Prompt

You are the paediatric registrar in a community clinic. The examiner moves from a day-5 breastfed infant with weight loss and jaundice to a 2-month visit with unsafe sleep and maternal low mood.

Branch A — Day-5 infant (6–8 minutes)

Examiner: "Day-5 exclusive breastfeeding, 11% weight loss, mild jaundice. What do you do first?" ^[1]

Strong candidate:

Doorway: is the infant well or unwell?
If unwell → ABCDE, glucose, sepsis pathway.
If currently stable → structured assessment: output, alertness, feed observation, full exam, measure bilirubin, plot weight in nomogram context, feeding rescue plan, early reweigh. ^[1]

Prompts if stuck:

"How do you decide admission?"
"What exactly do you tell the mother about breastfeeding tonight?" ^[1]

Fail actions: visual jaundice only; "any loss under 15% is fine"; no reweigh plan. ^[1]

References7Show

[1]Moon RY, Carlin RF, Hand I Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics, 2022.PMID 35726558
[5]Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 2022.PMID 35927462
[6]Flaherman VJ, Schaefer EW, Kuzniewicz MW, et al. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics, 2015.PMID 25554815
[7]Rafferty J, Mattson G, Earls MF, et al. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics, 2019.PMID 30559118
[12]Shane AL, Sánchez PJ, Stoll BJ Neonatal sepsis. Lancet (London, England), 2017.PMID 28434651
[9]Mahle WT, Martin GR, Beekman RH 3rd, et al. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics, 2012.PMID 22201143
[3]Meek JY, Noble L Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 2022.PMID 35921640

Branch A — Day-5 infant (6–8 minutes)

Examiner: "Day-5 exclusive breastfeeding, 11% weight loss, mild jaundice. What do you do first?" ^[1]

Strong candidate:

Doorway: is the infant well or unwell?

If unwell → ABCDE, glucose, sepsis pathway.

If currently stable → structured assessment: output, alertness, feed observation, full exam, measure bilirubin, plot weight in nomogram context, feeding rescue plan, early reweigh. ^[1]

Prompts if stuck:

"How do you decide admission?"

"What exactly do you tell the mother about breastfeeding tonight?" ^[1]

Fail actions: visual jaundice only; "any loss under 15% is fine"; no reweigh plan. ^[1]

References7Show

[1]Moon RY, Carlin RF, Hand I Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics, 2022.PMID 35726558
[5]Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 2022.PMID 35927462
[6]Flaherman VJ, Schaefer EW, Kuzniewicz MW, et al. Early weight loss nomograms for exclusively breastfed newborns. Pediatrics, 2015.PMID 25554815
[7]Rafferty J, Mattson G, Earls MF, et al. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics, 2019.PMID 30559118
[12]Shane AL, Sánchez PJ, Stoll BJ Neonatal sepsis. Lancet (London, England), 2017.PMID 28434651
[9]Mahle WT, Martin GR, Beekman RH 3rd, et al. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics, 2012.PMID 22201143
[3]Meek JY, Noble L Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics, 2022.PMID 35921640

Infant health supervision birth to 3 months — branching viva

Branch A — Day-5 infant (6–8 minutes)

Infant health supervision birth to 3 months — branching viva

Branch A — Day-5 infant (6–8 minutes)