop model, and a NICE CG158 stepped-care ladder built on evidence-based parenting programmes (Incredible Years, Triple P, PCIT, MST) rather than medication, with ANZ/UK/US guideline differences.

high

Delirium in children and adolescents

Fellowship guide to delirium in children and adolescents: DSM-5-TR criteria-based clinical diagnosis, motoric subtypes (hyperactive, hypoactive, mixed), CAPD and pCAM-ICU screening, the ABCDEF prevention bundle, cause-first treatment with non-pharmacologic priorities, antipsychotics as last resort, and the 2022 SCCM PADIS guideline evidence.

high

Depressive disorders in children and adolescents

Fellowship guide to depressive disorders in children and adolescents: criteria-based clinical diagnosis, irritability-and-school-failure presentation, suicide-risk assessment, stepped care with CBT or IPT-A and fluoxetine as first-line SSRI, the TADS/TORDIA/ADAPT/IMPACT evidence and Cipriani/Zhou network meta-analyses, the black-box warning used wisely, and ANZ/UK/US guideline differences.

medium

Disruptive mood dysregulation disorder

Fellowship guide to disruptive mood dysregulation disorder (DMDD): a DSM-5-TR diagnosis of severe, recurrent temper outbursts against a background of chronic, non-episodic irritability, created to curb paediatric bipolar overdiagnosis. Covers the criteria-clock of onset, duration and cross-setting impairment, the bipolar and ODD rule-outs, a behaviour-therapy-first stepped plan, when a stimulant or antidepressant is justified for comorbidity, and the Copeland, Benarous, Breaux and Zhang evidence.

high

Early-onset psychosis and mania

A fellowship approach to the child or adolescent presenting with psychotic or manic symptoms: recognising the gate, telling psychosis from mania and from mimics, excluding organic disease, screening suicide risk, and delivering evidence-based pharmacotherapy — risperidone and aripiprazole for early-onset schizophrenia, second-generation antipsychotics for paediatric mania — with active metabolic monitoring and early specialist referral, across ANZ, UK, US and Canada.

high

Emergency mental-health assessment and disposition

A fellowship approach to the child or young person who presents to the emergency department in a mental-health crisis: perform a rapid safety and medical screen at the door, run a structured suicide and self-harm risk assessment with a validated tool, synthesise the findings into a risk stratum, match that stratum to a least-restrictive disposition, and never let a young person leave without a safety plan and a real follow-up — grounded in the ASQ and CASSY instruments, the Knipe self-harm prognosis data and the NICE self-harm guideline across ANZ, UK, US and Canada.

medium

Family assessment and family interventions

Fellowship guide to systematic family assessment and evidence-based family interventions in paediatrics: the three-generation genogram plus validated family-functioning measures and naturalistic dyad observation that build a shared, non-blaming formulation; the three named mechanisms (coercive cycle, expressed emotion, chronic stress/adversity load) that link the family system to child outcomes; and the stepped ladder of family-level care from universal parenting guidance and home visiting through behavioural parent training (PMT, Triple P, Incredible Years, PCIT) to structured family therapy (FFT, BSFT, FBT) and intensive multisystem care (MST) — always with safety and child-protection gating the plan, across ANZ, UK, US and Canada.

high

Functional neurological symptoms in children

Fellowship guide to functional neurological symptoms in children and adolescents: positive diagnosis from internally inconsistent signs, the biopsychosocial 3-Ps formulation, red flags and organic mimics, a validating diagnosis conversation, and a stepped multidisciplinary plan led by physiotherapy-led functional rehabilitation and psychological therapy across ANZ, UK, US and Canada.

high

Grief, bereavement and adjustment disorder in children

Fellowship guide to grief, bereavement and adjustment disorder in children: separating normal grief from prolonged grief disorder (PGD) and from adjustment disorder using the DSM-5-TR and ICD-11 structure (the bereavement gateway and duration threshold that set PGD apart from any-stressor, three-month adjustment disorder), the grief-versus-MDD-versus-PTSD distinction, suicide and safeguarding assessment in every case, watchful waiting and caregiver-supported care as first-line, the Boelen CBT-for-PGD and Cohen/Mannarino TF-CBT evidence with no first-line medication, and a closed-loop disposition across ANZ, UK, US and Canada.

high

Mental state examination in children and adolescents

A fellowship approach to performing and documenting a mental state examination on a child or adolescent: setting the conditions, observing each of the seven domains, adapting the method to preschool, school-age and adolescent patients, integrating validated brief screens, weighing findings against the developmental norm and against medical mimics, and acting on suicide and safety risk in the room.

high

Obsessive-compulsive disorder in children

Fellowship guide to paediatric OCD: recognising the hidden obsession–compulsion cycle, multi-informant clinical diagnosis with CY-BOCS, differentials including autism, tics and anxiety, stepped CBT-with-ERP-first care with SSRI escalation, PANDAS/PANS controversy, family accommodation, regional pathway differences and exam pearls.

medium

Pica and rumination disorder

An age-aware fellowship approach to pica and rumination disorder: distinguish them from normal mouthing, culturally sanctioned practices and true vomiting; run a harm gate for lead, bezoar, helminth and malnutrition before assigning a label; treat reversible drivers such as iron and zinc deficiency; and replace the behaviour with supervision, response prevention and diaphragmatic breathing rather than punitive restraint.

high

Post-traumatic stress disorder and trauma responses

Fellowship guide to post-traumatic stress disorder and the wider trauma-response spectrum in children and adolescents: the reaction-to-disorder continuum, DSM-5-TR and ICD-11 structure, preschool subtype, trauma-informed assessment, risk factors that predict persistence, stepped care with trauma-focused CBT first-line, watchful waiting, no single-session debriefing, and a closed safeguarding and disposition plan across ANZ, UK, US and Canada.

high

Psychological impact of chronic illness and disability

A fellowship approach to the psychological impact of chronic illness and disability in children and adolescents: a biopsychosocial, resilience-oriented model in which most children adapt well. Classify the response from healthy adjustment to diagnosable disorder, recognise the illness, child, family and social factors that raise risk, screen routinely for depression, anxiety and quality of life, and co-build a stepped, family-centred, school-inclusive plan across ANZ, UK, US and Canada.

high

Psychopharmacology and psychotropic medicines in children and adolescents

Fellowship guide to psychopharmacology in children and adolescents: developmental pharmacokinetics, the major drug classes (stimulants, non-stimulants, SSRIs, antipsychotics, mood stabilisers, melatonin), starting-dose and titration frameworks, the FDA black-box suicidality warning, antipsychotic metabolic monitoring, valproate teratogenicity, choice by indication and age with trial evidence, adverse effects, and exam pearls across ANZ, UK, US and Canada.

medium

Selective mutism

Fellowship guide to selective mutism: recognising the child who speaks at home but freezes silent at school, the anxiety-driven freeze (not defiance), DSM-5-TR diagnosis from multi-informant history, the hearing-first differential, behavioural-intervention-first care (stimulus fading, shaping, school collaboration) with SSRI for moderate-to-severe, long-term outcomes and exam pearls.

high

Somatic symptom and related disorders

A fellowship approach to somatic symptom and related disorders (DSM-5) in children and adolescents: a validating, biopsychosocial, function-first model. Recognise the disorder on positive grounds (distressing symptoms plus disproportionate thoughts, feelings and behaviours — not 'medically unexplained'), screen once for organic disease, stop the test cascade, and co-build an interdisciplinary plan across ANZ, UK, US and Canada.

high

Substance intoxication, withdrawal and use disorders in youth

Fellowship guide to substance intoxication, withdrawal and use disorders in youth: separating the acute (intoxication, withdrawal) from the clinical diagnosis (DSM-5 use disorder), CRAFFT and S2BI screening, SBIRT stepped care with motivational interviewing, CBT and family-based therapy, the Dennis Cannabis Youth Treatment evidence and the Marsch buprenorphine trial, the cannabis-psychosis link, and the Australian context of cannabis, vaping and inhalant (chroming) use.

high

Acute monoarthritis and septic arthritis

A fellowship approach to the child with an acutely hot, swollen joint: the Kocher clinical prediction rule that separates septic arthritis from transient synovitis, the urgent joint aspiration that confirms pus in the synovial fluid, the empiric intravenous antibiotics stratified by age and organism, and the surgical emergency that a septic hip represents because intracapsular pressure threatens the femoral head blood supply within hours.

high

ANCA-associated and other childhood vasculitides

Fellowship guide to ANCA-associated and other childhood vasculitides beyond IgA vasculitis. Covers the Chapel Hill 2012 vessel-size nomenclature that splits large-vessel Takayasu arteritis, medium-vessel Kawasaki disease and childhood polyarteritis nodosa, and small-vessel ANCA-associated disease. Details the three ANCA-associated vasculitides — granulomatosis with polyangiitis (PR3 or c-ANCA, destructive upper-airway and pulmonary-renal disease), microscopic polyangiitis (MPO or p-ANCA, necrotising glomerulonephritis and pulmonary capillaritis without granuloma), and eosinophilic granulomatosis with polyangiitis (asthma, eosinophilia, cardiac and nerve involvement). Reproduces the EULAR/PRINTO/PRES Ankara 2008 childhood GPA and Takayasu criteria, the SHARE recommendations, and the remission-induction regimens of rituximab or cyclophosphamide with glucocorticoids followed by maintenance therapy, alongside the Kawasaki cross-link of intravenous immunoglobulin and aspirin and the Takayasu pathway of glucocorticoids, biologics and revascularisation.

high

Angular, rotational and gait variants

A fellowship approach to the common physiologic variants of the growing lower limb — bow legs, knock knees, and intoeing — anchored by the Salenius and Vankka developmental curve, the Staheli rotational profile, and the skill of separating the symmetric, painless, age-appropriate variant that resolves spontaneously from the progressive, asymmetric, or painful limb that points to Blount disease, rickets, or a skeletal dysplasia.

high

Back pain in children and adolescents

A fellowship approach to back pain in children and adolescents: back pain is uncommon in the pre-school child and a red flag in its own right, and the age-stratified differential runs from discitis in the toddler through spondylolysis in the school-age athlete to Scheuermann kyphosis and lumbar disc herniation in the adolescent — anchored by the red-flag screen that separates the benign mechanical back from the infection, tumour, or neurological compromise that demands urgent imaging and referral.

high

Bone pain and malignancy red flags

A fellowship approach to paediatric bone pain and the red flags that signal malignancy: separating the child whose limb pain is benign growing pain or transient synovitis from the child harbouring leukaemia, osteosarcoma, or Ewing sarcoma. Anchored on the Cabral and Tucker and Jones multicentre studies that distinguish childhood leukaemia from juvenile idiopathic arthritis, the radiographic leukaemic lines of Tafaghodi, the epidemiology and survival of the primary bone tumours from SEER and EURAMOS-1, and the delayed-diagnosis lesson of George and Grimer that an unplanned excision or a missed night pain costs a child their prognosis.

high

Clubfoot and congenital limb anomalies

A fellowship approach to the clubfoot (congenital talipes equinovarus) and the broad family of congenital limb anomalies: the four classical deformities (cavus, adductus, varus, equinus), the Ponseti serial casting method as the global gold standard with the percutaneous Achilles tenotomy and the foot-abduction brace to four to five years, the Pirani and Dimeglio severity systems, the idiopathic-versus-syndromic-versus-positional distinction, the relapse and its management, and the longitudinal, transverse, and digital congenital limb deficiencies with their orthopaedic and prosthetic disposition.

high

Common paediatric fractures and growth-plate injury

A fellowship approach to the common fractures of children's long bones and the growth-plate injuries they carry: the Salter-Harris classification of physeal injury and its prognosis, the greenstick, buckle and plastic-bowing patterns that come from the pliable paediatric bone, the Gartland classification and emergency percutaneous pinning of the displaced supracondylar humerus fracture with lateral-entry pins, the soft-bandage evidence for the torus fracture, the remodelling potential that accepts certain malunion, and the growth-arrest complications of physeal injury.

high

Concussion and return to learn or play

A fellowship approach to sport-related concussion in the child and adolescent, anchored by the 2022 Amsterdam Consensus Statement and its tools — the SCAT6 for athletes thirteen years and older and the Child SCAT6 for children six to twelve — built around the two graduated pathways that decide safe recovery: return to learn first, then a six-stage return to sport, with twenty-four to forty-eight hours of relative rest, no prolonged cocoon therapy, and a red-flag screen that sends the deteriorating child to the emergency department.

high

Developmental dysplasia of the hip

A fellowship approach to developmental dysplasia of the hip: the Ortolani and Barlow manoeuvres in the newborn, the Graf ultrasound angles that grade the infant hip, the Pavlik harness that reduces it, and the late-presenting toddler whose painless limp and short leg declare a hip that screening missed.

high

Heat illness, exertional collapse and sudden death prevention

A fellowship approach to exertional heat illness, exercise-associated collapse, and the prevention of sudden death in the young athlete: the spectrum runs from exercise-associated muscle cramps and heat exhaustion to exertional heat stroke, and the central rule is that an athlete who collapses during exercise with altered mental status has exertional heat stroke until a rectal temperature proves otherwise — managed by cold-water immersion to below 39 degrees Celsius before transport — while a collapsed athlete without a pulse has sudden cardiac arrest demanding immediate CPR and defibrillation, and both emergencies are prevented by heat acclimatization, wet-bulb globe temperature activity modification, hydration discipline, and a rehearsed emergency action plan.

