Which dengue warning signs most reliably justify admission in a child who still looks haemodynamically stable?
Admit a child with suspected dengue if there is any WHO warning sign, even if they are currently haemodynamically stable; the warning signs most likely to justify admission are clinical fluid accumulation, rising haematocrit with a rapid platelet fall, persistent vomiting, and mucosal bleeding because these are more pr
How should I use serial haematocrit and platelet trends to time escalation in a hospitalised child with dengue?
Trend haematocrit serially with the child’s haemodynamic state and urine output, not in isolation; a rising haematocrit with a rapidly falling platelet count is a warning sign for plasma leakage and should prompt closer monitoring and escalation before shock develops. Platelet count alone is a poor trigger for interven
What supportive care best maintains hydration in a child with HFMD who refuses to drink from mouth pain?
Give effective analgesia first, then use frequent small-volume oral rehydration. If mouth pain is controlled, most children with HFMD can maintain hydration without IV fluids. - Paracetamol (acetaminophen) for pain/fever to improve oral intake; use the labelled weight-based paediatric dose and a proper dosing syringe/c
Which neurological signs in HFMD should prompt urgent referral for possible enterovirus 71 complications?
Refer urgently today if HFMD is accompanied by any neurological sign suggesting CNS involvement — especially myoclonic jerks/startle, ataxia/unsteady gait, tremor, cranial nerve signs, seizure, reduced consciousness/lethargy, or acute limb weakness. In EV71, these can precede rapid brainstem encephalitis and cardioresp
Which infants should receive nirsevimab in their first RSV season?
Give nirsevimab to infants aged <8 months who are born during or entering their first RSV season if they are not protected by maternal RSV vaccination. In practice, that means eligible first-season infants whose pregnant parent did not receive RSV vaccine, whose vaccination status is unknown, or who were born ≤14 days
What is the correct nirsevimab dose and how is it administered in a child over 8 months?
Do not give nirsevimab to a child over 8 months old for their first RSV season. For first-season prophylaxis, nirsevimab is for infants <8 months old; the dose is 50 mg IM once if <5 kg or 100 mg IM once if ≥5 kg. - If the child is 8 months old and this is truly their first RSV season: nirsevimab is generally not indic
Which baseline metabolic tests are appropriate in an adolescent with obesity and acanthosis nigricans?
Order baseline screening for dysglycaemia, dyslipidaemia, and fatty liver disease now. In an adolescent with obesity + acanthosis nigricans, the minimum practical baseline panel is fasting plasma glucose and/or HbA1c, fasting lipid profile, and ALT; add AST if doing liver tests locally. - Acanthosis nigricans is a clin
How should I evaluate a child with obesity and suspected polycystic ovary syndrome features?
Assess for true adolescent PCOS criteria first, not ovarian ultrasound alone. In a child/adolescent with obesity and suspected PCOS features, confirm pubertal stage and years since menarche, document clinical/biochemical hyperandrogenism, and exclude mimics before labelling PCOS. - Rapid virilisation: voice deepening,
How do I clinically distinguish measles from other viral exanthems in a febrile child?
Use the triad of fever + the 3 Cs (cough, coryza, conjunctivitis) + cephalocaudal confluent maculopapular rash to clinically suspect measles; look specifically for Koplik spots because they are the most useful distinguishing sign before or at rash onset. Isolate immediately if measles is suspected, because clinical dis
What are the notification and isolation requirements when I suspect measles in a child in Malaysia?
Isolate immediately with airborne precautions and notify the case urgently through the MOH communicable disease pathway the same day; do not wait for laboratory confirmation if measles is clinically suspected. - Mask the child, separate from other patients, and minimise time in shared waiting areas because measles is h
