Paediatric nursing revision map: assess, calculate, communicate and protect

The map

Paediatric questions are scattered across the bank. This map groups them. For maternal care and newborns, see maternal and child health.

This is exam-preparation revision, not clinical guidance. In practice, follow your own organisation’s policies and the current guideline, and check doses and thresholds against them.

• Assessment: look at the child first, then measure.
• Calculations: doses and fluids by weight.
• Communication and consent: the child, the parent or carer, and the law.
• Safeguarding: recognise concern and follow policy.
• Acute illness: breathing, hydration, fever and seizures.

Assessment

Start from the general look. The paediatric assessment triangle taught in paediatric life support courses uses appearance, work of breathing and circulation to skin. A quiet, floppy or unresponsive child is more worrying than a crying one. Normal heart rate and breathing rate change with age, so exams give you the table or the numbers. Early warning scores for children work like adult scores: a rising score means escalate. Use SBAR when you call.

Calculations: maintenance fluids

The Holliday-Segar method (1957) estimates daily maintenance water by weight: 100 mL per kg for the first 10 kg, 50 mL per kg for the next 10 kg, and 20 mL per kg for each kg above 20. The hourly version is 4, 2 and 1 mL per kg per hour for the same brackets.

Worked example, invented. A child weighs 18 kg. First 10 kg: 10 x 100 = 1000 mL. Next 8 kg: 8 x 50 = 400 mL. Total 1400 mL a day, which is about 58 mL an hour. Using the hourly rule: 10 x 4 = 40, plus 8 x 2 = 16, which gives 56 mL an hour. The two versions differ slightly, and an exam will normally say which to use.

Maintenance does not include deficits or ongoing losses. NICE guideline NG29 on intravenous fluids in children covers choice of fluid, and it recommends isotonic crystalloids for routine maintenance in most children, to lower the risk of low sodium. For more calculation practice, see dosage calculations.

Communication and consent

Explain in words suited to the child’s age, involve the parent or carer, and use play where it helps. Consent rules for children depend on the law and the facility’s policy, so know that you should follow policy rather than guess. The ethics guide covers the principles.

Safeguarding

Recognise concerns such as injuries that do not fit the story, delay in seeking care, and a child who is withdrawn or fearful. Your role is to document facts, avoid leading questions, report through the route your organisation sets and avoid confronting the family. Exams reward reporting and documentation over investigation.

Common acute illnesses

Practise these as short patterns: bronchiolitis and croup (breathing and hydration), gastroenteritis (dehydration signs and oral rehydration first where safe), the febrile child (look for red flags before treating the temperature), asthma (see oxygen and asthma) and seizures (protect, time it, call for help). For doses, always check weight, allergies and the prescription against the chart, and use a second check when your policy asks for one.

Giving medicines to children safely

Most paediatric errors in exam questions involve weight, units or timing. Check the weight is current and in kilograms, calculate the dose per kilogram and compare it with the usual range in the reference your unit uses. Confirm the concentration of liquid medicines, and measure with an oral syringe, not a household spoon. Check identity with the child’s band and with the parent, since a child may not say their name. Get a second check where your policy asks for one, and do not give a dose that looks wrong without checking. See medication safety.

Related guide

For weight-based doses and development milestones in more depth, see paediatric nursing: dosing and development.

Frequently asked questions