high

IgA vasculitis

Fellowship guide to IgA vasculitis (Henoch-Schonlein purpura), the commonest childhood small-vessel vasculitis. Covers the EULAR/PRINTO/PRES Ankara 2008 classification criteria of mandatory palpable purpura plus at least one of diffuse abdominal pain, IgA deposition on biopsy, arthritis or arthralgia, or renal involvement. Details the clinical tetrad, the pathogenesis centred on galactose-deficient IgA1 immune complex deposition with leukocytoclastic vasculitis, the differentiation from meningococcaemia and other mimics, and the selective corticosteroid indications for severe gastrointestinal, joint, scrotal and renal disease. Reproduces the evidence from the Ronkainen and Jauhola trials that prednisone does not reliably prevent nephropathy, the Cochrane review conclusions, and the renal monitoring schedule of blood pressure and urinalysis for at least six months. Addresses the intussusception, the scrotal involvement, the nephritic and nephrotic presentations, the relapse rate, and the long-term prognosis determined by the renal outcome.

high

Juvenile dermatomyositis

Fellowship guide to juvenile dermatomyositis: the child with a heliotrope rash and Gottron papules who cannot climb stairs, the Bohan and Peter and 2017 EULAR and ACR classification criteria, the myositis-specific antibodies that define phenotype and prognosis, methotrexate with corticosteroids as first-line therapy, calcinosis and lipodystrophy as the long-term damage, and the CARRA, PRINTO and UK consensus treatment pathways.

high

Juvenile idiopathic arthritis

Fellowship guide to juvenile idiopathic arthritis, the commonest rheumatic disease of childhood. Covers the ILAR classification with its seven categories, the dominance of the oligoarticular subtype, the chronic anterior uveitis that is silent and blinding and that drives the slit-lamp screening schedule, the methotrexate at ten to fifteen milligrams per square metre per week that is the anchor disease-modifying drug, the etanercept and adalimumab biologics that transformed refractory disease, the Wallace clinically inactive disease criteria and the treat-to-target TREAT trial, and the long-term remission and uveitis outcomes that frame the prognosis.

high

Musculoskeletal examination and the limping child

A fellowship approach to the paediatric musculoskeletal examination and the limping child: pGALS as the bedside screen, pREMS as the regional deep-dive, and the age-stratified differential that turns a limp into a diagnosis — from transient synovitis to Perthes to slipped capital femoral epiphysis, anchored by the Kocher and Caird prediction rules that separate the irritable hip needing aspiration from the one that does not.

high

Nursemaid's elbow and common upper-limb injury

A fellowship approach to nursemaid's elbow (radial head subluxation) and the common paediatric upper-limb injuries: the classic traction history and the well child holding the arm in flexion and pronation, the two reduction manoeuvres with hyperpronation as the preferred first technique over supination-flexion on the evidence of the Macias and Aksel randomised trials, the dispensable role of radiographs in the classic case, the counselling to prevent recurrence, and the broader family of common upper-limb injuries — the supracondylar humerus fracture read through the Gartland classification with the lateral-entry pinning and the volar pulseless hand, the torus and the greenstick forearm fractures with the remodelling principle and the FORCE soft-bandage evidence, and the clavicle fracture of birth and fall.

high

Osteomyelitis and discitis

A fellowship approach to paediatric acute haematogenous osteomyelitis and discitis: the metaphyseal capillary bed where bacteria seed, the age-stratified microbiology dominated by Kingella kingae under four years and Staphylococcus aureus at all ages, magnetic resonance imaging as the diagnostic gold standard, and the evidence-based intravenous-to-oral antibiotic switch strategy that shortens hospital stays without compromising cure.

high

Pain amplification, juvenile fibromyalgia and complex regional pain syndrome

Fellowship guide to amplified musculoskeletal pain, juvenile fibromyalgia and complex regional pain syndrome in children. Covers the unifying concept of central sensitization as the driver of pain out of proportion to tissue injury, the 2010 American College of Rheumatology preliminary diagnostic criteria for juvenile fibromyalgia validated in adolescents with the Widespread Pain Index and Symptom Severity Scale, the Budapest clinical criteria for complex regional pain syndrome with sensory, vasomotor, sudomotor and motor categories, the clinical assessment of allodynia and functional disability, the exclusion of inflammatory and malignant disease, and the multidisciplinary management built on education, graded aerobic exercise, cognitive behavioural therapy and sleep hygiene with the intensive functional restoration programme for the refractory case.

medium

Performance-enhancing substances in young athletes

A fellowship approach to performance-enhancing substances in the young athlete: the WADA prohibited list and the principle of strict liability, the anabolic steroids that dominate illicit use and the cardiovascular, hepatic, endocrine, and psychiatric harm they inflict on a still-growing body, the supplements that work and the contaminated supplements that trigger inadvertent positive tests, and the non-judgemental, evidence-based counselling that prevents use.

high

Periodic fever and autoinflammatory syndromes

Fellowship guide to the periodic fever and autoinflammatory syndromes. Covers the distinction between autoinflammatory and autoimmune disease, the five syndromes a fellow must carry (familial Mediterranean fever, PFAPA, mevalonate kinase deficiency or hyper-IgD syndrome, tumour necrosis factor receptor-associated periodic syndrome, and the cryopyrin-associated periodic syndromes), the inflammasome and interleukin-one pathophysiology, the Livneh criteria for familial Mediterranean fever, the Gattorno 2019 Eurofever classification of the hereditary recurrent fevers, the colchicine-first principle for familial Mediterranean fever with its amyloidosis prevention, the interleukin-one blockade for the cryopyrin-associated periodic syndromes and mevalonate kinase deficiency, the corticosteroid-abort and tonsillectomy pathway for PFAPA, and the family and transition issues across a lifelong illness.

high

Perthes disease

A fellowship approach to Legg-Calve-Perthes disease: idiopathic avascular necrosis of the capital femoral epiphysis in the four-to-eight-year-old child, the four radiographic phases of necrosis through fragmentation to reossification and remodeling, the Herring lateral pillar classification that drives prognosis, and the containment principle that keeps the soft femoral head moulded within the acetabulum during reossification.

high

Pre-participation sports evaluation

A fellowship approach to the pre-participation sports evaluation of the child and adolescent: the AHA 14-element cardiovascular history and examination and its red-flag items, the common causes of sudden cardiac death in the young athlete, the history-versus-ECG screening debate, the AAP paediatric blood pressure thresholds, the female athlete triad and relative energy deficiency in sport, the focused musculoskeletal screen, the clearance decision into cleared, cleared with conditions and restricted pending evaluation, and the written emergency action plan with access to an automated external defibrillator that protects every athlete when the screen misses a latent condition.

medium

Primary immunodeficiency with rheumatic manifestations

A fellowship approach to the child in whom a primary immunodeficiency declares itself through rheumatic disease: recognise the overlaps that earn an immune work-up (CVID with symmetric polyarthritis and autoimmune cytopenia, chronic granulomatous disease with Crohn-like colitis, classical complement deficiency with childhood-onset lupus, and immune dysregulation syndromes), investigate the immune defect alongside the rheumatic phenotype, and treat both arms in parallel without letting the immunosuppression for the joints blind you to the infection behind it.

high

Reactive arthritis and post-infectious inflammatory syndromes

Fellowship guide to reactive arthritis and the post-infectious inflammatory syndromes of childhood. Covers the classic post-enteric and post-genitourinary reactive arthritis with its one-to-four-week latency, its asymmetric lower-limb oligoarthritis with enthesitis and its HLA-B27 association, the post-streptococcal reactive arthritis with its additive pattern and shorter latency, the acute rheumatic fever differential with the 2015 Jones criteria and the carditis that is the hallmark, the naproxen and ibuprofen first-line treatment, the intra-articular triamcinolone hexacetonide, the sulfasalazine and anti-tumour-necrosis-factor escalation, and the molecular mimicry and the cytokine cascade that link the distant infection to the sterile joint.

high

Relative energy deficiency in sport and athlete nutrition

A fellowship approach to relative energy deficiency in sport and athlete nutrition: low energy availability is the central driver that, when energy intake falls short of the energy spent in training, suppresses the hypothalamic-pituitary axis and dismantles reproductive function, bone accrual, and a dozen other systems in the growing athlete — anchored by the Female Athlete Triad screen of energy intake, menstrual function, and bone health, the energy-availability threshold of approximately thirty kilocalories per kilogram of fat-free mass per day, and the multidisciplinary, energy-restoration-first pathway that protects the adolescent from the stress fracture, the lost menstrual cycles, and the lifelong bone deficit.

high

Scleroderma, mixed connective-tissue disease and overlap syndromes

Fellowship guide to paediatric scleroderma, mixed connective-tissue disease and the overlap syndromes. Distinguishes the localised scleroderma (morphea), confined to skin and subcutaneous tissue with the linear subtype commonest in children, from the rare juvenile systemic sclerosis defined by the proximal skin sclerosis and the internal organ disease, and frames the mixed connective-tissue disease as the high-titre anti-U1-RNP overlap of lupus, scleroderma and myositis. Covers the Zulian 2006 morphea classification of circumscribed, linear, generalised, pansclerotic and mixed subtypes, the PReS and ACR provisional criteria for juvenile systemic sclerosis, the scleroderma pathophysiology triad of microvascular injury, immune activation and fibroblast-driven fibrosis, the autoantibody map of anti-Scl-70, anti-centromere, anti-RNA polymerase III and anti-U1-RNP, the methotrexate first-line therapy for the active localised disease, the vascular and organ-specific therapy for the systemic disease, and the pulmonary arterial hypertension and interstitial lung disease surveillance that drives the prognosis.

high

Scoliosis and spinal deformity

A fellowship approach to scoliosis and spinal deformity in children and adolescents: scoliosis is a lateral spinal curvature of 10 degrees Cobb or more with vertebral rotation, the adolescent idiopathic curve is common and painless, and the clinical skill is to separate the idiopathic curve managed by the observe-brace-surgery ladder (under 25, 25 to 40, 45 to 50 degrees or more) from the non-idiopathic curve that hides a congenital anomaly, a neural-axis lesion, or a syndrome behind the red flags of age under 10, a left thoracic curve, pain, a neurological deficit, and rapid progression.

high

Slipped capital femoral epiphysis

A fellowship approach to the overweight adolescent with an antalgic gait and referred knee pain: the Loder stability classification that separates stable from unstable slipped capital femoral epiphysis and predicts the risk of avascular necrosis, the Southwick angle that grades slip severity on the frog-lateral radiograph, Klein's line that reveals the subtle slip on the AP view, the single-screw in-situ pinning that is the gold standard for stable slips, the urgent reduction strategy for the unstable slip, and the endocrine work-up that the atypical age-weight presentation demands.

high

Sports injury prevention and overuse injuries

A fellowship approach to the overuse, or microtrauma, injuries of the young athlete — anchored by the acute-versus-overuse distinction, the vulnerability of the open physis and traction apophysis to repetitive load, the traction apophysitides (Sever, Osgood-Schlatter, Sinding-Larsen-Johansson, medial epicondyle), the injury-risk triad of sport specialization, training volume and inadequate recovery, the load-management principle of relative rest with a graded return to play, the neuromuscular warm-up prevention programmes, and the red-flag screen for the bone stress injury or stress fracture that points to relative energy deficiency in sport.

high

Systemic juvenile idiopathic arthritis and macrophage activation syndrome

Fellowship guide to systemic juvenile idiopathic arthritis and its life-threatening complication, macrophage activation syndrome. Covers the ILAR classification of sJIA with its quotidian fever and evanescent rash, the reframing of sJIA as an autoinflammatory disease driven by the innate-immune IL-1 and IL-6 axis, the pathophysiology of the macrophage activation syndrome as an uncontrolled IFN-gamma cytokine storm, the 2016 EULAR ACR PRINTO classification criteria with their ferritin threshold and the platelet, AST, triglyceride and fibrinogen cut-offs, the HScore and HLH-2004 framework, the IL-1 blockade with anakinra and canakinumab, the IL-6 blockade with tocilizumab, the management of MAS with high-dose glucocorticoids, ciclosporin and anakinra, and the escalation to etoposide and emapalumab for the refractory case.

high

Systemic lupus erythematosus

Fellowship guide to childhood-onset systemic lupus erythematosus: the SLICC 2012 and EULAR/ACR 2019 weighted classification criteria, the type I interferon and immune-complex pathophysiology behind low complement and anti-dsDNA, the multisystem clinical presentation dominated by adolescent girls, the hydroxychloroquine backbone for every patient with retinopathy screening, and the stepwise escalation from glucocorticoids through mycophenolate and azathioprine to belimumab and anifrolumab for refractory disease.

high

Transient synovitis and the irritable hip

A fellowship approach to the child with an irritable hip: transient synovitis as the commonest benign cause of acute limp, the Kocher clinical prediction rule that separates it from septic arthritis at the bedside, the ultrasound effusion and the inflammatory markers that frame the decision, and the watchful waiting with rest and a non-steroidal anti-inflammatory drug that resolves the limp within one to two weeks once pus has been excluded.

