Pediatrics for Family Medicine Boards: A Strategic Study Approach

Pediatrics is one of the trickier domains on the ABFM because the amount of pediatric exposure in family medicine residency varies enormously. Some programs have a robust pediatrics block; others fit it into a few rotations. Many residents finish PGY-3 feeling genuinely confident in adult medicine and uncertain about kids.

The good news is that ABFM pediatric content is quite predictable. It tests the child you will actually see in your future clinic, not zebras. Here's how to cover it strategically.

The Pediatric ABFM Blueprint

Pediatric questions touch roughly 10-12% of the exam, clustered around:

- Well-child care and developmental milestones - Immunizations - Common acute illnesses (otitis media, strep pharyngitis, bronchiolitis, UTI) - Behavioral and mental health (ADHD, autism screening, adolescent depression) - Growth and nutrition - Anticipatory guidance and safety counseling

Notice what's absent: complex cardiac lesions, rare metabolic disorders, specific pediatric subspecialty content. Those belong on ABP, not ABFM.

Well-Child Care: Bright Futures Schedule

Know the schedule by memory:

- Newborn: 3-5 days - First year: 1, 2, 4, 6, 9, 12 months - Second year: 15, 18, 24, 30 months - After 3: annually

Screenings to recognize: - Autism: M-CHAT at 18 and 24 months - Depression: annual beginning age 12 (USPSTF) - Lead: at 12 and 24 months (if Medicaid or high-risk) - Vision: objective screening starting ~3 years - Hearing: at birth, then periodic - Dyslipidemia: universal screening 9-11 and 17-21 (AAP)

Developmental Milestones: What ABFM Tests

You don't need to memorize the entire developmental chart. You need to know the red-flag milestones that warrant referral:

- 2 months: social smile - 4 months: laughs, holds head up - 6 months: rolls both directions, sits with support - 9 months: sits without support, transfers objects - 12 months: pulls to stand, first words, pincer grasp - 18 months: walks independently, 10-20 words, follows 1-step commands - 24 months: 2-word phrases, 50+ words, runs - 3 years: 3-word sentences, follows 2-step commands, rides tricycle - 4 years: tells stories, hops, dresses with minimal help

A 24-month-old with <50 words or no 2-word phrases → refer for evaluation.

Immunizations (Memorize the Controversial Ones)

Standard schedule is usually intuitive. The ones ABFM loves to test:

- HPV: starts age 9; 2-dose series if started before 15, 3-dose if 15+ - MenACWY: age 11-12, booster at 16 - MenB: shared clinical decision-making, age 16-23 - Tdap: every pregnancy, 27-36 weeks gestation (regardless of prior vaccination) - Flu: annually ≥6 months - COVID: current ACIP recommendations (check for latest before exam) - RSV: maternal vaccination (32-36 weeks during RSV season) or infant monoclonal (nirsevimab)

True contraindications (not "precautions"): - Anaphylaxis to a vaccine component - Severe combined immunodeficiency (live vaccines) - Pregnancy (live vaccines)

Common Acute Conditions

Acute Otitis Media Diagnosis: bulging TM + effusion + symptoms. Just red ≠ AOM.

Observation option: mild symptoms, age ≥2, reliable follow-up. Otherwise: - First-line: amoxicillin 80-90 mg/kg/day - Treatment failure at 48-72 hr: amoxicillin-clavulanate - Penicillin allergy: cefdinir, cefuroxime, or cefpodoxime (not contraindicated with most penicillin allergy histories)

Strep Pharyngitis Diagnose with rapid antigen test +/- throat culture confirmation in children. Treat positive GAS with: - First-line: penicillin V or amoxicillin - Penicillin allergy: cephalexin (if non-anaphylactic) or azithromycin

Bronchiolitis Supportive care. No bronchodilators, steroids, or antibiotics routinely. Admit for hypoxia, dehydration, apnea, severe distress, or inability to maintain hydration.

UTI in Young Children Catheterized or clean-catch urinalysis + culture. Threshold for evaluation: - All febrile girls <24 months with no other source - Febrile uncircumcised boys <12 months - Febrile circumcised boys <6 months

Post-first-UTI imaging: renal/bladder US for all; VCUG for recurrent or abnormal US.

Behavioral Health

ADHD DSM-5 criteria require symptoms in 2+ settings, onset before age 12, functional impairment.

Treatment: - Age 4-5: behavioral therapy first-line - Age ≥6: stimulant medications (methylphenidate or amphetamine class) are first-line - Second-line: atomoxetine, guanfacine, clonidine

Autism Spectrum Screen at 18 and 24 months with M-CHAT-R. Positive screen → developmental pediatrics referral, early intervention.

Adolescent Depression Screen annually age 12+ (PHQ-9 modified for adolescents, or PHQ-A). SSRIs (fluoxetine, escitalopram) are first-line when pharmacotherapy indicated, with monitoring for suicidal ideation in first weeks.

Growth

Failure to thrive: weight <5th percentile, dropping 2 major percentiles, or weight-for-length <80% ideal. Usually nutritional — feeding history is the key first step, not lab workup.

Short stature: bone age + growth velocity. Constitutional delay (normal bone age delay, family history) vs pathologic (drop in growth velocity, abnormal exam).

Anticipatory Guidance High-Yield

- Car seat: rear-facing until age 2 or max height/weight; booster until 4'9" and ~8-12 years - Safe sleep: supine, firm surface, no loose bedding, same room but not same bed until ≥6 months - Iron: at-risk infants start supplemental iron at 4 months - Vitamin D: 400 IU daily for exclusively/partially breastfed infants - Lead: ask housing history, screen if high-risk

Study Strategy

Because pediatrics is discrete (you can learn the common stuff in a focused burst), many residents benefit from a dedicated 2-3 week pediatric sprint at month 3-4 of exam prep. Spaced repetition then keeps it warm through the final months.

If your program was light on pediatrics, this is the area where getting a few hours with your pediatric-heavy co-resident to compare notes pays off disproportionately. Community study groups work particularly well for pediatric content because clinical pearls transfer well through conversation.