Pediatrics Board Prep

From newborn screening to adolescent care, pediatric ABFM questions cover the family medicine scope. Daily practice grounded in AAP Bright Futures.

Pediatrics makes up roughly 7 to 9 percent of the ABFM Family Medicine boards. The content reflects what family physicians actually do in pediatric practice: well child visits with developmental screening, vaccinations, common infections, behavior and learning concerns, and the most common acute pediatric complaints. The exam draws heavily from the AAP Bright Futures guidelines, the ACIP childhood immunization schedule, and AAP clinical practice guidelines on specific conditions.

Well child visits are the structural backbone of pediatric primary care and a high-yield exam topic. Bright Futures specifies the schedule (visits at 3 to 5 days, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months, then annually), the developmental milestones to assess at each, and the screening recommendations (autism at 18 and 24 months, depression starting at 12, lead at 1 and 2 years for at-risk groups, hemoglobin at 12 months). The 2022 update to AAP developmental milestones adjusted the ages for many milestones — questions reflecting this update are increasingly common.

Immunizations follow the ACIP childhood schedule, which is updated annually. Hepatitis B at birth, then a series of multi-vaccine visits at 2, 4, and 6 months (DTaP, Hib, IPV, PCV15 or PCV20, RV, hepatitis B). MMR and varicella at 12 to 15 months. The annual influenza vaccine starts at 6 months. HPV ideally at age 11 to 12 (two-dose series if started before 15, three-dose if started 15 or older). Tdap and meningococcal vaccines at 11 to 12, with MenACWY booster at 16. Recent additions include the RSV monoclonal antibody (nirsevimab) for infants entering their first RSV season.

Common pediatric infections are heavily tested. Acute otitis media follows AAP 2013 guidelines: antibiotic treatment for severe symptoms, bilateral AOM in children under 2, otorrhea, or moderate-to-severe disease; observation option for mild unilateral AOM in children 2 and older. Amoxicillin (90 mg/kg/day) is first-line. Group A strep pharyngitis requires positive testing (rapid antigen or culture) before antibiotics — Centor or McIsaac criteria help guide testing. Bronchiolitis (RSV) is supportive only — no albuterol, no steroids, no antibiotics for uncomplicated cases per AAP 2014 guidelines. Croup gets dexamethasone and (for severe cases) nebulized epinephrine. Pneumonia uses high-dose amoxicillin first-line for outpatient management.

Behavioral and developmental issues round out the high-yield content. ADHD diagnosis requires symptoms in two or more settings, onset before age 12, and functional impairment. AAP recommends behavioral therapy first for ages 4 to 5, with stimulants added if symptoms persist. For ages 6 and older, both medication and behavioral therapy are first-line. Autism screening at 18 and 24 months with M-CHAT-R/F is a frequently tested item. Adolescent confidentiality, HEEADSSS assessment, and reproductive health discussions are also fair game.

High-yield pediatrics topics

ABFM exam tips

Memorize the immunization schedule by visit, not by vaccine. The exam will give you a child's age and ask "what vaccines are due?" Knowing that the 2-month visit gets DTaP, Hib, IPV, PCV, RV, and hepatitis B (all at once) is more testable than reciting which diseases are covered.

Recognize fever in a young infant as an emergency. A rectal temperature of 100.4 (38.0) or higher in an infant under 28 days requires a full sepsis evaluation: CBC, blood culture, urinalysis and urine culture, lumbar puncture, and empirical antibiotics. Infants 29 to 60 days follow modified protocols (Rochester, Philadelphia, or Boston criteria), but the threshold for workup remains low.

For bronchiolitis, "do nothing" is often the right answer. Supportive care is the only intervention with evidence in uncomplicated bronchiolitis. Antibiotics, albuterol, racemic epinephrine, corticosteroids, and chest physiotherapy are all not recommended. The exam loves to test this restraint.

Anchor on amoxicillin 90 mg/kg/day for AOM. First-line antibiotic for acute otitis media when antibiotics are indicated. Augmentin (also at 90 mg/kg/day of amoxicillin component) for treatment failure or recent antibiotic use. The high dose addresses penicillin-resistant pneumococcus.

Use Bright Futures milestones, not memorized "average" milestones. The 2022 AAP/CDC update changed the milestone ages for several developmental items. Use the current Bright Futures and CDC milestone lists. Older textbooks may show different ages.

For ADHD, age determines first-line treatment. Ages 4 to 5: behavioral therapy first, medication only if persistent symptoms with functional impairment. Ages 6 and older: stimulant medication and behavioral therapy are both first-line. The age cutoff is testable.

