Paediatric emergencies account for 30 questions (16.7%) in the FRCEM SBA, making SLO 5 one of the most heavily weighted domains. Yet it's where most adult emergency medicine trainees feel least confident.
The challenge is real: you've spent years managing adult presentations, and suddenly you're expected to know weight-based drug dosing, developmental milestones, and safeguarding nuances—all at consultant level.
This guide breaks down the highest-yield SLO 5 topics that actually appear in FRCEM questions.
Why SLO 5 Feels Difficult
Most EM trainees come from adult medicine backgrounds. Paediatrics represents a different clinical language: vital signs vary by age, drug doses require calculations, and seemingly minor presentations can represent serious pathology.
The good news: SLO 5 topics follow predictable patterns. Master the core presentations and you'll recognize variations in exam questions.
The Febrile Child: NICE Traffic Light System
Every FRCEM candidate must know the NICE fever in under 5s guideline. Questions present clinical scenarios requiring risk categorization and appropriate management.
Risk Categorization & Management
Risk Level | Clinical Features | Management Strategy |
|---|---|---|
Green (Low) | Normal color, activity, and hydration. Responds normally to social cues. Strong cry or not crying. | Home care with safety-netting advice. |
Amber (Intermediate) | Reduced activity, not responding normally to cues. Decreased urine output, dry mucous membranes, poor feeding (infants), or fever ≥5 days. | Face-to-face assessment. Consider investigations. Safety-netting is essential. |
Red (High) | Reduced consciousness, pale/mottled/ashen appearance, weak continuous cry, grunting, RR >60/min, non-blanching rash, bulging fontanelle, neck stiffness, or focal neurological signs. | Urgent assessment. Full septic screen (bloods, urine, consider LP). Consider admission and parenteral antibiotics. |
FRCEM Question Angles
Questions test correct risk categorization, investigation pathways, when to give antibiotics, and when admission is mandatory.
Critical point: Any infant under 3 months with fever ≥38°C is high risk regardless of appearance. This requires full septic workup and admission.
Weight-Based Drug Dosing
FRCEM questions will provide the child's weight and clinical scenario. You must calculate the correct dose or recognize incorrect dosing in the multiple-choice options.
6 Essential Emergency Doses to Memorize
Drug | Indication | Dose Calculation | Maximum Dose |
|---|---|---|---|
Paracetamol | Analgesia/Antipyretic | Loading: 20mg/kg. Maintenance: 15mg/kg (every 4-6 hrs) | 90mg/kg/day or 4g/day |
Ibuprofen | Analgesia/Antipyretic | 10mg/kg (every 6-8 hrs) | 40mg/kg/day |
Adrenaline | Anaphylaxis | 10 micrograms/kg IM (0.01ml/kg of 1:1000) | 500 micrograms (0.5ml) |
Fluid Bolus | Shock | 20ml/kg of 0.9% sodium chloride | Repeat up to 40-60ml/kg if ongoing |
Ceftriaxone | Meningitis | 80mg/kg IV/IM | 4g |
Lorazepam | Status Epilepticus | 0.1mg/kg IV | 4mg |
Dexamethasone | Croup | 0.15mg/kg oral (usually 150 micrograms/kg) | N/A |
Calculation tip for the exam: If a 15kg child needs maintenance paracetamol, the math is simply 15 × 15 = 225mg.
Safeguarding Red Flags
Safeguarding contributes 5-7 questions within SLO 5. The FRCEM tests your ability to recognize concerning patterns, not to act as a forensic detective.
Physical Abuse Indicators
Concerning injury patterns:
Bruising in non-mobile infants (pre-cruising babies shouldn't have bruises)
Bruising to soft tissues: ears, neck, genitals, buttocks
Pattern bruising: hand marks, bite marks
Multiple injuries at different healing stages
Injuries inconsistent with developmental stage or history
Delay in seeking medical attention
Fractures raising concern:
Rib fractures (especially posterior)
Metaphyseal fractures
Fractures in non-mobile infants
Multiple fractures at different stages
Burns
Clear demarcation lines (immersion)
Symmetrical distribution
Glove and stocking pattern
Burns to genitals, buttocks, soles
Delay in presentation
Actions When Concerned
Ensure child safety (admit if immediate risk)
Document thoroughly
Senior ED review
Contact safeguarding team
Consider skeletal survey (under 2 years, suspected physical abuse)
Remember: You don't diagnose abuse—you recognize concern and escalate appropriately.