high

Acute nociceptive pain management

A fellowship approach to acute nociceptive pain in a child: score the pain with an age-appropriate tool, build a multimodal foundation of regular paracetamol (15 mg per kg per dose, max 60 mg per kg per day, adult max 1 g per dose and 4 g per day) and an NSAID (ibuprofen 5 to 10 mg per kg per dose, max 30 mg per kg per day, from three months and over 5 kg), and escalate up the WHO two-step ladder to morphine 0.1 mg per kg intravenously for moderate-to-severe pain. The 2025 JAMA Pediatrics network meta-analysis places NSAIDs first-line for acute paediatric pain. Severe or postoperative pain is run with a titrated opioid by patient- or nurse-controlled analgesia, a regional block and opioid-sparing adjuvants, with the sedation score and respiratory rate monitored and naloxone available. Codeine and tramadol are contraindicated under 12 and after tonsillectomy.

high

Care in the last days of life

Fellowship guide to care in the last days of life in children. Covers recognition of dying, anticipatory prescribing, syringe drivers, management of secretions, terminal agitation, pain and dyspnoea, hydration and feeding decisions, place of death, family presence and spiritual care, and after-death care including certification and memory-making. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.

high

Chronic primary and secondary pain in children

Fellowship guide to chronic primary and secondary pain in children. Covers the ICD-11 split of chronic pain into primary, where the pain is itself a nociplastic disease with distress and disability, and secondary, where pain arises from an identifiable cause; the three mechanisms of nociceptive, neuropathic and nociplastic pain; central sensitisation and the fear-avoidance cycle; the common primary syndromes of juvenile fibromyalgia, complex regional pain syndrome, chronic daily headache and functional abdominal pain; the biopsychosocial assessment centred on function; the red-flag screen; and the interdisciplinary rehabilitation plan built on graded physical reactivation, cognitive behavioural and acceptance therapies, sleep and a planned return to school, with opioids avoided for chronic primary pain.

high

Grief, bereavement and sibling support

Fellowship guide to grief, bereavement and sibling support after the death of a child. Covers anticipatory grief, developmental understanding of death by age, sibling support, parental complicated grief red flags, memory-making, cultural and religious variation, staff grief, and referral pathways. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.

high

Neuropathic pain in children

Fellowship guide to neuropathic pain in children: the IASP and NeuPSIG definition and grading system that separates neuropathic from nociceptive pain, the peripheral-versus-central causes driven by nerve injury, post-surgical pain, central neurological disease, and complex regional pain syndrome, the clinical signs of allodynia and hyperalgesia that make the diagnosis at the bedside, and the stepped management built on multidisciplinary rehabilitation and psychology with gabapentinoids and amitriptyline as off-label pharmacological adjuncts dosed cautiously with renal and cardiac monitoring.

high

Opioid stewardship and complex analgesia

A fellowship approach to opioid stewardship and complex analgesia in a child: give the right opioid at the right weight-based dose by the right route for the right duration, anchor it on a non-opioid multimodal backbone, monitor with a pain score and a sedation score, rotate with the equianalgesic principle and the incomplete cross-tolerance reduction, and wean after prolonged use to avoid tolerance, withdrawal and opioid-induced hyperalgesia. Morphine is the first-line strong opioid at 0.1 to 0.2 mg per kg intravenously or 0.2 to 0.5 mg per kg orally every four hours. Patient- and nurse-controlled analgesia uses a morphine bolus of 10 to 20 microgram per kg with a 5 to 10 minute lockout and an optional low background infusion. Opioid rotation uses the equianalgesic principle that 10 mg intravenous morphine approximates 30 mg oral morphine, and the calculated new-opioid dose is reduced by 25 to 50 per cent for incomplete cross-tolerance; methadone conversion is non-linear and specialist-only. Naloxone for therapeutic over-sedation is 0.5 to 2 microgram per kg intravenously titrated to the respiratory rate. After about a week of continuous opioid, wean by 10 to 20 per cent of the established dose every one to two days. Codeine and tramadol are contraindicated under 12 and after tonsillectomy because a CYP2D6 ultrarapid metaboliser converts the prodrug to a fatal morphine overdose.

high

Organ and tissue donation in children

Fellowship guide to organ and tissue donation in children. Covers donation after neurological determination of death (DBD), donation after circulatory determination of death (DCD), paediatric brain-death testing including apnea testing, the family approach, tissue donation, contraindications, PICU logistics, ANZICS/TSANZ/AAP-aligned practice, and family support regardless of the decision. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.

high

Paediatric palliative care principles and referral

Fellowship-level approach to the principles and referral of paediatric palliative care: the WHO definition, the parallel-care model, the four Together for Short Lives (ACT) categories of life-limiting and life-threatening conditions, the epidemiology of serious paediatric suffering, the referral triggers including the Paediatric Palliative Screening Scale (PaPaS), the whole-child and family assessment across the four domains, care across home, hospital and hospice, bereavement follow-through, and the regional models across ANZ, the UK, the US and Canada.

high

Pain assessment across developmental and cognitive abilities

Fellowship-level approach to measuring a child's pain honestly across every age and ability: self-report as the gold standard from about four years with the Faces Pain Scale-Revised and the Numerical Rating Scale from about eight years; behavioural observation with FLACC for the two-month to seven-year-old who cannot self-report; individualised observational tools (revised FLACC, Non-communicating Children's Pain Checklist) for children with cognitive impairment or communication disability; COMFORT-behaviour in the PICU; the developmental and cognitive logic that picks the right tool; the traps that undertreat pain (the quiet child, the paralysed child, the child whose behaviour has habituated); and the ANZ, UK and North American standard that pain is the fifth vital sign, reassessed after every intervention and documented in the chart.

high

Palliative care in cancer

Fellowship guide to palliative care in children with cancer. Covers the World Health Organization consensus definition of palliative care as the active total care of the child with a life-limiting illness and the family, the parallel model in which disease-directed and palliative care run together from the diagnosis of high-risk, relapsed or refractory malignancy, the dimensions of suffering (physical, psychological, social and spiritual) and the symptom burden of pain, fatigue, breathlessness and nausea, the early integration through the multidisciplinary team, the World Health Organization analgesic ladder and opioid stewardship for cancer pain, the advance care planning and goals-of-care conversation, the place-of-care and location-of-death decision between home, hospital and hospice, the bereavement follow-up and sibling support, the standards from IMPaCCT to GO-PPaCS, and the communication skill the fellow carries into the hardest conversation.

high

Palliative care in neurodisability and genetic disease

Fellowship guide to palliative care for children with severe neurodisability and life-limiting genetic disease. Covers Together for Short Lives non-malignant trajectories, seizures, spasticity, dystonia and secretions, gastrostomy and respiratory-support decisions, advance care planning before crisis, carer and sibling load, and parallel planning. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.

high

Symptom control in serious paediatric illness

Fellowship-level approach to recognising and treating the four highest-burden distressing symptoms in a child with a serious, life-limiting or life-threatening illness — pain, breathlessness, nausea and vomiting, and agitation or delirium — together with the related end-of-life phenomena of noisy respiratory secretions (death rattle) and terminal restlessness. Covers the WHO two-step analgesic ladder with weight-based paediatric morphine dosing, safe opioid rotation, anticholinergic choice for secretions, antiemetic matching to the emetic pathway, low-dose haloperidol and midazolam for agitation, titration of palliative sedation for refractory symptoms, the subcutaneous route and syringe driver for the dying child at home, anticipatory (just-in-case) prescribing, and the family-centred goals-of-care conversation that frames every drug decision across ANZ, UK and North American paediatric palliative guidance.

high

Withholding and withdrawing life-sustaining treatment

Fellowship guide to withholding and withdrawing life-sustaining treatment in children. Covers the ethical equivalence of withholding and withdrawing, the best-interests standard, parental authority and the zone of parental discretion, the RCPCH framework categories for limiting treatment, shared decision-making and documentation, escalation to clinical ethics and the court when disagreement persists, conscientious objection, and ANZ, UK and North American regional practice differences. Built for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examination.

high

Acute rheumatic fever and rheumatic heart disease

A fellowship approach to acute rheumatic fever and rheumatic heart disease: the child with a sore throat whose immune response scars a mitral valve for life, the Jones criteria that demand echo, the benzathine penicillin that prevents recurrence, and the disease-of-inequity reality that makes this a scourge of Indigenous Australia and the developing world rather than a closed chapter of Western medicine.

high

Adult congenital heart disease transition

Fellowship guide to the transition of the adolescent with congenital heart disease from paediatric to lifelong adult ACHD care: why transition is a planned process and not a single transfer clinic; how to build and measure transition readiness from early adolescence using tools such as the TRAQ; the anatomic-physiologic complexity classification that sets the surveillance interval and the care setting; the lesion-specific residua and sequelae that make follow-up lifelong even in the well-feeling patient; the danger of loss to follow-up and the gaps-in-care evidence; contraception matched to thrombotic and haemodynamic risk and pre-pregnancy counselling built on the modified WHO risk classes; the narrowed indications for infective endocarditis prophylaxis in the highest-risk lesions; and the 2018 AHA/ACC and 2020 ESC guidance that anchors ANZ practice.

high

Aortic and pulmonary stenosis

A fellowship approach to congenital aortic and pulmonary stenosis: classifying the obstruction by anatomic level (valvar, subvalvar, supravalvar), grading severity by echo peak gradient, recognising the duct-dependent critical neonate, and matching the intervention to the lesion — balloon valvuloplasty as first-line for valvar disease, the Ross procedure for the aortic valve that needs replacement, and syndromic associations from bicuspid aortic valve through Noonan and Williams syndromes.

high

Atrial septal defect and partial anomalous pulmonary venous return

A fellowship approach to atrial septal defect and partial anomalous pulmonary venous return: the auscultatory signature of a wide fixed split second heart sound, the left-to-right shunt that silently loads the right ventricle, the echo that confirms and quantifies, and the device-versus-surgery closure decision that must be made before pulmonary vascular disease becomes irreversible.

high

Atrioventricular septal defect

Fellowship guide to atrioventricular septal defect — the shared common atrioventricular junction at the crux of the heart, the partial–transitional–complete spectrum, the invariable superior QRS axis, the Down syndrome association, and why complete defects are repaired before six months to prevent irreversible pulmonary vascular disease.

high

Bradyarrhythmias, heart block and pacing

Fellowship guide to bradyarrhythmias, atrioventricular block and cardiac pacing in children: how to read the slow rhythm on a 12-lead ECG, the anatomy of first-degree, Mobitz I, Mobitz II and third-degree block, why maternal anti-Ro antibodies scar the fetal AV node, the post-surgical AV block that will not recover, the stable-versus-unstable resuscitation fork, atropine and transcutaneous pacing, and the permanent pacemaker indications — including the 2021 PACES consensus, the ACCF/AHA/HRS and ESC pacing guidelines, epicardial versus transvenous versus leadless systems, and the lifelong care of the paced child.

medium

Cardiac transplantation and ventricular assist devices

Fellowship guide to cardiac transplantation and ventricular assist devices in children: when to escalate from medical heart-failure therapy to mechanical circulatory support, the Berlin Heart EXCOR and continuous-flow durable devices, the INTERMACS urgency profiles, bridge-to-transplant versus bridge-to-recovery strategy, donor allocation and transplant surgery, the denervated transplanted heart, lifelong immunosuppression and surveillance for rejection, cardiac allograft vasculopathy and post-transplant malignancy, and the family pathway through retrieval, listing and long-term follow-up.

high

Cardiogenic shock and mechanical circulatory support

Fellowship guide to cardiogenic shock in children — the state where the heart cannot pump enough blood to perfuse the body, producing low cardiac output with congestion — and to the mechanical circulatory support that rescues the child who fails conventional therapy. The page covers the bedside distinction from other shock types, the cautious-fluid and inotrope resuscitation, the SCAI shock stages, the escalation to venoarterial extracorporeal membrane oxygenation and then a durable ventricular assist device, the four goals of support (bridge to recovery, transplant, candidacy and destination therapy), and the anticoagulation and complication burden of the devices.

high

Cardiomyopathies in children

Fellowship guide to the paediatric cardiomyopathies: the morphological framework (dilated, hypertrophic, restrictive, non-compaction, arrhythmogenic), the genetic substrate and cascade family screening, the pathophysiology that drives heart failure, arrhythmia and sudden cardiac death, the bedside and echocardiographic assessment, the medical, device and transplant management, and the long-term prognosis that makes this the commonest reason for paediatric heart transplantation.

high

Cardiovascular examination and murmur assessment

A fellowship approach to the paediatric cardiovascular examination and the heart murmur: perform a systematic inspection-palpation-auscultation sequence with four-limb blood pressure and pulse oximetry, recognise the benign fingerprint of an innocent murmur, identify the departures that mark a murmur as pathological, and resuscitate the duct-dependent neonate or the hypercyanotic spell before the echocardiogram confirms the lesion.

high

Coarctation and interrupted aortic arch

Fellowship guide to coarctation of the aorta and interrupted aortic arch: the two ductal-dependent left-heart-outflow obstructions that declare themselves as neonatal collapse when the duct closes, the four-limb blood-pressure gradient and weak femoral pulses at the bedside, prostaglandin E1 as the non-negotiable bridge to surgery, and the syndromic associations (Turner, 22q11.2, bicuspid aortic valve) that every candidate must name.

