Pediatric History

 

• Paediatric history

  Summary

  Standard history, plus the paediatric extras, BINDS:

  • Birth
  • Immunisations
  • Nutritrion/feeding
  • Development
  • Social history in detail, including School, Siblings, Smoking (parents), Salaries (parents' jobs), and Social services input.

  Past medical history

  • Key points: previous hospital admissions (inc. surgery), or out of hours GP or walk-in centre.
  • Ask specifically about asthma.

  Systems review

  • Cardio: cold sweats, turning blue.
  • Resp: cough, wheeze/stridor, coryza.
  • ENT: earaches/discharge, sore throat.
  • GI and GU: peeing (wet nappies? enuresis, day or night?), pooing, eating, drinking.
  • Derm and MSK: rashes, swollen/stiff joints.
  • Neuro: fits, faints, funny turns.
  • Systemic, WAFFLESS: Weight, Appetite, Fever, Feeding, Lumps, Energy/mood/crying, School absences, Sleep disturbance.

  Medication

  Remember to ask about creams and inhalers. Often forgotten if not specified.

  Allergies

  Including drug, foods, and household products.

  Social history

  • Parents' names and jobs.
  • Siblings, and if any they have illnesses.
  • Housing
  • Smoking contact
  • Pets
  • School
  • Travel
  • Social service contact.

  Family history

  • Congenital disease
  • Draw up family tree if presenting complaint suggests a congenital defect.
  • Childhood death
  • Atopy

  Birth

  • Pregnancy: complications, mum on drugs (recreational and medical).
  • Birth: where (home/hospital), when (term?), and how (vaginal/caesarean).
  • Health: birth weight, SCBU.

  Development and growth

  • Any concerns regarding development, behaviour, vision, hearing?
  • Ask about height and weight; ask to see growth chart.
  • Problems at school?
  • Specifically ask about problems in the 4 developmental domains: gross motor (e.g. sitting, walking), fine motor and vision (e.g. pincer grip), speech and hearing (e.g. hearing assessment), and social, emotional and behavioural.
  • It's even worth briefly covering this with teens.

  Feeding

  • Breast or bottle (and brand).
  • Frequency and volume in 24h.
  • Vomiting or posseting after feeds.

  Immunisations

  Had everything? If not, why?

• Paediatric examination

  • The main challenge of examining children is gaining their co-operation.
  • Games, toys, and parents can help. Experienced paediatricians often have stock phrases and tricks which can help – watch and learn.
  • Be pragmatic and flexible. The rigid, structured approach used to examine adults (for med school exams anyway) may be impractical, and it may be a case of doing what you can as and when the child wants to play along.
  • Leave the most unpleasant bit of the exam – e.g. examining the throat with a tongue depressor – until the end.

  Looking for signs

  Many signs that are found in adults don't tend to occur in children. However, the following should be looked for:

  • Hands: clubbing and cyanosis.
  • Face: pallor, tongue/perioral cyanosis.
  • Oedema: sacral (before they're standing), pedal (after they're standing).
  • Abdo: palpate liver whether it's cardio, resp, or GI exam, as it can be enlarged in HF or displaced in hyperinflation (asthma, bronchiolitis).
  • Always remember to check and plot height and weight.

  System-specific

  Cardio:

  • Palpate femoral pulse to check for coarctation.
  • For BP you can use Korotkoff 4 if age <12 years.

  GI:

  • Crohn's: perioral ulcers, perianal tags and fistulate.
  • Fissures from constipation.
  • Note that 1-2 cm of liver and spleen are normally palpable in infants, and kidney may also be palpable in neonates.

  Normal ranges for obs

  HR, RR, SBP:

  • 0-<1 year: 110-160 bpm, 30-40 resps, 70-100 mmHg.
  • 1-2 years: 100-140 bpm, 25-35 resps, 75-105 mmHg.
  • 3-5 years: 80-120 bpm, 20-30 resps, 80-110 mmHg.
  • 6-12 years: 70-110 bpm, 15-20 resps, 85-115 mmHg.