Pediatrics was easily one of my favorite rotations in medical school. There’s an incredible diversity in the patients you’ll meet, from toddlers excited to show off their stuffed animal collection, teenagers itching to leave, and babies who test your physical exam skills by screaming at full volume. There’s rarely a dull moment, that’s for sure!
The complexity of the environment you have to navigate means you’ll need more than medical knowledge to be successful on this rotation. Of course, you still need to know the developmental milestones and vaccine schedules, but mastering emotional intelligence is key! A huge part of the rotation is learning how to connect with children, reassure nervous parents, and create a calm environment during stressful moments.
If you’re a bit stressed about how you’re going to do all that, don’t worry. We can help! This pediatrics rotation survival guide is designed to make it all a little less overwhelming. We’re going to give you some practical tips when it comes to treating kids, interacting with their families, succeeding in the clinic, and studying for the shelf that will enable you to not only do well, but truly enjoy the experience!
4 Tips to Help You Succeed on Your Pediatrics Rotation
1. Age changes everything!
A child’s age isn’t just something that affects how you interact with them. It’s a key medical variable that has a huge impact on what you think is happening and the treatment plan you develop.
Here’s a few ways age plays an important role in pediatrics:
Disease timelines shape your differential.
One thing you’ll quickly discover when you’re on pediatrics is that conditions present very differently depending on age, and recognizing these patterns is key to building a strong differential.
For example:
- A fever in a neonate is a sepsis workup until proven otherwise, while in a school-aged child it’s often viral.
- Jaundice in the first 24 hours of life is considered pathological, while physiological jaundice presents after this time period.
- Legg-Calvé-Perthes disease typically affects children between the ages of 4-10, while SCFE commonly affects 12-15 year olds.
Understanding these age-based patterns and how age can play a key role in diagnosis and treatment becomes one of the most important clinical tools in pediatrics.
Normal isn’t normal across ages.
Additionally, pediatric vitals are not interchangeable with adult vitals. A heart rate of 150 and respiratory rate of 45 in a newborn is considered normal, but would be alarming in an adult. Familiarize yourself with the expected range for each age group prior to starting the rotation so you don’t misinterpret these vital signs.
Pediatric dosing often takes a child’s age into account.
Medication dosing in pediatrics requires extra attention because many drugs use age- or weight-adjusted dosing, so you can’t rely on standard adult regimens and often need to double-check calculations and recommended pediatric ranges.
Also, familiarizing yourself with basic formulas for maintenance fluids and nutrition goals goes a long way in making you feel more confident on rounds.
Adapt your physical exam for kids.
Ask residents and attendings how they adapt their physical exam for kids—it’s a skill in itself.
A few tips:
- Start with the heart and lung exam before the ears… Once the otoscope comes out, cooperation often ends!
- A sticker, badge reel, toy, or anything on your lanyard can help build quick rapport and entertain the patient as you examine.
- Let the child “examine” their stuffed animal or even you first if they’re hesitant about your instruments. This often turns resistance into curiosity!
2. Interact with a child in a way that’s appropriate for their age.
This builds on the first point, but it’s so important it’s worth mentioning in its own right. Needless to say, you shouldn’t talk to a toddler the way you would a teenager.
Here are some tips to help you effectively interact with kids of different ages:
Adapt your conversation for every age.
Excelling on your peds rotation often depends less on what you say and more on how you say it. Sitting down at eye level, giving younger kids a moment to warm up, or talking about something unrelated to medicine first can make the encounter much smoother.
A 4-year-old may open up more if you ask about their favorite cartoon before jumping into questions, while young adults will usually respond better if you speak directly to them instead of talking through the parent. Even small adjustments in tone or conversation content can dramatically improve rapport and cooperation.
Know when and how to separate the room for confidentiality.
Confidentiality is a major part of adolescent care and learning how to navigate parent presence is essential. In many cases, it’s appropriate to ask parents to step out for part of the visit, especially when discussing mental health, substance use, or sexual health.
A simple and respectful way to frame this is explaining that it’s standard practice to spend part of every visit speaking with the patient alone so they can feel comfortable sharing privately and practice building a relationship with their physician independently. This helps build trust with young adults while still maintaining a respectful relationship with the family.
Use the HEADSSS framework for adolescents.
The HEADSSS exam (home, education/employment, activities, drugs, sexuality, suicide/mental health, safety) is a structured way to ensure you’re covering key psychosocial domains when obtaining a history from young adult patients. It helps normalize sensitive questions and ensures important topics aren’t missed, especially since many adolescent health concerns are not purely physical.
3. It’s important to give patient and family-centered care.
Family obviously takes on added importance when you’re treating kids. The parents (or other adult family members) will be the ones giving the child medication, monitoring their progress, etc. So, it’s incredibly important to make sure they’re on board and that you involve them in any care-related discussions.
That said, it’s also important to take the child into consideration as well. So to succeed in your pediatric rotation, it’s vital to provide good patient and family-centred care.
