Well-child flow

Age-based screening, development, nutrition, elimination, sleep, hearing/vision, oral health, safety, mental health, school, sports, and vaccine review should be built into every preventive visit.

Growth and development

Interpret weight, length/height, BMI, head circumference, puberty timing, and milestone concerns in the context of feeding, genetics, psychosocial environment, and chronic disease.

Behavior and mental health

Screen for ADHD, mood symptoms, anxiety, school function, autism concerns, sleep disorders, trauma, and family stressors early and repeatedly.

Fever and dehydration

Age, appearance, hydration status, urine output, respiratory work, and immunization status drive how aggressive your workup and disposition need to be.

Wheezing and bronchiolitis

Separate bronchiolitis, asthma/reactive airway disease, pneumonia, and foreign body aspiration by age, exam, oxygen need, and response to bronchodilator trials when appropriate.

ENT and skin infections

Look for toxicity, airway issues, mastoiditis, orbital involvement, rapidly spreading skin disease, and when imaging or hospital care is needed.

GI illness

Vomiting, diarrhea, constipation, abdominal pain, appendicitis, intussusception, pyloric stenosis, and obstruction each have age-linked patterns and different escalation points.

Bronchiolitis

Pathophysiology: Viral inflammation of the small airways, usually RSV in infants, causes edema, mucus plugging, and increased work of breathing.

Diagnosis: Clinical diagnosis in the right age group with wheeze, crackles, tachypnea, retractions, and feeding difficulty; test only when another diagnosis is suspected.

First-line treatment: Supportive care with nasal suction, hydration, and oxygen if needed.

Second-line treatment: Escalate to hospital care for apnea, hypoxemia, dehydration, or exhaustion; bronchodilators and steroids are not routine unless another process is present.

Asthma

Pathophysiology: Chronic airway inflammation and hyperresponsiveness produce episodic bronchospasm, mucus, and variable airflow limitation.

Diagnosis: Symptom pattern, triggers, spirometry when age-appropriate, and response to bronchodilator therapy; young children may need a therapeutic trial.

First-line treatment: Albuterol (ProAir HFA/Proventil/Ventolin) for rescue and inhaled corticosteroid therapy such as budesonide (Pulmicort) or budesonide-formoterol (Symbicort) for control when persistent disease is present.

Second-line treatment: Add montelukast (Singulair) for selected patients, or use oral prednisone (Deltasone) for moderate/severe exacerbations with an asthma action plan.

Croup

Pathophysiology: Viral laryngotracheitis causes subglottic edema, barky cough, hoarseness, and inspiratory stridor.

Diagnosis: Clinical diagnosis by the classic barky cough and stridor, with severity based on work of breathing and ability to speak or drink.

First-line treatment: Dexamethasone (Decadron) is the core treatment, with cool humidified air and calming measures.

Second-line treatment: Nebulized racemic epinephrine for moderate/severe stridor with observation for rebound symptoms and hospital care when needed.

Community-acquired pneumonia

Pathophysiology: Viral, atypical, or bacterial infection causes alveolar inflammation, impaired gas exchange, and fever with cough or chest pain.

Diagnosis: Clinical assessment plus chest x-ray when the diagnosis or severity is uncertain; consider pulse oximetry and viral testing.

First-line treatment: Amoxicillin (Amoxil) for typical bacterial pneumonia in many outpatient cases.

Second-line treatment: Azithromycin (Zithromax) for atypical coverage or amoxicillin-clavulanate (Augmentin) when broader bacterial coverage is needed.

Acute otitis media

Pathophysiology: Eustachian tube dysfunction allows middle-ear fluid retention and bacterial overgrowth after a viral URI.

Diagnosis: Bulging tympanic membrane, middle-ear effusion, otalgia, and fever; recurrent disease changes management and follow-up.

First-line treatment: Amoxicillin (Amoxil) when antibiotics are indicated, plus analgesics.

Second-line treatment: Amoxicillin-clavulanate (Augmentin) or cefdinir (Omnicef) for recent amoxicillin exposure, conjunctivitis-otitis syndrome, or treatment failure.

