Paediatric Conditions Hub

Understanding Paediatric Nursing Assessment

Paediatrics covers neonates (birth–28 days), infants (1–12 months), children (1–10 years) and adolescents (10–19 years per WHO). Children differ from adults in physiology, pharmacokinetics, age-specific vital sign ranges and disease presentation, so assessment, prescribing and procedures must be age- and weight-appropriate. International guidance from WHO, NICE, the American Academy of Pediatrics (AAP), the Royal College of Paediatrics and Child Health (RCPCH), the European Academy of Paediatrics (EAP), the Indian Academy of Pediatrics (IAP) and the International Pediatric Association (IPA) shapes recognition of serious illness, sepsis, safeguarding, immunisation and management of common conditions.

Common cues include fever, poor feeding, lethargy, respiratory distress, dehydration, rashes, vomiting and diarrhoea, failure to thrive, developmental delay and behavioural concerns. Bedside assessment uses the WHO IMCI approach (Integrated Management of Childhood Illness) in lower-resource settings, the NICE traffic-light system for febrile children under 5, the Paediatric Early Warning Score (PEWS) and disease-specific scores (Westley croup score, mWPCSS, PRESS for asthma). Growth (weight, length/height, head circumference in <2 years) is plotted on the WHO Child Growth Standards (0–5 years) and country-adapted charts (e.g. UK-WHO, CDC) thereafter.

Paediatric care overlaps with neonatology, infectious disease, immunology, mental health, genetics, oncology and surgery. Core nursing responsibilities include weight-based drug dosing (BNF for Children, AAP/Pediatric Lexicomp, WHO Model Formulary for Children), atraumatic care, family-centred and culturally responsive practice, immunisation per the WHO Expanded Programme on Immunization (EPI) or national schedule, recognition of safeguarding concerns, and education on injury prevention, nutrition (including exclusive breastfeeding to 6 months as recommended by WHO), oral rehydration and home symptom management.

Core anatomy, physiology and pharmacology points

Children have a higher metabolic rate, larger surface-area-to-body-mass ratio, higher insensible water loss and immature thermoregulation — making them more vulnerable to dehydration, hypothermia and hypoglycaemia. The airway is small, anteriorly placed and easily obstructed; respiratory rate, work of breathing (recession, grunting, head bobbing) and oxygen saturation are key vital signs. Cardiovascular reserve is high but compensation can be misleading — hypotension is a late and pre-arrest sign in shock. Renal and hepatic clearance, plasma protein binding and body water composition vary with age, driving paediatric pharmacokinetics. The immune system matures progressively, so neonates and young infants are at higher risk of serious bacterial infection (SBI). Brain development continues into the mid-twenties, with measurable milestones across motor, language, cognitive, social and emotional domains screened at routine well-child visits.