high

Congenital coronary anomalies and anomalous left coronary artery

Fellowship guide to congenital coronary anomalies in children: the two-month-old with feeding-related pallor and irritability whose left coronary artery comes from the pulmonary artery (ALCAPA, Bland-White-Garland) and the outwardly well athlete whose coronary takes a malignant interarterial course (AAOCA) and collapses with exercise; the ECG anterolateral Q waves, echocardiographic definition of coronary origin and course, the ALCAPA steal, the surgical reimplantation that establishes dual coronary flow, risk stratification and exercise restriction for AAOCA, and the AATS expert consensus, ACC/AHA adult congenital guideline and athlete-screening positions.

high

Cyanotic newborn and critical congenital heart disease screening

A fellowship approach to the cyanotic newborn and critical congenital heart disease screening: read pulse oximetry as a layered screen that catches what antenatal scanning and the newborn examination miss, apply the ≥24-hour SpO₂ thresholds (≥95% pass, 90–94% repeat, <90% refer), start prostaglandin E1 before the echocardiogram when a duct-dependent lesion is suspected, and distinguish cyanotic congenital heart disease from pulmonary, sepsis and persistent-pulmonary-hypertension mimics using the hyperoxia test and bedside examination.

high

Duct-dependent congenital heart disease: recognition and stabilisation

Fellowship guide to duct-dependent congenital heart disease in neonates and infants: the two-pathway split (duct-dependent pulmonary versus systemic circulation), the physiology of why a baby who was well on day one collapses on day three, the hyperoxia test and pulse oximetry screening, emergency prostaglandin E1 (alprostadil) therapy with its apnoea and hypotension pitfalls, and the transfer pathway to a cardiac surgical centre.

medium

Ebstein anomaly and tricuspid valve disease

Fellowship guide to Ebstein anomaly and tricuspid valve disease in children: the apically displaced tricuspid valve from failed delamination, the hugely dilated right atrium swallowing a small functional right ventricle, the neonate who is ductal-dependent when functional pulmonary atresia closes off forward flow, the Carpentier grades and Great Ormond Street score that predict outcome, the cone reconstruction that rebuilds a competent valve, and the lifelong surveillance for tricuspid regurgitation, arrhythmia and sudden death.

high

Exercise evaluation and sports participation in heart disease

Fellowship guide to exercise evaluation and sports participation for the child with heart disease: how to turn the clearance question into a stratified decision built on the cardiac lesion, the haemodynamic load of the sport (Mitchell dynamic x static classification), and the athlete's symptoms and family history; the red-flag exertional history that mandates a 12-lead ECG before clearance; the layered workup from the 14-point history and examination through ECG, echocardiography and cardiopulmonary exercise testing; the three eligibility tiers (cleared, individualised, disqualified) applied across the common substrates from innocent murmurs and repaired simple lesions through bicuspid aortic valve and repaired tetralogy to hypertrophic cardiomyopathy, the channelopathies, anomalous coronary artery and Marfan aortic disease; the AHA/ACC 2015 and ESC 2020 guideline consensus, the Italian ECG-screening evidence, annual re-evaluation of the growing athlete, and venue safety with a written emergency action plan and accessible AED.

high

Heart failure in infants and children

Fellowship guide to heart failure as a clinical syndrome in infants and children: the volume-overload, pressure-overload and pump-failure mechanisms, the modified Ross severity grading, the neurohormonal vicious cycle, the infant presentation of tachypnoea and failure to thrive, echocardiographic assessment, acute resuscitation and chronic neurohormonal therapy, the carvedilol evidence, and escalation to the Berlin Heart EXCOR ventricular assist device and transplantation.

high

Hypertension in children

Fellowship guide to hypertension in children: the AAP 2017 definition based on age, sex and height percentiles, the rule that elevated office blood pressure must be confirmed by ambulatory monitoring before a label is fixed, the search for a secondary cause (renal, renovascular, endocrine, coarctation) in any young or stage 2 child, and the threshold — left ventricular hypertrophy — at which drug therapy becomes mandatory.

high

Hypoplastic left heart syndrome

Fellowship guide to hypoplastic left heart syndrome: the most severe ductal-dependent systemic-outflow obstruction, presenting as the day-two-to-four neonatal collapse with weak pulses and acidosis; the prostaglandin-E1-first resuscitation before the echo; the echocardiographic anatomy of atretic mitral and aortic valves with a hypoplastic ascending aorta and a right ventricle doing all the work; and the three-stage single-ventricle palliation — Norwood, Glenn, Fontan — whose SVR-trial evidence, interstage mortality and neurodevelopmental burden every candidate must own.

high

Infective endocarditis

Fellowship guide to infective endocarditis in children: a microbial infection of the endocardial surface, usually a heart valve, that presents as fever with a new or changing murmur, embolic phenomena or a sepsis-like illness in a child with or without underlying structural heart disease. The page covers the Modified Duke diagnostic criteria, the pivotal roles of blood culture and echocardiography, empirical and targeted antibiotic therapy for four to six weeks, the surgical triggers of heart failure, abscess and large mobile vegetations, and the prophylaxis strategy that now targets only the highest-risk cardiac lesions before dental and respiratory procedures.

high

Innocent murmurs and normal paediatric cardiovascular variants

Fellowship guide to recognising innocent murmurs and normal paediatric cardiovascular variants, distinguishing them from pathology, and avoiding unnecessary referral and investigation.

high

Kawasaki disease and coronary complications

Fellowship guide to Kawasaki disease and its coronary complications: the febrile infant with conjunctivitis, rash and red cracked lips, the diagnostic criteria for complete and incomplete disease, the 10-day IVIG and aspirin window that prevents aneurysms, the IVIG-resistant child and escalation to infliximab or steroids, coronary artery z-score grading and anti-thrombotic management, the long-term risk of stenosis and myocardial infarction, and the AHA, European SHARE and ANZ consensus positions.

high

Long-QT syndrome and channelopathies

Fellowship guide to long-QT syndrome and the inherited channelopathies in children: what a prolonged QTc means, the three cardinal genotypes (LQT1, LQT2, LQT3) and their trigger-specific biology, the Schwartz diagnostic score, the syncope-or-seizure child who needs a 12-lead ECG, beta-blocker-first management, left cardiac sympathetic denervation and ICD thresholds, and the related entities CPVT, Brugada syndrome and short-QT syndrome, with the AHA/HRS, ESC and CSANZ guideline positions.

high

Myocarditis and pericarditis

Fellowship guide to acquired inflammatory heart disease in children: myocarditis as inflammation of the cardiac muscle presenting with chest pain, dyspnoea, a raised troponin and arrhythmia, and pericarditis as inflammation of the pericardium presenting with sharp positional chest pain and a friction rub. The page covers the bedside recognition of fulminant myocarditis and tamponade, the diagnostic triad of troponin, electrocardiogram and echocardiogram, the Lake Louise cardiac magnetic resonance criteria, selective immunomodulation (intravenous immunoglobulin and corticosteroids), the newer phenotypes of multisystem inflammatory syndrome in children and mRNA vaccine myocarditis, and the non-steroidal anti-inflammatory plus colchicine regimen for pericarditis.

high

Patent ductus arteriosus

Paediatric cardiology fellowship guide to patent ductus arteriosus in term infants, children and adolescents: the persistent fetal communication between pulmonary artery and descending aorta, the continuous machinery murmur, the haemodynamic burden grading, the echocardiographic and angiographic assessment, the observe–transcatheter–surgical management ladder with the Amplatzer Duct Occluder, the infective-endocarditis-prophylaxis reframe, and the Eisenmenger boundary beyond which closure becomes harmful.

high

Postural orthostatic tachycardia syndrome

Fellowship guide to postural orthostatic tachycardia syndrome (POTS) in young people: chronic daily orthostatic symptoms with an excessive heart-rate rise on standing (≥40 bpm in adolescents, or ≥120 bpm) WITHOUT orthostatic hypotension, the neuropathic/hyperadrenergic/hypovolaemic phenotypes, the 10-minute active stand test, exclusion of cardiac syncope with an ECG on every child, and the stepwise management from fluid and salt to recumbent exercise and then phenotype-guided pharmacotherapy.

high

Pulmonary hypertension in children

A fellowship approach to pulmonary hypertension in children: a mean pulmonary artery pressure above twenty is never normal, the WHO group decides the cause, the cardiac catheter measures the resistance, and the right ventricle decides the prognosis. The thread runs from the syncope or the loud second heart sound through the echocardiogram and the catheter to combination therapy with phosphodiesterase-5 inhibitors, endothelin receptor antagonists, and prostacyclin analogues, and on to the surgical escalations of septostomy, the Potts shunt, and transplantation.

high

Supraventricular tachycardia

Fellowship guide to supraventricular tachycardia in children: the mechanisms (AVRT in infants, AVNRT in adolescents), the clinical presentations from irritable pale infant to palpitating teenager, the ECG hallmarks of a fast regular narrow complex, the stepwise acute termination with vagal manoeuvres and adenosine, long-term pharmacological control, catheter ablation, the special case of Wolff-Parkinson-White syndrome and sudden death risk, and the AHA/ACC/HRS, ESC and PACES/EHRA guideline positions.

high

Syncope and orthostatic intolerance

Fellowship guide to syncope and orthostatic intolerance in children and adolescents: transient loss of consciousness from global cerebral hypoperfusion, the benign reflex (vasovagal) and orthostatic (POTS, orthostatic hypotension) causes that dominate, the red-flag history that screens out the rare dangerous cardiac causes, an ECG for every child, orthostatic vital signs, and stepwise management from fluid and counter-pressure to urgent cardiology and sport restriction.

high

Tetralogy of Fallot

Fellowship guide to tetralogy of Fallot in children: the four features that share one embryologic fault, the severity spectrum from pink TOF to pulmonary atresia, the hypercyanotic tet spell and how to break it, the echo-to-MRI diagnostic strategy, primary repair versus staged palliation, the late burden of pulmonary regurgitation and sudden cardiac death, and the ANZ, AHA/ACC and ESC guideline positions.

high

Total anomalous pulmonary venous connection

A fellowship approach to total anomalous pulmonary venous connection: the cyanosed neonate with pulmonary oedema as a surgical emergency, the Darling classification of where the pulmonary veins drain, the echocardiographic diagnosis, the obligatory atrial septal communication, the surgical repair that re-routes blood to the left atrium, and the lifelong surveillance for recurrent pulmonary venous obstruction.

high

Transposition of the great arteries

Fellowship guide to transposition of the great arteries (d-TGA): the parallel-circulation problem that presents as deepening neonatal cyanosis with little respiratory distress, the anatomy that splits it into simple, VSD and LVOTO subtypes, the recognition sequence from failed hyperoxia test to diagnostic echocardiogram, the resuscitation trio of prostaglandin E1, balloon atrial septostomy and definitive arterial switch (Jatene), and the long-term legacy of the atrial-switch era.

high

Truncus arteriosus and single-ventricle physiology

Fellowship guide to two cyanotic congenital lesions that share the single idea of mixing red and blue blood. Truncus arteriosus is one great artery and one truncal valve carrying fully mixed blood to the body and lungs, with an obligatory ventricular septal defect, presenting first as neonatal cyanosis and then as high-output heart failure as pulmonary vascular resistance falls. Single-ventricle physiology is any heart with one functional pumping chamber, palliated through the staged Fontan pathway — Norwood, Glenn, Fontan — that routes venous blood passively to the lungs in series. Covers the Collett–Edwards and Van Praagh classifications, the near-obligatory 22q11.2 deletion, complete neonatal repair versus staged palliation, interstage mortality and home monitoring, and the lifelong Fontan burden of arrhythmia, protein-losing enteropathy and Fontan liver disease.

high

Ventricular arrhythmias and sudden cardiac death

Fellowship guide to ventricular arrhythmias and sudden cardiac death in children: distinguishing benign ventricular ectopy from sustained monomorphic and polymorphic VT and VF, the four cause families of SCD in the young (structurally normal heart, cardiomyopathy, congenital heart disease, acquired), the acute resuscitation of pulseless VT and VF with defibrillation and amiodarone, the synchronised cardioversion versus pharmacological termination of stable sustained VT, post-arrest targeted temperature management, ICD therapy and its paediatric-specific complications, the molecular autopsy and cascade screening, and the AHA/ACC/HRS and ESC guideline positions.

high

Ventricular septal defect

Fellowship guide to the commonest congenital heart defect: the anatomic and haemodynamic classification of a ventricular septal defect, the left-to-right shunt physiology, the natural history from spontaneous closure to Eisenmenger syndrome, the murmur and heart-failure presentations, echocardiographic sizing, and the surgical, device and medical management across infancy and adolescence.

high

Acute severe and life-threatening asthma

Fellowship guide to acute severe and life-threatening asthma in children: grading severity from the whole child, the pathophysiology of the failing airway, the stepwise escalation from oxygen and continuous salbutamol through ipratropium and systemic steroid to IV magnesium, IV salbutamol or aminophylline and PICU, recognising the silent chest and the exhausted child, avoiding the pitfalls that kill, and the ANZ, UK and North American guideline differences.