Streptococcal pharyngitis

Pathophysiology: Group A Streptococcus causes acute tonsillopharyngitis and can lead to rheumatic fever if untreated.

Diagnosis: Rapid antigen detection test and/or throat culture based on age and clinical risk, with Centor-like features helping decide testing.

First-line treatment: Penicillin V or amoxicillin (Amoxil) are standard options.

Second-line treatment: Cephalexin (Keflex), azithromycin (Zithromax), or clindamycin (Cleocin) when allergy or adherence issues change the plan.

Impetigo

Pathophysiology: Superficial bacterial infection, commonly Staphylococcus aureus or Streptococcus pyogenes, produces honey-colored crusts or bullae.

Diagnosis: Usually clinical; culture is helpful for recurrent, extensive, or MRSA-suspected disease.

First-line treatment: Mupirocin (Bactroban) for limited disease and hygiene measures.

Second-line treatment: Cephalexin (Keflex) or dicloxacillin (Dynapen), with TMP-SMX (Bactrim DS) or clindamycin (Cleocin) when MRSA is a concern.

Cellulitis

Pathophysiology: Dermal and subcutaneous bacterial infection causes warmth, tenderness, edema, and progressive erythema.

Diagnosis: Clinical exam, with ultrasound if abscess is uncertain and labs when systemic illness is present.

First-line treatment: Cephalexin (Keflex) or amoxicillin-clavulanate (Augmentin) depending on likely source and location.

Second-line treatment: Clindamycin (Cleocin), TMP-SMX (Bactrim DS), or linezolid (Zyvox) when MRSA risk or treatment failure is present.

Viral gastroenteritis and dehydration

Pathophysiology: Viral intestinal infection leads to vomiting/diarrhea, fluid loss, and electrolyte imbalance.

Diagnosis: Clinical assessment of hydration, urine output, perfusion, weight change, and red flags such as bilious emesis or bloody stool.

First-line treatment: Oral rehydration solution and ondansetron (Zofran) when vomiting blocks oral intake.

Second-line treatment: IV fluids and inpatient monitoring for severe dehydration, altered mental status, or inability to maintain hydration.

Constipation

Pathophysiology: Stool withholding, low fiber/fluid intake, and painful defecation create a cycle of retention and impaction.

Diagnosis: History of infrequent, hard, painful stools, stool soiling, abdominal pain, and a rectal or abdominal exam when indicated.

First-line treatment: Polyethylene glycol 3350 (MiraLAX) and behavioral toileting routines.

Second-line treatment: Lactulose (Enulose), senna (Senokot), or docusate (Colace) depending on age, severity, and cleanout need.

Appendicitis

Pathophysiology: Luminal obstruction causes progressive inflammation, ischemia, and perforation risk.

Diagnosis: Migratory abdominal pain, RLQ tenderness, fever, leukocytosis, and ultrasound or CT when the diagnosis is unclear.

First-line treatment: NPO, IV fluids, ceftriaxone (Rocephin), and metronidazole (Flagyl) while arranging surgical evaluation.

Second-line treatment: Appendectomy and inpatient antibiotics if perforation or abscess is present.

Intussusception

Pathophysiology: One bowel segment telescopes into another, causing obstruction and potential ischemia, classically in infants and toddlers.

Diagnosis: Episodic severe abdominal pain, vomiting, currant-jelly stool, and ultrasound showing a target sign.

First-line treatment: Air or contrast enema reduction when stable and without perforation signs.

Second-line treatment: Surgical management for failed enema reduction, peritonitis, or perforation.

Urinary tract infection

Pathophysiology: Ascending bacterial infection of the urinary tract may involve the bladder or kidneys, especially with voiding dysfunction or reflux.

Diagnosis: Urinalysis and urine culture; in febrile infants, a careful source evaluation matters because occult pyelonephritis can be serious.

First-line treatment: Cephalexin (Keflex) or cephalexin-class oral therapy when uncomplicated and susceptible.

Second-line treatment: TMP-SMX (Bactrim DS), cefdinir (Omnicef), or ciprofloxacin (Cipro) only when age, resistance, and severity make it appropriate.

