Core Revision
GP Diplomas · Core Lens
DCH Core Lens
A focused way to look at paediatrics for the Diploma in Child Health: for each topic, the safety cue you cannot miss, the guideline point that anchors the answer, and the exam trap that catches people out.
Can’t miss
Three themes run through every paper. If you learn nothing else, learn these.
1. The seriously unwell child — sepsis and meningococcal disease
- A non-blanching rash in an unwell or febrile child is meningococcal sepsis until proven otherwise: emergency transfer by 999 ambulance, with IM/IV benzylpenicillin or ceftriaxone given outside hospital only if it does not delay transfer (NICE NG240).
- Children compensate then crash. Tachycardia, tachypnoea, prolonged capillary refill, mottling, cool peripheries and reduced urine output come before hypotension; hypotension in a child is a late, pre-arrest sign.
- Altered behaviour matters as much as numbers: a drowsy, floppy, inconsolable or “just not right” child — especially where a parent says this illness is different — is a red flag on its own.
- Sepsis is a “treat now, think later” diagnosis. Do not delay antibiotics or transfer for investigations.
2. Safeguarding
- Injury that does not fit the story, the child’s developmental stage, or that is delayed in presentation. Bruising in a baby who is not independently mobile is a safeguarding concern until proven otherwise.
- Also think: torn frenulum, cigarette burns, scalds with clear margins, retinal haemorrhage, fractures in infants, unexplained faltering growth, neglect, and repeated attendance or non-attendance.
- You do not need proof — you need reasonable concern. Discuss with the named/designated safeguarding lead, document contemporaneously, refer to children’s social care, and make sure the child is safe now.
3. The NICE traffic-light system (fever in under-5s)
- Assess colour, activity, respiratory, circulation/hydration and “other” (age <3 months with fever ≥38°C, non-blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal signs, focal seizures).
- Red — urgent face-to-face specialist assessment (999/emergency). Amber — safety-net with a clear plan or arrange specialist review. Green — manage at home with verbal and written safety-netting advice.
- Any infant under 3 months with a temperature of 38°C or above is high-risk and needs paediatric assessment, however well they look.
The topics, through the lens
The first entry is open as a preview. The other 59 are for members.
Neonatal jaundice
Safety cueJaundice in the first 24 hours of life is always pathological — think haemolysis or sepsis — and needs urgent same-day assessment. Prolonged jaundice with pale stools and dark urine suggests conjugated hyperbilirubinaemia and possible biliary atresia.
Guideline pointNICE: measure bilirubin within 2 hours if jaundice appears <24 hours; use transcutaneous or serum bilirubin plotted on the gestation-specific treatment threshold chart. Investigate prolonged jaundice (>14 days at term, >21 days preterm) including a split (conjugated) bilirubin.
Exam trapCalling all prolonged jaundice “breast-milk jaundice” and reassuring, without checking the conjugated fraction. Biliary atresia needs surgery early — outcomes fall sharply after around 8 weeks.
The rest of the DCH Core Lens is in the DCH package
59 more entries across 20 topics, each sorted into the safety cue, the guideline point and the exam trap — written and reviewed by practising UK doctors.
- DCH question bank
- Pay once, no subscription
The rest of the DCH toolkit
Every part of the DCH track, one click away. Work across them rather than through them — the guide explains it, the tools drill the decision, the bank tests it and the Compass tells you what is left.