CCFP priority topic 52 of 105
In Children on the CCFP exam
7 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 7 key features for In Children. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 7
Illness by age
Keep everyday illnesses on your list, knowing a child may show them in unexpected ways.
CFPC skill Clinical reasoningPhase Hypothesis generationSources Canadian Paediatric Society, Choosing Wisely Canada
On the exam
A 16-year-old with fever and lower belly pain, a parent in the room. Expect a short menu of causes to consider.
Pick the causes to keep on your list.
Common mistakes
Settling on the school stomach bug, or on constipation. Two days of fever and lower belly pain in a teen needs pregnancy and pelvic infection on the list.
Approach
- Babies and toddlers with a urinary infection may have only a fever. Some are cranky, vomit or look very sick.
- Older children can tell you about burning or going often. Fever, vomiting and belly or flank pain point to a kidney infection.
- Pneumonia in a child can show up as fever and belly pain. Count the breathing rate and listen to the chest.
- In a teen with fever and lower belly pain, ask about sex in private. Pregnancy and pelvic infection belong on the list.
- Suspected appendicitis: ultrasound first, to spare radiation. Use CT only if the ultrasound is unclear.
- Ask every teen about mood. Depression is the illness most tied to suicidal thoughts in youth. Ask about suicide in plain words.
Key feature 2 of 7
Use the visit
Teens rarely come in, so use each visit to ask about school, friends, family life and daily habits.
CFPC skill Clinical reasoning, patient-centred approachPhase History, treatmentSources Canadian Paediatric Society
On the exam
A 15-year-old comes in for a sports form. Expect a short menu of things to ask before she leaves.
Pick what else to ask about today.
Common mistakes
Signing the form and nothing more, when you may not see this teen again for years. Asking the hard questions with a parent in the room fails too.
Approach
- Screen every preteen and teen for risky behaviour at regular visits.
- Ask how school is going. Falling grades or missed days can be the only clue to trouble at home or in mood.
- Ask about friends, family life and how they spend their free time.
- Screen youth for mental illness and for big stresses in their lives.
- Ask about safety: helmets on bikes, seat belts, life jackets, sport gear and sunscreen.
- Ask about exercise and food.
- Start with easy topics. Leave drugs, sex and mood until trust is built.
Key feature 3 of 7
Risky behaviour
Ask young people plainly about substances, sex and the road, then help them lower the harm.
CFPC skill Clinical reasoning, communicationPhase History, treatmentSources Canadian Paediatric Society
On the exam
A 16-year-old with fever and pelvic pain, now alone with you. Expect a short menu of questions to ask.
Pick what to ask in private.
Common mistakes
Spending the private minutes on diet, travel or family history the parent already gave. Or giving only an abstinence lecture.
Approach
- Ask about alcohol and drugs, sex, smoking and driving at every chance, in private.
- Stay calm and neutral. Judging makes it harder to get the safety message across.
- Encourage delay. If they already do it, give ways to lower the risk.
- Pair delay with condoms and birth control. That works better than abstinence-only advice.
- Use motivational interviewing: build on the teen's own goals and right to choose.
- Encourage condoms with every birth control method. They cut the risk of sexually transmitted infection (STI).
- Long-acting methods, an intrauterine device (IUD) or an implant, are the first choice for youth. In typical use, about 9% on the combined pill get pregnant in a year; under 1% with an IUD or implant.
Key feature 4 of 7
Confidential care
Keep a teen's care private, and help them bring family in when the time is right.
CFPC skill Communication, patient-centred approachPhase TreatmentSources Canadian Paediatric Society
On the exam
A capable 16-year-old asks you not to tell his mother he is sexually active. Expect one best answer.
Pick what you do with his request.
Common mistakes
Telling his mother because he is a minor, or reporting a lawful, consensual relationship. Promising secrecy and stopping there is wrong too: offer to help him bring her in.
Approach
- Explain privacy and its limits to the teen and the parent, ideally before the first visit.
- From early adolescence, see the teen alone for part of every visit. Present it to parents as routine.
- Do not ask about time alone in front of the parent. The teen may feel pushed to say no.
- Canada has no fixed age of consent for health care. In most provinces, a teen who understands the treatment and its results can consent alone. Quebec sets age 14 for some rights.
- Encourage the teen to talk with a parent, and offer to help. First ask why they hold back: not every home is safe.
| Situation | Privacy | What you do |
|---|---|---|
| Consensual sex, birth control, STI testing | Kept private if the teen is capable | Give care. Encourage talking with a parent. |
| Serious risk of harm to self or others | Must be broken | Tell the teen, then bring in family or services |
| A young person who needs protection | Must be broken | Report to child protection |
| Some infections, or a court order | Limited by law | Report as the law requires |
Key feature 5 of 7
Words a child knows
Talk to each child in words that fit their age and stage.
CFPC skill Communication, patient-centred approachPhase Treatment, historySources Canadian Paediatric Society
On the exam
A 4-year-old with fever and belly pain sits on her mother's lap. Expect one best answer: the question to ask her.
Pick the question she can answer.
Common mistakes
Asking about "urinating" or "micturition". She does not know the words, so she shrugs or says yes to please you.
Approach
- Use the child's own words for body parts, pee and poo. Ask the parent which words the family uses.
- Ask one short, concrete question at a time: "Does it sting when you pee?"
- Ask a young child to point to where it hurts.