Atopic dermatitis

Pathophysiology: Skin-barrier dysfunction and type 2 inflammation cause chronic pruritic eczema with flares from irritants and allergens.

Diagnosis: Clinical diagnosis based on pruritus, flexural or age-patterned eczema, xerosis, and recurrent flares.

First-line treatment: Emollients and topical corticosteroids such as hydrocortisone 2.5% or triamcinolone (Kenalog) based on severity and location.

Second-line treatment: Topical tacrolimus (Protopic) or pimecrolimus (Elidel), with infection treatment and trigger control when disease is refractory.

Iron deficiency anemia

Pathophysiology: Inadequate iron intake, excess milk intake, blood loss, or growth demands lead to microcytic anemia and impaired oxygen delivery.

Diagnosis: CBC, ferritin, iron studies, dietary history, and blood-loss evaluation when indicated.

First-line treatment: Oral ferrous sulfate (Feosol/Fer-In-Sol) with dietary iron counseling.

Second-line treatment: Ferrous gluconate (Fergon) or IV iron when oral therapy fails, is not tolerated, or malabsorption is present.

ADHD

Pathophysiology: Neurodevelopmental differences in attention, executive function, and impulse regulation produce school and home impairment.

Diagnosis: Multi-setting symptom history with Vanderbilt or similar rating scales and assessment for learning, sleep, mood, or trauma contributors.

First-line treatment: Methylphenidate (Ritalin/Concerta) or amphetamine-dextroamphetamine (Adderall) when stimulant therapy is appropriate.

Second-line treatment: Atomoxetine (Strattera), guanfacine ER (Intuniv), or clonidine ER (Kapvay) for stimulant intolerance or selected symptom patterns.

Autism spectrum / developmental delay

Pathophysiology: Neurodevelopmental differences affect social communication, sensory processing, behavior, and adaptive function; specific etiology may be genetic or multifactorial.

Diagnosis: Developmental surveillance, screening tools, speech/language and hearing evaluation, and referral for formal developmental assessment when concerns are present.

First-line treatment: Early intervention, speech/occupational therapy, behavioral supports, and family coaching.

Second-line treatment: Risperidone (Risperdal) or aripiprazole (Abilify) may be used for severe irritability or aggression under specialist guidance.

Type 1 diabetes

Pathophysiology: Autoimmune beta-cell destruction causes absolute insulin deficiency, weight loss, and risk for DKA.

Diagnosis: Hyperglycemia with symptoms, ketosis, A1c, glucose, ketones, and C-peptide or autoantibodies when classification is uncertain.

First-line treatment: Basal-bolus insulin with glargine (Lantus/Basaglar) plus rapid-acting insulin lispro (Humalog) or aspart (NovoLog).

Second-line treatment: Diabetes education, CGM such as Dexcom G7 or FreeStyle Libre, insulin pump therapy, and DKA prevention planning.

Febrile seizures

Pathophysiology: Fever lowers seizure threshold in neurologically normal young children, usually during a viral illness.

Diagnosis: Age-appropriate febrile seizure history with evaluation for the fever source and red flags for meningitis or CNS infection.

First-line treatment: Supportive fever management and rescue benzodiazepine such as diazepam (Diastat) or intranasal midazolam (Nayzilam) if prolonged seizure occurs.

Second-line treatment: Hospital evaluation and broader neurologic/infectious workup when the seizure is prolonged, focal, recurrent in the same illness, or accompanied by concerning exam findings.

Obesity

Pathophysiology: Childhood obesity reflects energy imbalance, genetics, sleep, environment, and metabolic risk, and it raises the chance of dyslipidemia, hypertension, and insulin resistance.

Diagnosis: BMI-for-age percentile, growth pattern review, blood pressure, sleep history, and screening for complications such as A1c or lipids when indicated.

First-line treatment: Family-based nutrition, activity, and sleep interventions with behavior change support.

Second-line treatment: Obesity medicine referral and, in selected adolescents, medication strategies such as liraglutide (Saxenda) or semaglutide (Wegovy) with careful monitoring.