Respiratory Emergencies
Croup
Presentation: Barking cough, inspiratory stridor, hoarse voice. Ages 6 months-3 years, worse at night.
Management:
Oral dexamethasone 0.15mg/kg (single dose)
Nebulized adrenaline if severe (5ml of 1:1000)
Observe 2-4 hours post-adrenaline
Bronchiolitis
Presentation: Under 12 months, coryzal symptoms, cough, wheeze, respiratory distress, feeding difficulties.
Management:
Supportive care only
Oxygen if SpO2 <92%
NG/IV fluids if not feeding
Admission if high-risk or moderate-severe distress
Important: No salbutamol, steroids, or antibiotics in uncomplicated bronchiolitis.
Asthma Exacerbation
Severity:
Moderate: SpO2 ≥92%, talking in sentences
Severe: SpO2 <92%, too breathless to talk, HR >140 (age 2-5) or >125 (>5 years)
Life-threatening: Silent chest, poor respiratory effort, altered consciousness
Management:
Oxygen to maintain SpO2 94-98%
Salbutamol (10 puffs via spacer or nebulizer)
Oral prednisolone: 20mg (2-5 years), 30-40mg (>5 years)
IV magnesium if severe/life-threatening.
Developmental Milestones
The FRCEM occasionally tests whether a child's development is appropriate for their age, primarily to assess if an injury is consistent with their physical capabilities.
Key milestones:
6 weeks: Social smile, fixes and follows
6-9 months: Sits unsupported, stranger anxiety
12 months: Stands with support, says "mama/dada"
18 months: Walks independently, several words
2 years: Runs, 2-3 word sentences
3 years: Pedals tricycle, 3-word sentences
Use: Recognizing developmental delay, assessing whether injury consistent with developmental stage.
Common FRCEM SLO 5 Mistakes
1. Not recognizing age <3 months + fever as high risk
Regardless of appearance, infants under 3 months with fever ≥38°C require full workup and admission.
2. Treating bronchiolitis with salbutamol
Bronchiolitis is viral. Salbutamol doesn't work. Management is supportive only.
3. Missing safeguarding red flags
Non-mobile infants shouldn't have bruises. Inconsistent history is a red flag. When in doubt, escalate.
4. Weight-based dosing errors
Always calculate doses. Don't guess. Check maximum doesn't exceed adult doses.
5. Forgetting traffic light nuances
A child can look well but still be amber/red risk based on specific features (age <3 months, fever >5 days, reduced urine).
SLO 5 Preparation Strategy
Focus areas:
Master traffic light system thoroughly
Memorize 8-10 essential weight-based doses
Understand safeguarding red flags
Know respiratory emergency management
Practice volume: Given SLO 5 represents 30 questions (16.7%), approximately 300-400 paediatric questions during your preparation ensures adequate exposure.
Frequently Asked Questions
Do I need a paediatrics textbook?
If paediatrics is a weak area, "Paediatric Emergency Medicine" by Cameron et al. is excellent. Otherwise, focused SLO 5 question practice with good explanations suffices.
What if I've never worked in paediatric ED?
Many successful candidates haven't. Focus on guideline-based learning (NICE, APLS) and systematic question practice.
Are paediatric vital signs tested?
Not explicitly, but you need to recognize abnormal vital signs for age when assessing severity.
Should I memorize all weight-based doses?
Memorize the 8-10 most common emergency drugs. FRCEM doesn't expect every paediatric drug dose.
How many SLO 5 questions should I practice?
Approximately 300-400 paediatric questions ensures comprehensive exposure to patterns.
SLO 5 feels daunting because it represents unfamiliar territory for most adult EM trainees. However, the topics tested follow predictable patterns: febrile child assessment, safeguarding recognition, respiratory emergencies, and weight-based dosing.
Master the traffic light system, learn essential drug doses, recognize safeguarding red flags, and understand common respiratory presentations. These core areas account for 25+ of the 30 SLO 5 questions.
Systematic question practice builds pattern recognition faster than textbook reading alone. Seeing how FRCEM presents paediatric scenarios teaches you what to look for.
Ready to master SLO 5 with targeted paediatric question practice? Register with StudyFRCEM for comprehensive SLO-mapped questions covering all high-yield paediatric topics.