- From about age 4, give simple facts about what will happen.
- Never say "This won't hurt" or "It's all over" unless it is true. Skip "I'm sorry" during a procedure: it confuses children.
- Give school-age children real information and choices, in words they know.
- With teens, speak plainly and do not talk down.
| Instead of | Try | Why |
|---|---|---|
| Any pain on urinating? | Does it sting when you pee? | She knows "pee", not "urinate" |
| Any change in your bowel pattern recently? | Was your poo hard today? | "Pattern" and "recently" are too abstract |
| You have a urinary tract infection. | There are germs in your pee. This medicine gets rid of them. | She needs the fix, not the label |
| This won't hurt. | This will pinch for a moment. You can squeeze my hand. | False comfort breaks trust |
Key feature 6 of 7
Talk to the child
Get the story from the child and explain the plan to them, not only to parents.
CFPC skill Communication, patient-centred approachPhase History, treatmentSources Canadian Paediatric Society
On the exam
A 4-year-old with a bladder infection refuses her syrup. Expect one best answer: what you say, and to whom.
Pick who you speak to, and how.
Common mistakes
Asking her mother to explain it later, or warning that she will need a needle. Tell her yourself, and offer a choice she can make.
Approach
- Greet the child first and ask them what is wrong. Fill the gaps with the parent after.
- Explain the plan to both the child and the parent. Both need to hear it.
- Offer choices the child can make, such as where a needle goes.
- From school age, seek the child's agreement. Take a strong no seriously, and rethink whether the step is needed.
- Never threaten a needle or the doctor.
- A capable teen consents for themselves. A parent's signature is not required.
Key feature 7 of 7
Tests that hurt
Order the tests a child needs, even when the child, family or staff would rather skip them.
CFPC skill Clinical reasoning, selectivityPhase Treatment, investigationSources Canadian Paediatric Society, Choosing Wisely Canada
On the exam
A febrile 4-year-old; the dipstick suggests a urinary infection, and her mother asks to skip the culture. Expect one best answer.
Pick how to confirm the diagnosis.
Common mistakes
Treating on a dipstick or a bag sample to spare her. Ordering a scan instead is wrong too: a scan does not confirm a urinary infection, the culture does.
Approach
- Screen with a dipstick. If it shows white cells or nitrite, send a culture.
- A toilet-trained child gives a clean-catch or midstream sample (caught mid-flow into a clean cup). A child in diapers should give a catheter sample, or a needle sample above the pubic bone.
- Bag urine is for dipstick screening only. Never culture it, and avoid it in a sick child.
- Ease pain instead of skipping the test: numbing cream for needles, sitting up, comfort holds, a parent close by.
- Distraction helps from age 2. Breastfeeding or sugar water (sucrose) helps young babies.
- Skip tests that add nothing: no end-of-treatment urine culture, no belly X-ray for constipation.
| Sample | Use it for | Counts as infection |
|---|---|---|
| Bag | Dipstick screen only | Never cultured |
| Clean catch or midstream | Culture in a toilet-trained child | At least 10⁸ CFU/L |
| Catheter | Culture in a child in diapers | At least 5 × 10⁷ CFU/L |
| Needle above the pubic bone | Culture | Any growth |
Flashcards
Answer it first, then check.
KF 1A 10-month-old has a fever and no clear source. Which infection must you look for?
A urinary infection. In babies it can show as fever alone, crankiness or vomiting. Source: Canadian Paediatric Society
KF 1A 9-year-old may have appendicitis. Which scan comes first?
Ultrasound, to spare radiation. Use CT only if the ultrasound is unclear. Source: Choosing Wisely Canada
KF 3Does abstinence-only advice work best for teens?
No. Pairing delay with condoms and birth control works better than abstinence alone. Source: Canadian Paediatric Society
KF 4Can a capable 15-year-old consent to care without a parent?
Yes, in most of Canada. There is no fixed legal age; understanding the treatment decides. Source: Canadian Paediatric Society
KF 4When must you break a teen's confidence?
When the teen may seriously harm themselves or others, or needs protection. Source: Canadian Paediatric Society
KF 5What should you not say before a blood draw?
"This won't hurt." False comfort breaks trust. Give simple, true facts instead. Source: Canadian Paediatric Society
KF 6A 7-year-old says no to a step in her care. What do you do?
Take the no seriously. Rethink whether the step is needed before you go on. Source: Canadian Paediatric Society
KF 7A 2-year-old in diapers needs a urine culture. How do you collect it?
By catheter. A bag sample is for dipstick screening only, never for culture. Source: Canadian Paediatric Society
FAQ
What is HEADSS?
A memory aid for the teen interview: home, education, activities, drugs, sexuality, and suicide and mood. Start with the easy topics. Leave the hard ones until trust is built.
Is there an age of consent for health care in Canada?
No single one. In most provinces, a teen who understands the treatment and its results consents alone. Quebec sets age 14 for some rights. Know the law where you work.
What if the parent will not leave the room?
Explain that time alone is routine for every teen, ideally before the visit starts. It helps them grow into managing their own care. Then see the parent too.
Which statement on urinary infection in children is current?
The Canadian Paediatric Society posted a new statement in August 2026. It covers first infections from 1 month to 5 years. It updates the 2014 statement.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Position statements and practice pointsCanadian Paediatric Society
- Choosing Wisely recommendationsChoosing Wisely Canada