high

Aspiration, swallowing dysfunction and chronic lung injury

Fellowship guide to aspiration, swallowing dysfunction and chronic lung injury in children: the child who mis-directs feeds, refluxed gastric contents or saliva into the airway and slowly damages the lung; the three aspiration routes and the phases of swallowing; recognising the recurrent wet cough, wet voice, feeding-related choking and the silent aspiration of the neurologically impaired child; confirming it with a clinical feeding assessment, videofluoroscopy or FEES rather than a single test; grading lung impact from occasional wet cough to bronchiectasis; and the multidisciplinary bundle of texture modification, thickened fluids, salivary control with anticholinergics, botulinum toxin and surgery, reflux management, airway clearance and prompt antibiotics, across ANZ, UK and North American practice.

high

Asthma diagnosis and long-term control

Fellowship guide to the diagnosis and long-term control of asthma in children: recognising the variable, reversible airflow obstruction that defines the disease, confirming it with spirometry, bronchodilator reversibility and exhaled nitric oxide, distinguishing the preschool wheeze phenotypes and using the Asthma Predictive Index, separating current control from future risk, and delivering the stepwise controller ladder built on the inhaled corticosteroid — including the shift to anti-inflammatory reliever therapy from the SYGMA trials, the ICS-and-growth evidence from CAMP, and the written action plan.

high

Behavioural insomnia and circadian rhythm disorders

Fellowship guide to behavioural insomnia of childhood and the circadian rhythm sleep-wake disorders: the sleep-onset association and limit-setting subtypes and their diagnosis on a picture of difficulty sleeping despite adequate sleep opportunity, the two-process and melatonin physiology behind the adolescent phase delay, the sleep history, diary and actigraphy, behavioural treatment as first-line, timed morning bright light and correctly timed low-dose evening melatonin for delayed sleep-wake phase disorder, the special place of melatonin in neurodevelopmental disability, and the families and populations that change the plan.

high

Bronchiectasis in children

Fellowship guide to bronchiectasis in children — the chronic wet cough that defines it, the chronic suppurative lung disease continuum that precedes it, the vicious cycle that drives it, the HRCT that confirms it, the aetiological work-up that must follow, and the airway-clearance-and-antibiotic management that can reverse early disease and prevent lifelong lung damage.

high

Bronchiolitis and viral lower respiratory tract infection

Fellowship guide to bronchiolitis and viral lower respiratory tract infection: the RSV-driven small-airway obstruction of infancy that gives cough, tachypnoea, wheeze and crackles and difficulty feeding; grading severity by work of breathing, oxygenation and feeding; the differential from viral-induced wheeze, pneumonia, cardiac failure and foreign body; supportive care with feeding, targeted oxygen and high-flow or CPAP rescue while resisting bronchodilators, steroids and antibiotics; nirsevimab and palivizumab prevention; and the ANZ, UK and North American guideline differences.

high

Central sleep apnoea and hypoventilation syndromes

Fellowship guide to central sleep apnoea and hypoventilation syndromes in children: the disorders in which the brain fails to generate an adequate breathing signal, so airflow and effort fall together (central apnoea) or tidal volume is chronically inadequate (hypoventilation), worst during sleep. The page covers congenital central hypoventilation syndrome and its PHOX2B genetic basis, ROHHAD and ROHHAD-NET, the acquired central apnoeas of Chiari malformation, brainstem lesions and prematurity, the polysomnography and capnography that define the pattern, and the lifelong ventilatory support from mask non-invasive ventilation through tracheostomy to diaphragm pacing that keeps these children alive.

high

Chronic cough: diagnostic approach

Fellowship guide to chronic cough in children — the four-week threshold, the wet-versus-dry split that drives the whole work-up, protracted bacterial bronchitis as the commonest cause, the specific-cough pointers that flag serious disease, and the evidence-based algorithm that turns a vague symptom into a diagnosis.

high

Community-acquired pneumonia

Fellowship guide to community-acquired pneumonia in children: the febrile, coughing, fast-breathing child with alveolar consolidation acquired outside hospital; the age-dependent shift from viruses and pneumococcus in the young child to Mycoplasma in the school-age child; grading severity by WHO respiratory-rate thresholds, chest indrawing, oxygenation and feeding; the differential from bronchiolitis, viral wheeze, foreign body and tuberculosis; clinical diagnosis with restrained imaging; first-line oral amoxicillin with the SAFER and CAP-IT evidence for short-course standard-dose therapy; oxygen and intravenous care for severe disease; recognising parapneumonic effusion and empyema; and the ANZ, UK and North American guideline differences.

high

Congenital lung and airway malformations

Fellowship guide to congenital lung and airway malformations — the CPAM, sequestration, lobar emphysema, bronchogenic cyst and bronchial atresia spectrum, how antenatal detection has rewritten the epidemiology, the two questions that drive management (is it causing trouble now, and does an asymptomatic lesion need surgery or surveillance?), and the malignancy risk that keeps the resection debate alive.

high

Croup

Fellowship guide to croup (viral laryngotracheobronchitis): the parainfluenza-driven subglottic oedema that gives a barking cough, inspiratory stridor and a hoarse voice in a young child; the Westley score; the discriminators from epiglottitis, bacterial tracheitis and foreign body; steroid for every child, nebulised adrenaline for stridor at rest, calm handling, observation and disposition; and the ANZ, UK and North American guideline differences.

high

Cystic fibrosis: diagnosis and screening

Fellowship guide to diagnosing and screening for cystic fibrosis in children: recognising the child whose salty skin, chronic wet cough, greasy stools and poor growth should trigger a sweat test; how newborn bloodspot screening with immunoreactive trypsinogen and CFTR mutation panels finds most infants before symptoms; confirming the diagnosis with the sweat chloride test and genetic analysis using the Cystic Fibrosis Foundation and ECFS criteria; interpreting an intermediate sweat chloride and the CRMS/CFSPID equivocal-screen category; the differential from other causes of failure to thrive and chronic suppurative lung disease; the meconium ileus, pseudo-Bartter and false-negative-screen traps; and the ANZ, UK and North American differences in screening protocols.

high

Cystic fibrosis: pulmonary and multidisciplinary management

Fellowship guide to the pulmonary and multidisciplinary management of cystic fibrosis in children: the CFTR channel defect that dehydrates the airway surface and starts a self-perpetuating cycle of mucus plugging, chronic infection and neutrophilic inflammation ending in bronchiectasis; the four pillars of daily airway clearance physiotherapy, mucoactive nebulisers such as dornase alfa and hypertonic saline, an anti-infective ladder from Pseudomonas eradication through cycled inhaled antibiotics and chronic azithromycin to intravenous therapy for exacerbations, and CFTR modulator therapy with elexacaftor-tezacaftor-ivacaftor; the nutrition, pancreatic enzyme and psychosocial work of the multidisciplinary team; infection segregation; recognising exacerbations, haemoptysis, pneumothorax, allergic bronchopulmonary aspergillosis and CF-related diabetes; and the ANZ, UK and North American approach to monitoring, transition and lung transplantation.

high

Epiglottitis and bacterial tracheitis

Fellowship guide to paediatric epiglottitis and bacterial tracheitis: recognising the toxic child with a threatened airway, distinguishing supraglottic from subglottic and tracheal disease, the changing microbiology after Haemophilus influenzae type b vaccination, the do-no-harm rule of not distressing the child, controlled airway management in theatre, and empiric antibiotic selection including anti-staphylococcal cover for tracheitis.

high

Exercise-induced bronchoconstriction

Fellowship guide to exercise-induced bronchoconstriction in children: the transient airway narrowing that follows a burst of exercise, why it usually signals inadequate asthma control, how it is confirmed objectively with an exercise or eucapnic voluntary hyperpnoea challenge and a ten-percent fall in FEV1, the osmotic and thermal mechanisms that drive it, the mimics that catch the unwary — above all inducible laryngeal obstruction — and the management that keeps a child fully in sport, built on controlling the underlying asthma, a warm-up, and a pre-exercise reliever.

high

Foreign-body aspiration

Fellowship guide to foreign-body aspiration in children: the choking toddler and the three clinical phases, why the small paediatric airway and organic objects make aspiration dangerous, the anatomy that sends objects into the right bronchus, the valve mechanisms that produce air trapping or collapse, the crucial teaching that a normal chest radiograph does not exclude aspiration, the choking basic-life-support algorithm, and rigid bronchoscopy as the definitive diagnostic and therapeutic step.

high

Interstitial lung disease in children

Fellowship guide to children's interstitial lung disease (chILD) — the chILD syndrome that flags it, the infancy-versus-older-child classification that frames it, the surfactant-dysfunction and neuroendocrine-cell-hyperplasia biology that drives the commonest genetic forms, the HRCT-genetics-biopsy pathway that names it, and the supportive-plus-disease-specific management delivered through a specialist chILD centre.

high

Laryngomalacia, tracheomalacia and vocal-cord dysfunction

Fellowship guide to the three dynamic paediatric airway-collapse disorders: laryngomalacia as the commonest cause of infant stridor, tracheomalacia as the barking cough and salbutamol-unresponsive wheeze that mimics asthma, and vocal-cord dysfunction (inducible laryngeal obstruction) as the exertional inspiratory stridor of adolescents. Covers localising the noise by respiratory phase, awake flexible laryngoscopy versus dynamic bronchoscopy, when the child needs only reassurance versus supraglottoplasty or airway surgery, the salbutamol and steroid escalation traps, and speech-therapy breathing retraining.

medium

Narcolepsy and hypersomnolence

Fellowship guide to narcolepsy and the central disorders of hypersomnolence in children: the conditions in which the brain cannot hold a stable boundary between wakefulness and REM sleep, so the child is overwhelmed by daytime sleepiness and, in narcolepsy type 1, loses muscle tone with emotion (cataplexy). The page covers the loss of hypothalamic orexin (hypocretin) neurons that defines narcolepsy type 1, its autoimmune associations with HLA-DQB1*06:02 and the H1N1 pandemic, the split into type 1 and type 2 and the differential from idiopathic and secondary hypersomnolence, the paediatric clues of rapid weight gain, precocious puberty and cataplectic facies, the polysomnography and multiple sleep latency test that confirm it, and the layered management from scheduled naps through modafinil, stimulants, pitolisant and sodium oxybate.

high

Neuromuscular respiratory failure and airway clearance

Fellowship guide to neuromuscular respiratory failure and airway clearance in children: the two-part respiratory pump-and-cough failure that follows weakness of the diaphragm, expiratory and bulbar muscles in Duchenne muscular dystrophy, spinal muscular atrophy and related disorders. The page covers how inspiratory weakness produces nocturnal then daytime hypoventilation while expiratory and bulbar weakness produce an ineffective cough with secretion retention, how to monitor with vital capacity, peak cough flow and overnight carbon dioxide, and the ladder of airway clearance from manual assisted cough through breath stacking and lung volume recruitment to mechanical insufflation-exsufflation, alongside non-invasive ventilation, the chest-infection rule to clear secretions and ventilate rather than merely oxygenate, and the surveillance that has transformed survival.

high

Non-invasive ventilation and home respiratory support

Fellowship guide to non-invasive ventilation and home respiratory support in children: what CPAP, bilevel non-invasive ventilation and high-flow nasal cannula actually do, how to tell an obstructive problem that needs CPAP from a hypoventilation problem that needs bilevel and a central problem that needs ventilation with a back-up rate, the interfaces and their complications, the assessment and sleep-study titration that guide therapy, the acute use of high-flow and CPAP in respiratory failure, the stepwise set-up of long-term home ventilation with secretion clearance and caregiver training, and the neuromuscular, central and technology-dependent populations that define the field.

high

Obstructive sleep apnoea in children

Fellowship guide to obstructive sleep apnoea in children: the spectrum of sleep-disordered breathing and the paediatric severity thresholds, why adenotonsillar hypertrophy and obesity narrow the airway, the pathophysiology that links intermittent hypoxaemia and sleep fragmentation to cardiovascular, neurobehavioural and growth morbidity, the bedside assessment and the role of polysomnography and oximetry, adenotonsillectomy as first-line therapy with continuous positive airway pressure and medical adjuncts, and the high-risk populations that change the plan.

high

Oxygen therapy and home oxygen in children

Fellowship guide to oxygen therapy and home oxygen in children: how to treat hypoxaemia safely without tipping a child into hyperoxia. The page covers the oxygen delivery devices from low-flow nasal cannula through high-flow nasal cannula, Venturi and non-rebreather masks to head boxes, the saturation targets that differ between the acutely unwell child, the extremely preterm neonate and the child with cyanotic heart disease, the physiology of the oxyhaemoglobin dissociation curve that makes those targets matter, the criteria and equipment for discharging a child on home oxygen, and the structured weaning that gets a child off oxygen safely.

high

Paediatric sleep investigations: polysomnography, sleep-study interpretation and MSLT

Fellowship guide to paediatric sleep investigations: the polysomnogram that records brain, eye, muscle, airflow, effort, oxygen and carbon dioxide across a night of a child's sleep, the rules that turn those traces into scored events and an apnoea-hypopnoea index, and the multiple sleep latency test that measures daytime sleepiness. The page covers how to choose between attended in-laboratory polysomnography and simpler oximetry or limited studies, how respiratory events are classified as obstructive, central or mixed, how the obstructive apnoea-hypopnoea index grades severity in children rather than adults, how sleep hypoventilation is proven with carbon dioxide, and how the multiple sleep latency test with its sleep-onset REM periods supports a diagnosis of narcolepsy.

