Saudi Board Pediatrics Part 1 Complete Review Guide 2026–2027

4. Unexplained short stature in a girl needs a karyotype for Turner syndrome; at diagnosis, image the heart for coarctation and bicuspid aortic valve.
5. Screen for GH deficiency with IGF-1 and IGFBP-3; confirm with GH stimulation testing.
6. GH therapy complications include slipped capital femoral epiphysis and idiopathic intracranial hypertension.
7. Precocious puberty: basal ultrasensitive LH separates central from peripheral. Central precocious puberty in boys always needs brain MRI. Treat with a long-acting GnRH agonist.
8. In undernutrition, weight falls first, then length, while head circumference is spared.
9. Social smile by 6–8 weeks; stranger anxiety around 9 months; independent walking is normal up to about 18 months.
10. At 12 months: first steps, neat pincer grasp, one word plus specific mama/dada. At 24 months: two-word phrases and two-step commands.
11. Strangers understand about 75% of speech at 3 years and nearly all at 4. At 4 years a child hops on one foot and copies a cross.
12. Hand preference before 12 months is a red flag, often meaning hemiplegic cerebral palsy.
13. DQ = developmental age ÷ chronological age × 100; below 70 is significant delay. Loss of acquired skills argues against cerebral palsy.
14. Refer a delayed child to early intervention now; do not wait for genetic results.
15. AAP recommends a standardised developmental screen at 9, 18 and 30 months, and autism screening at 18 and 24 months.
16. Hearing 1-3-6 goal: screen by 1 month, diagnose by 3 months, intervene by 6 months.
17. Breastfed infants need vitamin D 400 IU daily from the first days, and iron 1 mg/kg/day from 4 months until iron-rich foods are established.
18. Cow's milk protein allergy: extensively hydrolysed formula first; amino acid formula for severe cases. If breastfed, the mother avoids dairy.
19. WHO severe acute malnutrition: MUAC <115 mm, weight-for-height <−3 SD or bilateral oedema. Stabilise with F-75 and advance slowly to avoid refeeding syndrome.
20. Holliday–Segar daily: 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, 20 mL/kg for each kg above 20.
21. Mild to moderate dehydration: ORS 50–100 mL/kg over 4 hours; one dose of ondansetron if vomiting. Zinc 20 mg daily for 10–14 days (10 mg under 6 months).
22. Hyponatraemic seizure: 3% saline 2 mL/kg (max 100 mL) over 10 minutes, repeated if needed.
23. Hyperkalaemia with ECG changes: IV calcium gluconate first, then insulin–dextrose and salbutamol to shift potassium; dialysis removes it.
24. Suspected abuse under 2 years needs a full skeletal survey; under 6 months also needs neuroimaging even if neurologically normal, plus a dilated retinal exam.

Common mistakes in this chapter

• ✕ Low IGF-1 is often read as GH deficiency, but it also falls in malnutrition and hypothyroidism, so it is not diagnostic alone.
• ✕ Obesity with short stature is often called simple obesity. Dietary obesity usually comes with tall stature; falling height points to an endocrine cause.
• ✕ Starting thyroxine before hydrocortisone in hypopituitarism is wrong; it can trigger adrenal crisis. Replace cortisol first.
• ✕ Judging a preterm infant by chronological age shows false delay. Use corrected age until about 2 years.
• ✕ Isolated speech delay with good social communication is sometimes sent for autism work-up first. Formal hearing assessment comes first.
• ✕ Fast correction of hypernatraemia with hypotonic fluid causes cerebral oedema. Lower sodium by no more than 10–12 mmol/L per 24 hours.
• ✕ A normal anogenital exam is often taken to exclude sexual abuse. Over 90% of abused children have normal findings; the disclosure is the key evidence.
• ✕ Pyloric stenosis is treated as an immediate surgical emergency. Correct dehydration, alkalosis, chloride and potassium before surgery.