DEPARTMENT OF PAEDIATRICS

FACULTY OF MEDICINE, UKM

(FF4127)

_____________________________­­­­­____________

 

YEAR 4, GROUP 4, SESSION 2024/2025

 

Date: 14 APRIL 2025 – 16 JUN 2025

 

1. LECTURERS/SPECIALISTS

 

1. AP Dr. Shareena Ishak
2. AP Dr. Adli Ali
3. Doris Lau Sie Chong
4. Joyce Hong Soo Synn
5. Nur Azah Mohd Isa
6. Shyahlini Devi
7. Wan Nurulhuda Wan Md Zin
8. Wan Syanaz Wan Ghazali
9. Yang Wai Wai
10. Leela Mariappen
11. Farin Masra

 

2. INTRODUCTION

 

      During this 7-week paediatric posting, the students will be exposed to various aspects of clinical training in paediatric and neonatology including history taking, physical examination and assessment of developmental milestones.

 

1. PRE-REQUISITES

 

1. Good understanding of basic biomedical sciences
2. Basic history taking skills
3. Basic physical examination skills

 

 

1. COURSE LEARNING OUTCOMES

 

• General Paediatric Posting

At the end of the posting, the students should be able to:

1. Demonstrate the ability to take an adequate history
   • Realize and understand that history taking in paediatrics is usually from a care-giver rather than the patient.
   • Appreciate the importance and relevance of other aspects of the history such as birth, perinatal, developmental, immunisation, feeding, social and family histories.
2. Perform clinical examination of a child competently
   • Appreciate the need to modify the systematic examination depending on their age and ability to understand/cooperate.
   • Appreciate the relevance of clinical signs at different ages.
   • Applying and improving the basic clinical skills.
3. Demonstrate how basic growth parameters (weight, height/length and head circumference) are measured and how to interpret growth charts.
4. Discuss normal growth patterns and common growth problems.
5. Discuss the principles of infant nutrition and breast-feeding practices.
6. Describe the importance of developmental assessment in a child, the patterns of development (gross motor, fine motor and vision, hearing and speech/language, social and emotional) – to perform an appropriate and adequate developmental assessment and interpret the assessment appropriately.
7. Discuss the rationale of the current expanded programme for immunisation, describe the current immunisation schedule, routes of immunisation, side-effects and contraindications to immunisation.
8. Formulate provisional and differential diagnoses based on information obtained from the history and physical examination.
9. Correlate the clinical diseases with the knowledge of pathophysiology acquired.
10. Illustrate the importance of social aspects of disease – the child as a member of a family and community.
11. Utilize relevant investigations; interpret common laboratory results and radiological studies to confirm the diagnosis.
12. Formulate principles of management based on current evidence.
13. Demonstrate effective communication skills and convey information in a way that is understood by parents and the child.

 

• NICU Posting

1. Perform newborn screening examination.
2. Discuss normal primitive reflexes in a newborn.
3. Able to approach and manage common neonatal problems e.g. respiratory distress in term and pre-term newborns, jaundice, problems associated with infant of diabetic mothers, birth injuries, infection, cyanotic baby, convulsion, etc.
4. Discuss about infant feeding i.e. breastfeeding vs. formula feeding, feeding of term vs. preterm infants
5. Observe common procedures (e.g. blood sampling, lumbar puncture, insertion of umbilical venous and arterial catheters, instillation of surfactant) and explain briefly the (i) indications/contraindications, (ii) risks and (iii) preparation prior and after procedure.
6. Describe briefly how to operate and manage certain equipments, e.g. standard incubators, phototherapy, CPAP.

 

 

3. FOCUSED HISTORY TAKING

 

10.00 am – 11.00 am (after seminar)

Venue: Seminar Room 3, 3^rd Floor, HPKK

 

Cases	Dates	Supervisors
A child with prolonged fever	30/11/2023	Dr. Wan Nurulhuda WMZ
A child with gross motor delay	07/12/2023	Dr. Nur Azah MI
A child with puffy eyes	14/12/2023	Dr. Doris Lau
A child with bloody diarrhoea	21/12/2023	AP Dr. Adli Ali

 

Selected students will be given a scenario during the workshop. They are expected to perform a focused history taking from a simulated patient within a set time frame under direct observation by the supervisor-in-charge.

 

 

 

 

4. SEMINARS

Venue: Seminar Room 3, 3^rd Floor, HPKK

 

Students are required to prepare the presentations for the topics.