high

Pleural effusion and empyema

Fellowship guide to paediatric pleural effusion and empyema: the parapneumonic fluid that turns a child's pneumonia into persistent fever and pleuritic pain; Light's criteria and the exudative, fibrinopurulent and organising stages; ultrasound as the pivotal investigation; antibiotics for all, chest drain with intrapleural fibrinolytics or primary VATS for empyema; the excellent long-term prognosis; and the ANZ, UK and North American guideline differences.

high

Pneumothorax and air-leak syndromes

A fellowship approach to pneumothorax and the wider family of air-leak syndromes in children: recognise tension physiology and decompress before imaging, understand the Macklin route by which alveolar air tracks to the pleura, mediastinum, interstitium and pericardium, separate primary spontaneous from secondary, traumatic and neonatal disease, size the leak, and match management from observation and oxygen through needle decompression, aspiration and chest drainage to surgery for persistent or recurrent leaks.

high

Primary ciliary dyskinesia

Fellowship guide to primary ciliary dyskinesia: why a genetic defect of motile cilia produces a lifelong triad of chronic wet cough, chronic rhinosinusitis and otitis media, how the same immotile cilia randomise left-right asymmetry to give situs inversus and Kartagener syndrome, the neonatal respiratory distress that is the earliest clue, the diagnostic pathway of nasal nitric oxide, high-speed video microscopy, electron microscopy and genetics, and the multidisciplinary airway-clearance-centred management that preserves lung function.

high

Pulmonary haemorrhage and haemoptysis

Fellowship guide to pulmonary haemorrhage and haemoptysis in children — why young children rarely cough up their blood, how to separate focal bleeding from diffuse alveolar haemorrhage, the haemosiderin-laden macrophage that confirms it, the immune-versus-bland split that drives treatment, and the resuscitation-and-corticosteroid management of idiopathic pulmonary haemosiderosis, Heiner syndrome, and capillaritis.

high

Recurrent pneumonia and localised lung disease

Fellowship guide to recurrent pneumonia in children — the two-or-more-in-a-year definition, the single question that reorganises the whole work-up (same site or different sites?), the structural causes behind same-site disease, the systemic causes behind multifocal disease, and the staged investigation that turns a repeat X-ray into a diagnosis.

high

Recurrent wheeze in preschool children

Fellowship guide to recurrent wheeze in preschool children: the phenotype framework (episodic viral versus multiple-trigger wheeze), the Asthma Predictive Index and atopy as the risk stratifier, the small-airway and inflammatory pathophysiology, the bedside assessment that separates wheeze from mimics, the acute and preventive management with the pivotal randomised trials (PEAK, MIST, Ducharme, Bacharier, Panickar), and the natural history that lets most children outgrow it.

high

Respiratory distress and failure in children

A fellowship approach to the child in respiratory distress and failure: recognise the continuum from compensated increased work of breathing to exhaustion, clear the pre-arrest threat gate, localise the cause to airway, lung, pump or drive, distinguish type 1 from type 2 failure, and escalate oxygen and support from low-flow through high-flow nasal cannula, CPAP and mechanical ventilation while treating the cause.

medium

Respiratory manifestations of systemic disease

Fellowship guide to the lung as a target organ of systemic disease in children — the sickle cell chest that can kill in hours, the connective tissue diseases that scar the interstitium, the immunodeficiencies that let infection and bronchiectasis take hold, and the malignancies and their treatments that infiltrate, compress, and injure the growing lung.

high

Spirometry and paediatric pulmonary-function testing

Fellowship guide to spirometry and pulmonary-function testing in children: how a forced blow into a spirometer generates the FEV1, FVC and their ratio and the flow-volume loop, how the ratio below the lower limit of normal defines obstruction and a low FVC with a preserved ratio raises restriction that lung volumes confirm, how bronchodilator responsiveness is measured and read, why the Global Lung Function Initiative reference equations and z-scores have replaced fixed cut-offs and percent-predicted, how quality is judged against ATS/ERS acceptability and repeatability standards, and how the whole result is interpreted in the child sitting in front of you rather than in isolation.

high

Tracheostomy care and emergencies

Fellowship guide to paediatric tracheostomy care and emergencies: the tube types and their parts, the physiology of an airway that bypasses the upper airway, routine humidification and suctioning, the blocked and displaced tube emergency algorithm with oxygen to both the face and the stoma, safe first and routine tube changes, the structured decannulation pathway, and recognition of the technology-dependent child at home.

high

Upper-airway obstruction and stridor

Fellowship guide to upper-airway obstruction and stridor in children: how the flow phase of stridor localises the obstruction, why the small paediatric subglottis makes minor oedema catastrophic, the acute causes (croup, epiglottitis, bacterial tracheitis, foreign body, anaphylaxis, retropharyngeal abscess) and the chronic causes (laryngomalacia, subglottic stenosis, vocal-cord palsy), the Westley croup score, the do-not-distress principle, dexamethasone and nebulised adrenaline for croup, and the theatre-based approach to the critical airway.

high

Adolescent chronic pain and functional symptoms

A fellowship approach to adolescent chronic pain and functional symptoms: a biopsychosocial, function-first model. Validate the symptom as real, screen for red flags once, avoid over-investigation and opioid escalation, and coordinate an interdisciplinary plan (physiotherapy, psychology, sleep, school reintegration) across ANZ, UK, US and Canada.

high

Adolescent consent for research and sensitive services

A fellowship approach to consent when an adolescent is asked to take part in research or to receive a sensitive clinical service. Covers informed consent, parental permission and child assent; bedside capacity assessment using the Gillick or mature-minor principle; the three-element model for ethical research enrolment and when a research ethics committee may waive parental permission; statute-based minor consent for contraception, STI, mental-health and substance-use care; conditional confidentiality with lawful limits and how to override ethically; and protection of sensitive content in shared records, portals, billing and study datasets across ANZ, UK, US and Canada.

high

Adolescent consultation, HEEADSSS assessment and confidentiality

A fellowship approach to running the adolescent consultation: youth-friendly setup, rapport, time alone, conditional confidentiality with its lawful limits, a full HEEADSSS psychosocial assessment with validated screens, same-visit action on positive screens, and red-flag interrupts across clinic, ED, inpatient and telehealth settings.

high

Adolescent health care for young people in out-of-home care

A fellowship approach to health care for adolescents living in out-of-home (foster, kinship, residential) care: classification of placement and legal status; the heavy cumulative mental-health, developmental, reproductive, dental, growth and immunisation burden and its toxic-stress mechanism; a trauma-informed initial and comprehensive health assessment on entry to care; consent-authority and conditional confidentiality when the state holds parental responsibility; management of pregnancy, sexual-health, mental-health and substance-use needs; transition to adult care and support for aging out — across ANZ, UK, US and Canada.

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Adolescent health in rural and remote settings

A fellowship approach to the equity gap in adolescent health in rural and remote settings: why the gap exists, how it presents clinically, and the tiered service model — youth-friendly primary care, telehealth, outreach, school-based health and retrieval — that closes it across ANZ, UK, US and Canada.

high

Adolescent pregnancy and parenting

A fellowship approach to adolescent pregnancy and parenting: non-judgemental confirmation and dating, safeguarding-aware options counselling, coordinated antenatal care, adolescent-specific obstetric and psychosocial risk recognition, mental health, nutrition, breastfeeding and education support, postpartum contraception to prevent rapid repeat pregnancy, and longitudinal parenting support across ANZ, UK, US and Canada.

high

Adolescent risk assessment and harm minimisation

A fellowship approach to assessing adolescent risk across all domains and applying harm-minimisation principles: structured screening, risk formulation, brief intervention, and pragmatic domain-specific harm reduction that meets young people where they are across ANZ, UK, US and Canada.

high

Adolescent sexual health and contraception

A fellowship approach to adolescent sexual health and contraception: confidential, youth-centred sexual history (the 5 Ps), LARC-first counselling using Medical Eligibility Criteria principles, dual protection against pregnancy and STIs, quick-starting, emergency contraception, HPV vaccination, red-flag safety action, and follow-up across ANZ, UK, US and Canada.

high

Adolescent substance-use screening, brief intervention and harm reduction

A fellowship approach to adolescent substance-use screening, brief intervention and harm reduction: universal frequency-based screening (S2BI/CRAFFT), motivational-interviewing brief intervention, a domain-specific harm-reduction bundle (naloxone, needle–syringe linkage, vaping cut-down), and the fentanyl-era safety response across ANZ, UK, US and Canada.

high

Chronic disease self-management in young people

A fellowship approach to chronic-disease self-management in young people: what self-management is and its three task-domains; why it breaks down in adolescence through developmental, psychosocial and system mechanisms; how to assess skills and transition readiness with the TRAQ; how to measure adherence objectively rather than trust self-report; and how to build a stepwise self-management plan with motivational interviewing, shared goals, written action plans and technology — across type 1 diabetes, asthma, sickle cell disease, cystic fibrosis, IBD, JIA, CKD and transplant, for ANZ, UK, US and Canada.

high

Consent and confidential care for adolescents

A fellowship approach to consent and confidential care for adolescents: informed consent, assent and parental permission; bedside capacity assessment using the Gillick/mature-minor principle; conditional confidentiality with lawful limits and how to override ethically; protecting sensitive records, portals and billing; and consent for contraception, STI care, mental health, vaccination, gender-affirming care and research across ANZ, UK, US and Canada.

high

Digital media, gaming and cyberbullying

A fellowship approach to the digital life of young people: how to ask about screen time, social media, gaming, cyberbullying and online sexual risk; how to separate normative use from the use that harms; and how to build a harm-reduction plan that keeps a young person safe and engaged rather than lectured into silence.

high

Dysmenorrhoea and heavy menstrual bleeding

A fellowship approach to the adolescent with menstrual pain and heavy bleeding: separating primary from secondary dysmenorrhoea, applying the FIGO PALM-COEIN classification with the adolescent-dominated COEIN causes, the bleeding-disease screen, and the stepwise NSAID-to-hormonal-to-LNG-IUS management ladders, run in parallel with iron repletion, school and sport reintegration, and the HEEADSSS and confidentiality frame.

high

Eating disorders: recognition and medical instability

A fellowship approach to recognising eating disorders in adolescents and deciding who is medically unstable: DSM-5 categories including anorexia, bulimia, binge-eating disorder and ARFID; SCOFF and HEEADSSS-based screening; physiological red flags and Junior MARSIPAN-style triage; focused assessment of weight, vital signs, posture and ECG; emergency stabilisation; and the threshold for admission — across ANZ, UK, US and Canada.

high

Eating disorders: refeeding and multidisciplinary care

A fellowship approach to refeeding the malnourished adolescent with an eating disorder and to the multidisciplinary team that carries recovery: refeeding-syndrome risk stratification and prevention, phosphate–magnesium–potassium and thiamine management, the conservative-versus-higher-calorie evidence, family-based treatment as first-line therapy, and tiered care across outpatient, day-program and inpatient settings across ANZ, UK, US and Canada.

high

Gender diversity and gender-affirming paediatric care

Fellowship-level approach to caring for trans and gender-diverse children and adolescents: separating gender identity, expression, dysphoria and orientation; the affirmative, exploratory, biopsychosocial model; staged, reversible-first care from exploration through social transition, pubertal suppression with GnRH analogues at Tanner 2, and gender-affirming hormones; eligibility, consent and bone-health considerations; and regional differences between the international (Endocrine Society/WPATH), North American (AAP), UK (Cass) and ANZ models.

high

Medication adherence and treatment fatigue

A fellowship approach to assessing and promoting medication adherence in adolescents living with chronic disease, recognising treatment fatigue as an expected phase, measuring adherence with the right tool, mapping modifiable barriers, and applying a non-judgemental, engagement-preserving stepwise intervention across ANZ, UK, US and Canada.

high

Menstrual disorders in adolescents

A fellowship approach to menstrual disorders in adolescents: what is normal after menarche, how to classify abnormal uterine bleeding (PALM-COEIN), the work-up for heavy bleeding, dysmenorrhoea and amenorrhoea, stepwise management with combined hormonal contraception, the levonorgestrel intrauterine system, tranexamic acid and iron, and red flags across ANZ, UK, US and Canada.

high

Normal puberty and adolescent development

A fellowship approach to normal puberty and adolescent development: the reactivated HPG axis, Tanner staging of breast/genital and pubic hair development, the sex-specific sequence and timing of events, the coupled growth spurt and brain changes, the normal variants, the referral thresholds for abnormal timing, and counselling across ANZ, UK, US and Canada.

high

Obesity and body-image concerns in adolescents

A fellowship approach to adolescent obesity and body-image concerns: BMI-based classification with adult crossover, multifactorial aetiology, comorbidity screening, staged and weight-neutral lifestyle-to-surgery management, and concurrent mental-health and body-image care that refuses to reduce a young person to a number on the scale.