Here’s a few ways to ensure both the child and the family are treated properly:
Take time to understand the family dynamic.
Pediatrics is very much a team sport, and every family member often plays a different role in a child’s care. Spending a few extra minutes learning who the child lives with, who normally brings them to appointments, or what concerns the parents most can completely change the context of an encounter.
Grandparents, siblings, foster parents, or other caregivers may also be involved. Make sure to take a few extra minutes to understand these dynamics.
Meet the child where they are.
As we stated earlier, excelling on your peds rotation often depends less on what you say (or do) and more on how you say it (or do it). Sitting down at eye level, giving younger kids a moment to warm up, or talking about something unrelated to medicine first can make the encounter much smoother.
Use language that both the child and family can understand.
A unique skill you acquire in pediatrics is learning to communicate by avoiding excess medical jargon. Parents are often overwhelmed in the hospital and children may be scared simply because they don’t understand what’s happening.
For example, instead of saying, “We need an X-ray to rule out a fracture,” you might tell a child, “We’re going to take some pictures of your arm to make sure your bones are okay.”
Similarly, rather than telling parents their child has “gastroenteritis,” explaining “They have a stomach virus that’s causing vomiting and diarrhea” is often clearer and more reassuring. Small adjustments in wording can make families feel far more comfortable and included in the conversation.
4. Always go the extra mile in pediatrics!
Finally, pediatrics is a field with unique demands. This means that sometimes you have to do a bit more than you would on other rotations.
Here’s a few ways you can go above and beyond for children and their families:
Keep the whole care team in the loop.
Communication is key. Updating nurses, pharmacists, and other members of the care team after you’ve rounded helps keep care coordinated. A quick “Hey, I just saw your patient in room five and here’s the plan,” goes a long way in keeping everything running smoothly.
Circle back on your patients during the day.
Pediatrics is one of the rotations where this really stands out. Stopping back in the afternoon to check on a child, answer lingering parent questions, or simply say hi again can make a big difference in how families perceive care. Even brief follow-ups show ownership and continuity beyond morning rounds.
Anticipate needs before you’re asked.
Going the extra mile often means thinking one step ahead. This could be noticing that a parent looks confused and taking a moment to re-explain the plan in simpler terms, obtaining a missing piece of history before rounds, or making sure discharge instructions are actually realistic for the family. These small proactive steps show that you’re staying one step ahead in the patient’s care.
3 Ways to Shine in Outpatient Clinic
Now let’s take a look at some ways you can crush it in the outpatient clinic while you’re on pediatrics!
Some good tips for navigating this key aspect of your rotation include:
1. Be familiar with the bread-and-butter outpatient complaints.
One of the easiest ways to impress in clinic is to come in already familiar with common pediatric outpatient conditions, their basic workup, and management. Before starting clinic, spend time reviewing common presentations like viral URIs, acute otitis media, strep pharyngitis, asthma exacerbations, eczema, impetigo, constipation, gastroenteritis, urinary tract infections, ADHD/behavioral concerns, and more.
Even a basic sense of what is reassuring versus when to escalate care helps make your assessment and plan more developed.
2. Familiarize yourself with preventive care (vaccines and well-child visits).
Vaccines come up constantly in outpatient pediatrics, especially during well-child checks. Familiarizing yourself with the general vaccine timeline will set you up to give a successful presentation. There are various mnemonics to help you memorize the pediatric immunization schedule.
3. Learn the developmental milestones.
Developmental milestones come up in almost every well-child visit, so getting comfortable with them early makes a big difference. Memorizing all the milestones in one pass is difficult, so instead try to learn it gradually through repetition and patient encounters.
The “Bright Futures” booklet gives you a great overview of these milestones. Memorizing them not only helps clinically, it becomes extremely high-yield for the shelf exam.
5 Ways to Excel in Newborn Clinic
You’re also going to be spending some time in the newborn clinic, which to say the least, can be an adventure!
Here’s some tips that’ll help you succeed on this portion of your rotation:
1. Get comfortable with the newborn physical exam.
The newborn exam is different from the standard pediatric exam and takes some intentional practice to feel comfortable. It includes components like the primitive reflexes (Moro, palmar grasp, rooting, Babinski, etc.), as well as screening maneuvers like Barlow and Ortolani for developmental hip dysplasia and the red reflex for congenital eye abnormalities.
On top of that, don’t underestimate the basics of learning how to safely handle a newborn and swaddle. It’s completely reasonable to ask your resident or attending to walk you through it once or watch them do it first before trying it yourself.
2. Know the maternal history—it’s half the newborn story!
When presenting a newborn, maternal history is just as important as the newborn exam. The delivery details matter, such as vaginal versus C-section, gestational age, and any complications such as prolonged rupture of membranes or fetal distress.
You should also be comfortable discussing maternal labs, including GBS status, hepatitis B, HIV, syphilis screening, and rubella immunity. The maternal history often determines what screenings or monitoring the newborn needs in the first few days of life.