 

Topics	Date	Time	Supervisors
1.       Childhood immunisation	23/11/2023	8.00-9.30 am	Dr. Shyahlini Devi
2.       Principles of infant nutrition and breastfeeding (TBL)	30/11/2023	8.00-9.30 am	Dr. Joyce Hong
3.       Normal development	01/12/2023	9.30-11.00 am	Dr. Wan Syanaz Wan Ghazali
4.       Common respiratory problems	07/12/2023	8.00-9.30 am	Dr. Nur Azah Mohd Isa
5.       A child with gross motor delay	08/12/2023	9.30-11.00 am	Dr. Tan Jen Ern
6.       Renal problems * (Monday)	11/12/2023	10.00-11.30 am	Dr. Leela Mariappen
7.       The pale child (TBL)	14/12/2023	8.00-9.30 am	Dr. Doris Lau
8.       Vomiting & diarrhoea, assessment of dehydration/shock *	15/12/2023	9.30-11.00 am	Dr. Lee Pei Chuen
9.       Viral exanthems	21/12/2023	8.00-9.30 am	AP Dr. Adli Ali
10.   Neonatal jaundice (TBL)	22/12/2023	9.30-11.00 am	Dr. Farin Masra

*Case-based seminars

TBL – team-based learning

 

 

 

 

 

 

5. WEB-BASED ONLINE E-LEARNING MODULE

Access the online e-learning website of “Early Nutrition eAcademy Southeast Asia” via https://enea-sea.med.lmu.de/. Register online for a log-in access to:

• Breastfeeding and Complementary Feeding module: This module is to be completed prior to the “Principles of infant nutrition and breast-feeding” seminar. Upon completion of this self-learning module, a certification shall be generated from the website. The certificate (printed)/e-certificate (on mobile) will be verified on the day of the seminar.
• Breastmilk Substitutes module: This module is self-directed learning and can be completed during the NICU rotation.

 

 

6. WORKSHOP ON SKILLS IN COMMUNICATION

 

Venue: Seminar Room 3, 3^rd Floor, HPKK

Date/Time: 24/11/2023 (9.30 AM – 12.00 PM)

Lecturer: Dr. Wan Syanaz / Dr. Yang Wai Wai

SEMINAR TOPICS

Childhood immunization

 

Learning outcomes:

1. Recognise the importance of immunisation.
2. Discuss the types of immunity – active versus passive.
3. Explain the concept of herd immunity.
4. Explain the types of vaccines (e.g. live, killed, attenuated).
5. Describe the Malaysian Expanded Programme of Immunisation (EPI).
6. Discuss the rationale and timing of the various vaccines in the EPI.
7. Describe the routes of immunisation.
8. Discuss the contraindications (relative and absolute) to immunisation.
9. Discuss the side-effects of immunisation.

 

Normal development

 

Learning outcomes:

1. Explain the principles of development.
2. Describe normal childhood development (0-5 years old with emphasis on the first 2 years of life).
3. Discuss the factors that affect development.
4. Demonstrate the developmental assessment of a child.

** Video to be shown by students.

1. List the developmental assessment methods available.

 

Viral exanthems

 

Learning outcomes:

1. Describe the following aspects of common childhood exanthems with regards to:

• aetiological agents
• incubation period
• infectious period
• method of transmission
• clinical features
• associated complications
• management
• preventive measures

 

in the following diseases:

1. measles
2. mumps
3. rubella
4. varicella
5. hand-foot-mouth
6. roseola infantum

1. erythema infectiosum (fifth disease)

 

Please include photographs of the relevant rash in your presentation.

 

Neonatal jaundice (TBL)

 

Learning outcomes:

1. Describe bilirubin metabolism.
2. Discuss the causes of conjugated and unconjugated hyperbilirubinaemia.
3. Define prolonged jaundice and list the causes.
4. Plan a systematic diagnostic approach to a neonate with jaundice from the history, physical examination and appropriate laboratory investigations.
5. Discuss the complications of severe unconjugated hyperbilirubinaemia.
6. Discuss the various methods of treatment:
   1. phototherapy – mechanism of treatment, principles of treatment, complications
   2. exchange transfusion – principles, complications

 

Renal problems

 

Learning outcomes:

1. Explain the pathophysiology of oedema in nephrotic syndrome and acute glomerulonephritis.
2. Discuss the following conditions with regards to the clinical features (history & physical examination) and laboratory investigations:

• nephrotic syndrome
• acute glomerulonephritis
• urinary tract infection

 

3. Describe the complications of the diseases above. Formulate short and long-term management plans.

 

 

 

Principles of infant nutrition and breastfeeding (TBL)

 

Learning outcomes:

1. Nutritional requirement of infants – volume, calorie.
2. Breastfeeding

            –     Content and nutritional composition of breast milk

            –     Differences between breast milk and commercial milk

• Benefits of breastfeeding (nutritional & non-nutritional)
• How to breastfeed (when to start, how frequent)
• Problems associated with breastfeeding and how to overcome them (inadequate milk, sore nipples, etc)
• Conditions in which breastfeeding is contraindicated
• Collection & storage of breast milk

1. Bottle feeding

• Content of commercial milk (infant formula)
• Milk for specific conditions (what is available, indications, special features)
• premature formula
• “anti-reflux”
• lactose-free milk
• soy-based milk
• How to prepare milk feed
• Bottle hygiene

 

1. Complementary feeding

• When to introduce
• How to start
• What types of food should be given

 

       * Students are reminded to complete the e-learning online (Breastfeeding and Complementary Feeding module) prior to the seminar and show their certificate of completion (printed or on mobile) when attending this seminar.

 

 

 

A child with gross motor delay

 

Learning outcomes:

1. Recognise early warning signs in a child with gross motor delay.
2. Identify common aetiologies of gross motor delay.
3. Compare the differences in physical findings and aetiologies of UMNL and LMNL by anatomic and physiologic approach.

 

 

 

 

 

 

Common respiratory problems

 

Learning outcomes:

1. Describe the common respiratory symptoms and signs in children:

• cough and coryza
• wheezing
• stridor
• respiratory distress

 

1. Discuss the following conditions with regards to the definition, pathogenesis, pathophysiology, clinical features and the principles of management:

• upper respiratory tract infections
• asthma
• bronchiolitis
• pneumonia
• croup
• acute epiglotitis

 

 

Vomiting & diarrhoea, assessment of dehydration and shock

 

Learning outcomes:

1. Identify the causes of diarrhoea and vomiting.
2. Differentiate between infective versus non-infective causes.
3. Classify the severity of dehydration.
4. Formulate the emergency management of hypovolaemic shock.
5. Determine fluid therapy after initial resuscitation (type & volume).

 

 

The pale child

Learning outcomes:

1. Define anaemia and recognise that the normal range of haemoglobin values and the composition of haemoglobin in infancy changes with age and is different from adults.
2. List the common causes of anaemia in children, using a systematic classification of the types of anaemia.
3. Explain the relationship between the pathophysiology, clinical presentation and laboratory findings of conditions presenting with anaemia.
4. Plan a systematic diagnostic approach to a child with pallor from the history, physical examination and appropriate laboratory investigations.
5. Describe the effects of both the disease and its treatment. Formulate short and long-term management plans.

 

 

 

 

 

 

 

 

 

 

 

Prerequisites

 

1. Students will only be eligible to sit for the end-of-posting OSCE and end-of-semester examination if their ATTENDANCE is 100% for all teaching-learning activities.

 

1. Has submitted their log book and case report.

	Core Clinical Component
Continuous Assessment	Case report					30%
	Logbook
	Participation in group discussion
	Seminars/TBLs
	CBD
	MINI-CEX
Theory	OBA / EMQ / KFQ					35%
Clinical	Unmanned OSCE					35%
	Manned OSCE
TOTAL					100%

 

 

Passing criteria

 

In order to pass the module, student must pass the continuous asseSSment and each component of the semester exam.

 

 

RECOMMENDED TEXTBOOKS

 

1. Tom Lissaeur, Will Carroll (2021) Illustrated Textbook of Paediatrics; 6^th edition; Elsevier.
2. Mary Rudolf, Anthony Luder, Kerry Jeavons (2020) Essential Paediatrics and Child Health; 4^th edition; Wiley-Blackwell.
3. Sunil Sinha, Lawrence Miall, Luke Jardine (2017) Essential Neonatal Medicine; 6^th edition; Wiley-Blackwell. 
4. Lee Way Seah, Tay Chee Geap, Lum Su Han (2019) Textbook of Paediatrics and Child Health; University of Malaya Press.

 

REFERENCE BOOK

 

1. Karen J Marcdante, Robert M Kliegman, Abigail M Schuh (2022) Nelson Essentials of Pediatrics; 9^thedition; Elsevier.