How to present on pediatrics rounds
Pediatric presentations change in two ways. The numbers are all per kilogram, and the audience often includes the parents, because many children's hospitals round at the bedside with the family. A good peds presentation is precise enough for the team and plain enough for the family to follow.
- Target
- 2 to 4 minutes on inpatient family-centered rounds
- Lead with
- Hydration, feeding and per-kilogram numbers
Here is the format, a word-for-word example from a fictional bronchiolitis admission, and the pearls and questions that come up on the wards.
What your attending listens for
Pediatric rounds often happen at the bedside with parents listening. Your attending wants hydration status, feeding and wet diapers, growth, and every number expressed per kilogram: mL/kg/hr for urine and mg/kg/day for medications.
The structure
Step 1: ID line and growth context
Age (in days, weeks or months under age 2), sex, gestational age at birth for children under 2, relevant history, and the presenting problem.
Step 2: Overnight and caregiver report
What the parents are worried about, oral intake (ounces or percent of usual feeds), wet diapers and stools, sleep and activity.
Step 3: Vitals and growth
Today's weight in kilograms and the change from admission, Tmax, heart and respiratory rates against age norms, oxygen saturation and where the oxygen wean stands.
Step 4: Exam, general first
General appearance (playful, consolable or toxic-appearing), work of breathing (retractions, nasal flaring), and hydration (mucous membranes, capillary refill, fontanelle).
Step 5: Labs and weight-based ins and outs
Urine output in mL/kg/hr (a goal of at least 1), total intake in mL/kg/day, and viral testing or labs.
Step 6: Plan by system or problem
Respiratory and oxygen weaning criteria, fluids and feeds (maintenance or bolus), medications in mg/kg, and discharge criteria.
A word-for-word example
Step 1: ID line and growth context
Leo is a 7-month-old boy born at 38 weeks, previously healthy, on hospital day 2 for RSV bronchiolitis with hypoxemia and dehydration.
Step 2: Overnight and caregiver report
Overnight he weaned from high-flow nasal cannula to half a liter by regular nasal cannula. He took 4 ounces of oral rehydration solution three times without vomiting and had 5 wet diapers. His mom says he is acting more like himself.
Step 3: Vitals and growth
He weighs 8.2 kilograms, up 100 grams from yesterday. Tmax 99.7°F, heart rate 132, respiratory rate 38, satting 97% on half a liter.
Step 4: Exam, general first
He is alert and smiling in his mom's arms, with mild subcostal retractions that are better than yesterday, moist mucous membranes, and capillary refill under 2 seconds.
Step 5: Labs and weight-based ins and outs
Urine output was 2.4 mL/kg/hr.
Step 6: Plan by system or problem
This is a 7-month-old with improving RSV bronchiolitis. For respiratory, we will trial him off oxygen this morning and watch him on room air. For fluids and nutrition, we will stop IV fluids and let him breastfeed or take formula as he wants. He can go home once he is comfortable on room air and drinking well.
Ward pearls
- Convert raw urine output to mL/kg/hr before rounds.
- On family-centered rounds, face the parents first, skip the jargon ("low oxygen," not "hypoxemia"), and ask for their input before you give the plan.
- For a neonate under 28 days, always include maternal GBS status, the delivery history and where the bilirubin plots.
- State concrete discharge criteria in every pediatric plan.
Classic pimp questions
- The AAP bronchiolitis guideline, and why albuterol, steroids and chest X-rays are not routine
- The PECARN head trauma rules, under age 2 and age 2 and older
- Kawasaki disease criteria (CRASH and Burn) and treatment with IVIG and aspirin
- The febrile infant workup by age: 8 to 21 days, 22 to 28 days, and 29 to 60 days
Not sure how to field them? How to take the questions
Practice it out loud
A script you have read is not one you can say. Present a fictional patient to an AI attending who cuts in, asks why, and grades you on a rubric, then drills whatever you missed.
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Other rotations
Educational content with fictional patients, not medical advice. Teams and institutions differ: follow your attending, your institution's protocols and current guidelines.