NEW Added to close a syllabus gap — neonatal resuscitation and paediatric special requirements are both named explicitly.

Paediatric & neonatal

How children differ, the numbers to carry, neonatal resuscitation, and the conditions that turn up in vivas.

How children differ

System	Difference	Consequence
Airway	Large head and tongue · short neck · larynx higher (C2–C3) and anterior · floppy U-shaped epiglottis · narrowest at the cricoid (classically) · obligate nasal breathers to ~6 months	Neutral position, not sniffing. Straight blade in neonates
Respiratory	Alveolar ventilation : FRC ≈ 5:1 (adult 1.5:1) · high O₂ consumption 6–8 ml/kg/min · compliant chest wall · horizontal ribs · diaphragm-dependent	Very rapid desaturation; fast inhalational induction
Cardiovascular	Rate-dependent cardiac output — fixed stroke volume · high vagal tone	Bradycardia is catastrophic; commonest cause is hypoxia
Thermoregulation	High surface-area-to-volume · non-shivering thermogenesis via brown fat · cannot shiver	Rapid heat loss — warm the theatre and the fluids
Renal / hepatic	Immature GFR until ~1 year · immature enzymes · low albumin	Prolonged drug effects; higher free fraction

Weight estimate: (age + 4) × 2 kg for 1–10 years.
Maintenance fluid — 4-2-1: 4 ml/kg/h first 10 kg, 2 for next 10, 1 thereafter.
Fluid bolus 10–20 ml/kg; 10 ml/kg in trauma and in neonates.
MAC peaks in infancy (~6 months), not in the neonate.

Dry, wrap and keep warm — under a radiant heater; a plastic bag for preterm infants. Start the clock.
Assess tone, breathing and heart rate at 30 seconds. Heart rate is the best indicator of response.
If not breathing: 5 inflation breaths, each 2–3 seconds, at 30 cmH₂O in term infants (20–25 preterm).
Start in AIR for term infants (21%); 21–30% for preterm. Titrate to preductal SpO₂ targets — about 60% at 2 min, 80% at 5 min, 85% at 10 min.
If heart rate <60 after effective ventilation: chest compressions at 3:1 with ventilation — the ratio is 3:1 in neonates, not 15:2.
Adrenaline 10–30 µg/kg IV if heart rate remains below 60 despite compressions.
APGAR at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration — each 0–2, total 10. It describes, it does not guide resuscitation.

Pyloric stenosis — a MEDICAL emergency, not a surgical one. Correct the hypochloraemic, hypokalaemic metabolic alkalosis and dehydration first. RSI with gastric aspiration.
Croup — 6 months to 3 years, gradual onset, barking cough, viral. Treated with dexamethasone and nebulised adrenaline. Contrast epiglottitis: rapid onset, drooling, high fever, toxic child — do not distress, inhalational induction with the surgeon present.
Tracheo-oesophageal fistula — associated with VACTERL. Avoid positive pressure ventilation before the fistula is controlled.
Congenital diaphragmatic hernia — avoid bag-mask ventilation; intubate early; permissive hypercapnia, gentle ventilation.
Post-operative apnoea in ex-premature infants — significant risk below 60 weeks post-conceptual age; admit for apnoea monitoring, consider caffeine, avoid day-case surgery.