high

Polycystic ovary syndrome in adolescents

A fellowship approach to PCOS in adolescents: Rotterdam-based diagnosis modified for developmental physiology, exclusion of mimics, lifestyle-first management with symptom-directed pharmacotherapy, metabolic and mental health screening, and long-term partnership.

high

School refusal, bullying and social exclusion

A fellowship approach to the adolescent whose school attendance collapses, where school refusal, bullying victimisation and social exclusion overlap. Covers Kearney functional analysis adapted to adolescence, bully-role assessment, school belonging, exposure-based CBT with graded return, whole-school anti-bullying response, and SSRI evidence for the underlying anxiety or depression — across ANZ, UK, US and Canada.

high

Sexual orientation, identity and inclusive care

Fellowship-level approach to sexual orientation, identity and inclusive care for adolescents: distinguishing sexual orientation from gender identity, expression and sex assigned at birth; the three components of orientation (attraction, behaviour, identity); the minority-stress model and why sexual minority youth carry excess depression, anxiety, suicidality and substance-use burden; affirming history-taking (HEEADSSS sexuality module), SOGI data collection and documentation; building an affirming environment and confidentiality; acute risk management (suicidality, family rejection, disclosure crisis); family acceptance; the harms of sexual orientation and gender identity change efforts; and care for Aboriginal and Torres Strait Islander, Maori, culturally diverse, rural, out-of-home-care and neurodiverse sexual minority youth.

high

Sexually transmitted infection screening and management

A fellowship approach to confidential, youth-friendly STI care in adolescents: time alone and conditional confidentiality, the 5 P's sexual history, risk- and anatomy-based screening (universal CT/GC for sexually active females under 25, selective extragenital testing, syphilis/HIV by risk), syndrome recognition, guideline-based treatment with local-dose verification, partner services and expedited partner therapy, ~3-month rescreening, and prevention across ANZ, UK, US and Canada.

high

Sleep, fatigue and circadian disorders in adolescents

A fellowship approach to sleep, fatigue and circadian disorders in adolescents: the biologically delayed sleep phase, the two-process model, the differential of the 'tired teenager' (insufficient sleep, insomnia, delayed sleep-wake phase disorder, central disorders of hypersomnolence, obstructive sleep apnoea, depression and medical fatigue), a sleep-history and sleep-diary assessment, and stepped-care management (sleep hygiene, CBT-I, timed light and melatonin) across ANZ, UK, US and Canada.

high

Tobacco, vaping and nicotine dependence

A fellowship approach to adolescent nicotine and tobacco use across combustible, electronic, pod and smokeless products: faster-onset dependence in the developing brain, validated dependence assessment, the 5 A's and motivational interviewing, evidence-based pharmacotherapy, EVALI recognition, and prevention across ANZ, UK, US and Canada.

high

Transition readiness and transfer from paediatric to adult health services

A fellowship approach to transition readiness and transfer from paediatric to adult health services: defining transition as a purposeful staged process distinct from transfer; applying the Got Transition Six Core Elements; assessing readiness across self-management, navigation, communication, legal and psychosocial domains with tools such as the TRAQ; building a portable medical summary and emergency plan; organising a warm handoff to a named adult primary and specialty home; managing chronic-condition populations (diabetes, congenital heart disease, cystic fibrosis, IBD, sickle cell disease, complex/technology-dependent and neurodevelopmental disability); re-engaging youth lost to follow-up; and comparing ANZ, UK, US and Canadian service models.

high

Youth violence, risky behaviour and injury prevention

A fellowship, public-health approach to preventing youth violence, risky behaviour and injury in adolescence: how to recognise the young person at risk, screen privately across violence, road, self-harm and weapon domains, stratify by prevention tier, and deliver evidence-based prevention from graduated driver licensing and safe firearm storage to positive youth development and lethal-means counselling across ANZ, UK, US and Canada.

high

Adolescent transition for neurodevelopmental disability

Fellowship guide to adolescent transition for neurodevelopmental disability: structured transition frameworks, readiness assessment, portable summaries, warm handoff, legal and family preparation, crisis rescue, and ANZ/UK/US/Canada system differences.

high

Attention-deficit hyperactivity disorder

Fellowship guide to paediatric ADHD: multi-setting diagnosis, differentials including sleep and learning mimics, age-banded multimodal care, stimulant and non-stimulant frameworks with monitoring, comorbidity, school partnership, regional pathway differences and exam pearls.

medium

Augmentative communication, assistive technology and adaptive equipment

Fellowship-level prescription and coordination of AAC, assistive technology and adaptive equipment for children with complex communication and motor needs — feature-matching, trials, partner training, powered mobility, seating, and participation outcomes.

high

Autism spectrum disorder

Fellowship assessment and management of autism spectrum disorder: DSM-5-TR diagnosis, multimodal evaluation, early supports, comorbidity care, irritability pharmacotherapy with monitoring, crisis care, education interfaces and regional pathways.

high

Behavioural assessment and functional analysis

Fellowship guide to paediatric behavioural assessment and functional analysis: operational definitions, medical and communication screens, multi-setting ABC data, four maintaining functions, descriptive versus experimental FA, PBS and FCT linkage, limited medication after formulation, and multi-agency plan leadership.

high

Behavioural management of defiance and oppositional behaviours

Fellowship guide to behavioural management of defiance and oppositional behaviours in general paediatrics: normative noncompliance versus ODD and CD, coercive cycles, multi-informant assessment, parent training first-line, school plans, ADHD comorbidity, limited medication role, safeguarding and regional guidance.

high

Cerebral palsy: early recognition and classification

Fellowship approach to early recognition of cerebral palsy, motor phenotype and topography, functional classification systems (GMFCS, MACS, CFCS, EDACS), early detection tools and first-step intervention planning.

high

Cerebral palsy: surveillance and multidisciplinary management

Fellowship guide to lifelong cerebral palsy surveillance and multidisciplinary management: functional classification, hip and comorbidity surveillance, tone and motor interventions, medical-home coordination, transition and exam defence — cross-linked to early recognition without cloning it.

high

Children with developmental disability in acute care

Fellowship approach to children with developmental disability in ED and hospital: avoid diagnostic overshadowing, use caregiver baseline and hospital passports, apply reasonable adjustments, assess pain with adapted tools, and manage medical complexity safely.

high

Children with disability in school and community settings

Fellowship-level paediatric role for children with disability in school and community: ICF-style function, medical home partnership, school letters, emergency plans, participation supports, and regional education-interface principles.

high

Developmental assessment: history, examination and standardised tools

Fellowship approach to structured developmental history and examination, correct age use, selection and limits of standardised screening and diagnostic tools, first-line hearing and vision, synthesis, referral and exam performance.

medium

Developmental coordination disorder

Fellowship guide to developmental coordination disorder: DSM/EACD criteria, red-flag exclusions, DCDQ and standardised motor testing, task-oriented intervention, comorbidity, school and activity supports, and regional practice — without inventing uncited cut-offs or drugs for core DCD.

high

Developmental delay: global diagnostic approach

Fellowship diagnostic approach to global developmental delay: multi-domain pattern recognition, threat-first assessment, hearing and vision, evolving genetic testing tiers, selective metabolic and imaging tests, early intervention without waiting for labels, and exam-ready communication.

high

Developmental regression: urgent diagnostic approach

Fellowship urgent diagnostic approach to developmental regression: confirm true skill loss, triage threat, phenotype-guided investigation, parallel supports, and exam-ready communication across ages.

high

Early intervention and developmental care planning

Fellowship guide to early intervention and developmental care planning: from parental concern and failed screens to urgent gates, parallel referral, family-centred goals, key-worker coordination, parent-mediated supports, equity, waitlist safety-nets and ANZ/UK/US/Canada system principles without cloning tool-level assessment or condition-specific therapy leaves.

high

Family-centred developmental care and goal setting

Fellowship-level approach to family-centred developmental care and goal setting: PFCC principles, ICF-CY and F-words framing, SMART/GAS/COPM goals, shared decisions, structural barriers, and regional service models.

high

Feeding problems, food refusal and selective eating

Fellowship approach to feeding problems, food refusal and selective eating: separate ordinary toddler neophobia from pediatric feeding disorder and ARFID, exclude organic red flags, map four PFD domains, stop force-feeding, and deliver stepwise multidisciplinary care with clear safety-nets.

high

General movements assessment and Hammersmith infant neurological examination

Fellowship approach to Prechtl general movements assessment and the Hammersmith Infant Neurological Examination: timing windows, what each tool assesses, combination with neuroimaging for high-probability cerebral palsy, pitfalls, training limits and counselling.

high

Hearing impairment and development

Fellowship-level approach to childhood hearing impairment and development: permanent versus temporary loss, classification, critical-period language effects, early amplification and cochlear implants, OME, family-centred intervention, and regional practice differences.

high

Intellectual developmental disorder

Fellowship approach to intellectual developmental disorder: dual intellectual and adaptive criteria, severity by adaptive function, GDD-to-ID framing, aetiological evaluation including CMA and genomics, treatable mimics, medical-home longitudinal care, comorbidity without overshadowing, education and transition.

high

Motor delay, hypotonia and the floppy infant

Fellowship approach to motor delay, hypotonia and the floppy infant: bedside localisation of central versus peripheral tone problems, can't-miss differentials including SMA and infant botulism, first-line investigations, airway and feeding protection, disease-modifying pathways and early intervention without cloning dedicated CP tool chapters.

high

Neurodiversity-affirming developmental care

A fellowship approach to neurodiversity-affirming developmental care: person-environment fit, double empathy, language preference, anti-ableism, camouflaging and burnout recognition, clinic and hospital adjustments, co-occurring medical care, and closed-loop school supports without abandoning diagnosis or safety.

high

Normal cognitive, emotional and behavioural development

Fellowship approach to normal cognitive, emotional and behavioural development from infancy through adolescence: age bands, temperament, executive function, self-regulation, red flags, counselling, screening triggers and multi-board exam performance.

high

Normal growth from fetal life through adolescence

Fellowship guide to normal fetal-to-adolescent growth physiology, ICP phases, chart interpretation, mid-parental height, puberty and red-flag growth patterns.

high

Normal language, communication and social development

Fellowship guide to normal language, communication and social development from infancy through school age: age-banded milestones, bedside observation, red flags, bilingual assessment, anticipatory guidance and early escalation without cloning speech-delay or autism chapters.

high

Normal motor development and developmental variation

Fellowship guide to normal gross and fine motor development, WHO windows of achievement, healthy variation including non-crawling paths, bedside motor examination, and the first decision between reassure, recheck or escalate.

high

School refusal and school attendance problems

Fellowship guide to school refusal and attendance problems: behaviour not diagnosis, Kearney four-function analysis, Egger anxious-refusal versus truancy profiles, multi-informant assessment, exposure-based CBT and caregiver training, graded return-to-school, SSRI evidence for underlying anxiety (CAMS) with Melvin fluoxetine caution, and stepped multi-agency care.

high

Sensory processing differences

Fellowship-level approach to sensory processing differences in children: dimensional features, classification, medical mimics, functional assessment, environmental supports, occupational therapy evidence and controversies, comorbidity, and ethics of care when tactile defensiveness collides with indicated treatment.

high

Social communication concerns and autism recognition

Fellowship approach to recognising social communication concerns and autism risk from infancy through school age: red flags, differential diagnosis, autism-specific screening limits, early referral and family counselling without replacing full ASD diagnostic management.

high

Specific learning disorders

Fellowship guide to specific learning disorders: DSM-5 domain thinking for reading, writing and maths; medical evaluation of academic underachievement; differentials from IDD, ADHD and sensory impairment; psychoeducational pathway; evidence-based remediation; school supports; and exam defence across ANZ, UK, US and Canada.

high

Speech and language delay

Fellowship guide to speech and language delay: speech versus language versus social communication, late talkers versus DLD (CATALISE), mandatory hearing pathway, red flags, differentials, concurrent SLP and early intervention, equity and exam defence across ANZ, UK, US and Canada.

high

Temper tantrums, aggression and emotional dysregulation

Fellowship guide to temper tantrums, aggression and emotional dysregulation: developmental norms versus impairing behaviour, ABC assessment, medical and safeguarding differentials, first-line behavioural parenting, no corporal punishment, specialist escalation and exam defence.

high

Toilet training and elimination behaviour

Fellowship approach to toilet-training readiness and elimination behaviour: non-punitive counselling, DSM and ICCS classification of enuresis and encopresis, enuresis triad and constipation-overflow mechanisms, alarm versus desmopressin strategy, retentive encopresis bowel programmes, organic red flags, neurodiversity adaptations and regional pathway differences.

high

Visual impairment and development

A fellowship approach to childhood visual impairment: definitions, red-reflex and age-adapted surveillance, critical-period urgency, cerebral versus ocular pathways, developmental consequences, multidisciplinary habilitation and regional screening differences.

high

Adverse drug reactions and pharmacovigilance

A fellowship approach to adverse drug reactions and pharmacovigilance in children: Rawlins and Thompson Type A/B classification with DoTS and EIDOS extensions, paediatric epidemiology, immune and non-immune mechanisms, recognition, Naranjo causality and Hartwig severity assessment, management from stopping the drug through anaphylaxis and SJS/TEN, and the reporting pathway from TGA, MHRA Yellow Card and FDA MedWatch to WHO VigiBase across ANZ, UK, US and Canada.