3. Understand the APGAR score and what it represents.
The APGAR score is a quick assessment of newborn status at one and five minutes after birth, based on appearance, pulse, grimace, activity, and respiration. It helps describe how well the newborn tolerated delivery and whether immediate intervention is needed.
4. Track the basics: feeding, diapers, and early output.
A huge part of newborn care is making sure there’s normal intake and output. In the first days of life, you should know what’s expected in terms of wet diapers, stool frequency, and feeding patterns, since these are often used as indirect markers of hydration and intake adequacy.
Early weight loss is also expected (5%-10% of their birth weight in the first few days of life), so trends matter more than single values. Being able to clearly explain what trends are expected can go a long way in reassuring parents and easing their anxiety.
5. Know the standard newborn screening and early interventions.
Every newborn receives a set of routine screenings and interventions shortly after birth. This includes newborn metabolic, hearing, and congenital heart disease screening. Bilirubin levels are also closely monitored to assess for hyperbilirubinemia. Additionally, standard newborn care includes the vitamin K injection, erythromycin eye ointment, and the first dose of the hepatitis B vaccine.
How to Prepare for Your Pediatric Shelf Exam
Before wrapping up, let’s talk a bit about how to get ready for the peds shelf.
Here’s a few tips that’ll help on exam day:
1. A strong internal medicine foundation is key!
Pediatrics has a lot in common with internal medicine when it comes to differential diagnosis and coming up with a treatment plan. Having a solid IM foundation will make many pediatric concepts feel more familiar and easier to work through clinically.
2. Know your congenital disorders.
Although you may not encounter many congenital conditions on your rotation due to their lower prevalence, they’re still heavily tested on the shelf exam. Be sure to thoroughly review the classic presentations and associated findings for these disorders.
3. Make sure you’re comfortable with frequently-tested topics.
Here’s a list of topics you’ll want to be familiar with for the pediatrics shelf exam:
Growth/Development
- Milestones
- Feeding schedule
- Normal growth/weight
- Regression
- Puberty staging (Tanner stages)
- Short stature algorithm
Neonates
- APGAR
- Hyperbilirubinemia/jaundice differential
- TORCH infections
- Screening
- Apnea
Cardiology
- Cyanotic heart disease – 5 Ts
- Acyanotic congenital lesions – VSD, ASD, PDA
- Murmurs – physiological, PDA, coarctation
- Rheumatic fever
- Kawasaki’s disease
- Endocarditis
Pulmonology
- Respiratory distress (NRDS, TTN, meconium aspiration, BPD)
- Congenital (cystic fibrosis, ciliary dyskinesia, TEF, choanal atresia)
- Wheezing by age
- Stridor differentiation (laryngomalacia, vascular ring, tracheomalacia )
- Asthma
- Epiglottis vs peritonsillar abscess vs retropharyngeal abscess
GI
- Bilious versus non bilious vomiting algorithm
- Hepatocellular versus cholestatic injury
- GI bleeds/blood in stool
- Tumors (Peutz-Jeghers, Osler–Weber–Rendu, plummer vinson, lynch, FAP, juvenile polyposis)
Renal
- Nephrotic/ nephritic syndromes
- UTI
- Peds HTN differential
- Stones
- Tumors (Wilms versus neuroblastoma, Beckwith-Wiedemann, WAGR, VACTERL)
- Anatomic abnormalities (PUV, reflux, atresia)
Endocrine/Genetics
- Diabetes
- Thyroid disease
- Congenital adrenal hyperaplasia
- Inborn errors of metabolism (glycogen storage disorders, lysosomal storage disorders, PKU, etc.)
Hemetology/Oncology
- Hemolytic disease of newborn
- Anemia
- Leukemia
- Childhood tumors
Neurology
- Seizures
- Hypotonia
- Headache red flags
- Meningitis
ID
- Febrile infant work up
- Vaccine schedule
- Pharyginitis
- Otitis media vs otitis externa
- Skin infections
Rheumatology
- Juvenile idiopathic arthritis
- Henoch-Schönlein purpura
- Systemic lupus erythematosus
Dermatology
- Neonatal rashes
- Seborrheic dermatitis
- Eczema
- Fungal infections
- Birthmarks (nevus simplex vs port-wine stain)
Ortho/MSK
- Development dysplasia of hip
- Clubfoot
- Transient synovitis versus septic arthritis
- Legg calve perthe versus SCFE
- Osgood schlatter
- Nursemaid’s elbow
- Bone tumors and cancers
Emergency
- Child abuse red flags
- Ingestion emergencies
- Anaphylaxis
Final Thoughts
Pediatrics challenges you to think beyond diagnosis and treatment and to truly engage with patients across every stage of development. While the learning curve can feel steep at times, each patient encounter is an opportunity to build confidence and clinical intuition. Use this guide and you’ll feel more prepared (and hence more confident) as you step into the rotation.
Good luck on peds, and be sure to reach out if you need any assistance!