Common pitfalls

Do not treat fever under 28 days outpatient. Even a "well-appearing" infant under 28 days with a fever needs full sepsis workup including LP and empirical antibiotics until cultures are negative. Going home to "see how things go" is a tested error.

Do not use albuterol for bronchiolitis. RSV bronchiolitis is not bronchospasm and does not respond to bronchodilators. The AAP 2014 guidelines explicitly recommend against routine albuterol. This is one of the most-tested pediatric pearls.

Do not test for strep in children under 3. Group A strep pharyngitis is rare in this age group, and the risk of acute rheumatic fever is essentially zero. Routine testing leads to false positives (carriers) and unnecessary antibiotics.

Do not delay HPV vaccination past 12. The CDC recommends HPV at age 11 to 12 (with catch-up to age 26 for everyone). Earlier vaccination has better immunogenicity and adherence. The exam tests timing and the "two doses if started before 15, three if 15 or older" rule.

Do not miss intussusception in a young child with intermittent severe abdominal pain. Classic triad: episodic abdominal pain, currant jelly stools, and palpable mass — but only present in a minority. Suspect in any child 6 months to 3 years with paroxysmal pain and lethargy between episodes. Air or contrast enema is both diagnostic and therapeutic.

Do not use codeine or tramadol in children. FDA contraindications: codeine and tramadol are contraindicated in children under 12, and codeine in adolescents under 18 with respiratory conditions. CYP2D6 ultra-rapid metabolizers can develop fatal respiratory depression. Use acetaminophen and ibuprofen for pediatric pain.

Do not miss pyloric stenosis in a 3- to 6-week-old with projectile vomiting. Olive-sized epigastric mass, hypochloremic metabolic alkalosis, ultrasound shows hypertrophied pylorus. Surgical correction (pyloromyotomy) is curative. Vomiting in this age group is often dismissed as reflux — pyloric stenosis is the testable miss.

Frequently asked questions

How much pediatrics is on the ABFM?

Pediatric content typically makes up 7 to 9 percent of the ABFM exam, or roughly 22 to 28 questions. Well child visits, immunizations, common infections, and developmental screening account for the majority. Adolescent care and behavioral health add significant volume.

Do I need to memorize the entire pediatric vaccine schedule?

Yes, in functional terms. Know what is given at each well visit (2, 4, 6, 12-15, 18 months, 4-6 years, 11-12 years, 16 years), and the rules for catch-up. The CDC childhood immunization schedule is the gold reference. New additions like nirsevimab for RSV are testable as they enter the schedule.

How is acute otitis media managed for the boards?

Antibiotics for severe symptoms (pain over 48 hours, temp 39 or higher, otorrhea), bilateral AOM in children under 2, or any AOM with significant symptoms. Observation option for unilateral AOM in children 2 and older without severe symptoms, with reassessment in 48 to 72 hours. Amoxicillin 90 mg/kg/day is first-line; Augmentin for treatment failure.

When does autism screening happen?

AAP and Bright Futures recommend autism-specific screening with M-CHAT-R/F at 18 and 24 months, in addition to general developmental surveillance at every visit. Positive screens warrant follow-up and referral to developmental specialists. Earlier identification improves outcomes through early intervention services.

What is the ADHD treatment approach by age?

Ages 4 to 5: behavioral therapy is first-line, with medication added only if symptoms persist with functional impairment. Ages 6 to 11: behavioral therapy and FDA-approved medication (stimulants preferred) are both first-line. Ages 12 to 18: medication and behavioral or psychological treatment. Stimulants (methylphenidate, amphetamines) work for about 70 percent.

How do I evaluate a febrile infant under 90 days?

Under 28 days: full sepsis evaluation (CBC, blood culture, urinalysis, urine culture, LP, empirical antibiotics) regardless of appearance. 29 to 60 days: apply low-risk criteria (Rochester, Philadelphia, or Boston) — well-appearing low-risk infants may have urine and possibly blood cultures with close follow-up. 61 to 90 days: similar low-risk criteria with often less aggressive workup. The threshold for full evaluation remains low.

Should I learn growth chart percentiles?

At a recognition level. Know that crossing two major percentile lines downward warrants evaluation, that BMI percentile drives obesity classification (over 85th overweight, over 95th obese, over 99th severe obesity), and that head circumference tracking matters in infancy. The exam will not ask you to read raw growth charts in detail.