high

Analgesics and antipyretics

A fellowship approach to choosing and dosing an analgesic or antipyretic in a child: weigh the child, calculate the dose from a current paediatric formulary, cap it at the adult maximum, and combine the drug with age-appropriate comfort. Paracetamol 15 mg per kg per dose (maximum 60 mg per kg per day, adult maximum 1 g per dose and 4 g per day) and ibuprofen 5 to 10 mg per kg per dose (maximum 30 mg per kg per day, from three months and over 5 kg) cover most fever and mild-to-moderate pain. Morphine 0.1 to 0.2 mg per kg intravenously treats severe pain. Aspirin is avoided in under-16s with viral illness because of Reye syndrome, and codeine and tramadol are contraindicated in children under 12 and after tonsillectomy because CYP2D6 ultrarapid metabolisers convert a therapeutic prodrug dose into a fatal morphine overdose. Alternating paracetamol and ibuprofen is not routine: use one effective agent with a clear plan.

high

Cardiovascular medicines in children

A fellowship approach to prescribing cardiovascular medicines in children, covering the diuretics, ACE inhibitors and beta-blockers used in heart failure, the inotropes digoxin and milrinone, the antiarrhythmics adenosine, amiodarone, flecainide and sotalol, the vasodilator antihypertensives amlodipine, labetalol, hydralazine and sodium nitroprusside, prostaglandin E1 for duct-dependent congenital heart disease, and the pulmonary vasodilators such as sildenafil — with weight-based doses, developmental pharmacokinetics, monitoring and the high-risk adverse effects that shape every prescription.

medium

Chemotherapy and supportive pharmacology

A fellowship approach to chemotherapy and supportive pharmacology in children covering the cytotoxic drug classes and their organ-specific toxicities, the antiemetic ladder built on 5-HT3 antagonists (ondansetron), the NK1 antagonist aprepitant and dexamethasone for chemotherapy-induced nausea and vomiting, the colony-stimulating factors filgrastim and pegfilgrastim for febrile neutropenia prophylaxis, palifermin (keratinocyte growth factor) for oral mucositis after stem-cell transplant conditioning, dexrazoxane for anthracycline cardioprotection and extravasation, and the non-negotiable rule that vincristine is given intravenously and never by the intrathecal route.

medium

Complementary, alternative and traditional medicines

Fellowship guide to complementary, alternative and traditional medicines in children: the five CAM domains, why families use them and why most use stays hidden, the four pathways to harm (adulteration and heavy-metal contamination, herb-drug interactions via cytochrome P450, misidentification and dosing inconsistency, and delay or displacement of conventional care), the respectful bedside safety conversation, and the regional regulatory picture including the WHO Traditional Medicine Strategy.

high

Corticosteroid therapy and adverse effects

A fellowship approach to corticosteroid therapy in children covering glucocorticoid versus mineralocorticoid potency and the equivalent-dose ladder (hydrocortisone, prednisolone, methylprednisolone, dexamethasone), weight-based prednisolone and dexamethasone dosing for asthma and croup, the hypothalamic-pituitary-adrenal axis and how exogenous steroids suppress it, the recognition and emergency management of adrenal crisis with age-banded stress-dose hydrocortisone, the safe weaning of longer courses, and the full spectrum of adverse effects from growth suppression to osteopenia.

high

Developmental pharmacology and age-related pharmacokinetics

Fellowship guide to how absorption, distribution, metabolism and excretion of medicines change across paediatric development, and the dosing and monitoring consequences from preterm neonate to adolescent.

high

Drug interactions and medication reconciliation

A fellowship approach to drug interactions and medication reconciliation in children covering cytochrome P450 induction and inhibition, pharmacodynamic additive toxicity, developmental changes in drug handling that shift interaction risk by age, the Best Possible Medication History, and the structured reconciliation of every medicine across admission, transfer and discharge.

high

Endocrine and diabetes medicines

A fellowship approach to the three highest-yield paediatric endocrine medicine families: insulin for type 1 diabetes and diabetic ketoacidosis, levothyroxine for congenital and acquired hypothyroidism, and recombinant human growth hormone for growth hormone deficiency and licensed growth-failure indications. Covers insulin pharmacokinetic classes, the 0.05 to 0.1 unit per kg per hour DKA infusion, basal-bolus and pump regimens, ISPAD 2024 glycemic targets, neonatal levothyroxine 10 to 15 microgram per kg per day, and recombinant growth hormone 0.045 to 0.050 mg per kg per day with monitoring and safety surveillance from neonatal life through transition.

high

Immunosuppressive and biologic therapies

A fellowship approach to immunosuppressive and biologic therapies in children covering low-dose weekly methotrexate as the anchor disease-modifying antirheumatic drug in juvenile idiopathic arthritis, the tumour necrosis factor inhibitors etanercept, adalimumab and infliximab across rheumatology and inflammatory bowel disease, the interleukin-1, interleukin-6 and B-cell-depleting biologics, the pre-biologic screen for tuberculosis, hepatitis B and varicella with dual tuberculin and IGRA testing, folic acid supplementation and full-blood-count and liver-enzyme monitoring on methotrexate, and live-vaccine timing before immunosuppression begins.

high

Inhaled therapies and device selection

A fellowship approach to inhaled therapies and device selection in children covering the four device families — pressurised metered-dose inhaler, dry-powder inhaler, soft-mist inhaler and nebuliser — why a valved holding chamber (spacer) transforms pressurised-inhaler delivery, how aerosol particle size, inspiratory flow and coordination decide where a drug lands, and the age-based device ladder from the masked spacer in infants and toddlers to the dry-powder inhaler in the school-age child and self-managed adolescent.

high

Medication adherence and formulation challenges

Fellowship guide to medication adherence and formulation challenges in children: why adherence is the prescriber's job, the dimensions of non-adherence (initiation, implementation, persistence), the formulation gap and palatability science, age-appropriate formulations (liquids, chewable and dispersible tablets, mini-tablets), excipient safety in neonates, the bedside assessment of adherence barriers, the stepwise formulation-and-adherence management pathway, and the regional initiatives (STEP database, paediatric investigation plans) closing the formulation gap.

high

Off-label and unlicensed medicine use

Fellowship guide to off-label and unlicensed medicine use in children: the three prescribing categories, why paediatric prescribing is so often outside the product licence, prevalence across settings, the link with adverse drug reactions, the safe-use governance pathway (licensed alternative, evidence, formulation, documentation, consent, monitoring and reporting), and the regional regulatory frameworks that are closing the paediatric evidence gap.

high

Opioids and acute pain medicines

A fellowship approach to opioids and acute pain medicines in children covering the WHO two-step analgesic ladder, mu-opioid receptor pharmacology and its dose-limiting adverse effects, developmental morphine pharmacokinetics, weight-based dosing for morphine, oxycodone, fentanyl and hydromorphone, the CYP2D6 prodrug mechanism that makes codeine and tramadol contraindicated in children, multimodal opioid-sparing analgesia, patient- and nurse-controlled analgesia safety, age-appropriate pain assessment, and naloxone reversal of opioid-induced respiratory depression.

medium

Pharmacogenomics and precision therapeutics

A fellowship approach to pharmacogenomics and precision therapeutics in children covering how inherited gene variants change the way an individual child handles a drug, the Clinical Pharmacogenetics Implementation Consortium gene-drug pairs a general paediatrician must know, thiopurine methyltransferase and NUDT15 before azathioprine or 6-mercaptopurine, CYP2D6 and the codeine ultrarapid-metaboliser trap, HLA-B star 15 colon 02 screening before carbamazepine, HLA-B star 57 colon 01 before abacavir, CYP2C19 and clopidogrel, and how to order a genotype, read a report, and change the prescription.

high

Poisoning antidotes and toxicology pharmacology

A fellowship approach to poisoning antidotes and toxicology pharmacology in children, covering the four mechanism classes of antidote, the toxidrome-driven bedside assessment, N-acetylcysteine for paracetamol poisoning, naloxone for opioid-induced respiratory depression, snake and other antivenoms, and chelation therapy for iron and lead. It gives weight-based doses and routes, the receptor, substrate, and binding mechanisms each antidote exploits, and the monitoring and pitfalls of reversing a toxin in a child.

high

Procedural sedation medicines

Fellowship guide to the medicines used for procedural sedation and analgesia in children: matching the agent and the depth to the procedure (ketamine, nitrous oxide, midazolam with an opioid, dexmedetomidine, propofol), the pharmacology that decides each choice, how to set up safely (an independent sedationist, ASA depth, capnography, suction and reversal), the preprocedural fasting question and why fasting should not delay emergency sedation, and how to manage the complications that matter (laryngospasm, hypoventilation, emergence agitation, oversedation), with ANZ, UK, US and Canada guidance.

high

Renal and hepatic dose adjustment in children

A fellowship approach to adjusting medicine doses for reduced kidney and liver function in children: bedside Schwartz eGFR, KDIGO staging, the Child-Pugh score, the high-risk nephrotoxic and hepatotoxic drugs, vancomycin and gentamicin therapeutic drug monitoring, and a stepwise prescribing algorithm from neonatal life through transition to adult care across ANZ, UK, US and Canada.

high

Safe prescribing, administration and monitoring

Fellowship guide to safe prescribing, administration and monitoring of medicines in children: the medication-use process, the paediatric factors that make dosing error-prone (weight-based calculation, developmental pharmacokinetics, off-label use), where errors happen and how to stop them (the rights of administration, independent double-checks, computerised order entry with decision support, unit-based pharmacists, standard concentrations), high-alert medicines, and therapeutic drug monitoring targets for gentamicin, vancomycin and phenytoin, with ANZ, UK, US and Canada guidance.

high

Therapeutic drug monitoring

A fellowship approach to therapeutic drug monitoring in children covering why narrow-therapeutic-index drugs such as aminoglycosides, vancomycin, phenytoin, digoxin and tacrolimus are monitored, how developmental pharmacokinetics and the maturation of glomerular filtration move a level, how linear and Michaelis-Menten nonlinear kinetics differ, the vancomycin area-under-the-curve target, extended-interval aminoglycoside dosing, the phenytoin free fraction in hypoalbuminaemia, and the correct sampling times for a true trough, peak and steady-state level.

high

Vaccines and immunobiology

A fellowship approach to vaccines and immunobiology in children covering the scheduled immunisation programme with on-time dosing at birth, two, four, six, twelve and eighteen months, the distinction between live attenuated vaccines (measles-mumps-rubella, varicella, rotavirus, BCG, yellow fever) and inactivated subunit, toxoid, conjugate and recombinant vaccines, the absolute contraindications to live vaccines of significant immunocompromise and pregnancy, the four-week spacing rule when two live vaccines are not given on the same day, the strict rotavirus age limits with the first dose before fifteen weeks and the course complete by twenty-four weeks, vaccination of premature infants by chronological age with full doses and no reduction, catch-up scheduling built on minimum intervals rather than restarting, and the recognition and management of adverse events following immunisation including anaphylaxis.

high

Weight-based dosing, body-surface area and dose calculation

A fellowship approach to calculating a safe paediatric drug dose: weigh the child in kilograms on a calibrated scale, measure length or height for body-surface-area drugs, take the mg per kg or Mosteller body-surface-area dose from a current paediatric formulary, calculate the dose, cap it at the maximum adult single and daily dose, round sensibly, write a leading zero, and have a second clinician check it independently. For therapeutic drug monitoring drugs such as vancomycin and gentamicin, sample at the correct time and adjust to the AUC or trough target. Never estimate a weight unless it is an emergency, and never let a tenfold decimal error reach the child.

medium

Advocacy, policy and health-service design for rural children

Fellowship guide to advocacy, policy and health-service design for rural children. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Avoiding racism and institutional bias in child health

Fellowship guide to avoiding racism and institutional bias in child health. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Child protection in small and remote communities

Fellowship guide to child protection in small and remote communities. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Disaster, outbreak and public-health response for children

Fellowship guide to disaster, outbreak and public-health response for children. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Environmental, occupational and agricultural child health

Fellowship guide to environmental, occupational and agricultural child health. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Implementing culturally safe Indigenous care in rural and remote services

Fellowship guide to implementing culturally safe indigenous care in rural and remote services. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Refugee, immigrant and humanitarian paediatrics

Fellowship guide to refugee, immigrant and humanitarian paediatrics. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Remote prescribing and medication access

Fellowship guide to remote prescribing and medication access. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Retrieval coordination and transfer risk

Fellowship guide to retrieval coordination and transfer risk. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Rural developmental, disability and mental-health care

Fellowship guide to rural developmental, disability and mental-health care. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Rural general paediatric practice and scope

Fellowship guide to rural general paediatric practice and scope. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Rural newborn and acute paediatric care

Fellowship guide to rural newborn and acute paediatric care. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Stabilisation with limited paediatric resources

Fellowship guide to stabilisation with limited paediatric resources. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Telepaediatrics and remote specialist support

Fellowship guide to telepaediatrics and remote specialist support. Covers context-specific assessment, resource-aware pathways, escalation and retrieval, equity and cultural safety, documentation, and board-relevant practice for RACP, RCPCH/MRCPCH, ABP/ACGME and RCPSC examinations.

high

Age-specific normal vital signs and physiological ranges