Paediatric history

Definitions  

• Neonate  = <28 days
• Infant = 1-12 months
• Child = 1-12 years
• Adolescent = >12 years  

Presenting complaint

• Determine symptoms which brought patient in

History of presenting complaint

• Exploreeach symptom (including further symptoms you elicit in system reviews)
  • Timeframe
    • Duration
    • Onset (sudden or gradual)
    • Progression
    • Timing (intermittent or continuous)
  • Symptom-specific questions, e.g. SOCRATES for pain (see exploring symptoms)
• Paediatric systems review (similar to adults but slightly different)
  • General: fever, behaviour, activity/apathy/alertness, rashes, growth and weight
  • Cardiorespiratory: cough, noisy breathing (stridor, croup, wheeze), dyspnoea, cyanosis
  • Gastrointestinal: vomiting, abdominal pain, diarrhoea/constipation
  • Genitourinary: wetting nappies/toilet trained, dysuria, frequency
  • Neuromuscular: seizures/fits, headaches, abnormal movements
  • ENT: sore throat, snoring, noisy breathing, earache

Birth

• Pregnancy: scan results (dating and anomaly; if had extra scans – why?), any problems (e.g. maternal illness/alcohol/drug use)
• Birth history
  • Location, mode of delivery, gestation (term = 38-42 weeks) and birth weight (normal = 2.5-4.5kg)
  • Birth complications, e.g. resuscitation required, birth injury, maternal/fetal compromise, risk factors for sepsis (group B Streptococcus, maternal fever, prolonged rupture of membranes), any meconium?
  • Neonatal problems, e.g. jaundice, fits, fevers, bleeding, feeding problems, admissions to neonatal unit/neonatal ICU

Feeding

• Diet and appetite – ascertain what the child normally feeds and compare against current feeding
  • Breast/bottle milk (usually <12 months): type (breast, standard formula, modified formula e.g. hydrolysed, high energy etc.), volume and frequency, feeding difficulties (e.g. latching difficulties, reflux symptoms, SOB)
  • Weaning (usually from 6 months): starts with pureed jars, then mashed up food, then solids gradually added
  • Solid meals and cow’s milk (usually >12 months)
• Toileting
  • Toilet training (between 2-4 years; dry by day at 2 years; dry by night at 3-4 years)
  • Frequency: wet nappies? (usually ~5 soaking wet nappies per day and 3 yellow stools)

Growth

• Weights: ask to see The Red Book (personal child health record) – used from birth to 5 years
• Puberty if older child/adolescent (on average, starts at 11 years for girls, 12 years for boys)

Development

• Any concerns
• School progress and attendance
• Developmental screen if <5 years
  • Smiling by 6 weeks
  • Turns to sounds by 6 months
  • Sitting by 9 months
  • First words by 18 months
  • Walking by 18 months
  • Short sentences by 3 years

       

Normal developmental milestones

Some developmental red flags

• Loss of skills
• Not fixing/following objects
• Hearing loss
• Low muscle tone/floppy
• Can’t hold objects by 5 months
• Can’t sit unsupported by 12 months
• Can’t walk by 18-24 months
• Persistent toe walking
• No speech by 18 months

Past medical history

• Medical problems
• Previous illness, accidents, surgery
• Previous hospital/emergency department visits

Drug history

• Immunisations: up to date? – see schedule below
• Current medication (including creams etc.): include dose, route, compliance
• Relevant recent medication, e.g. course of corticosteroids for asthma
• Allergies: drugs, foods, others

Family history

• Anything relevant to HPC
• Anyone else ill?
• ‘Anything in the family that affects newborn babies or children?’

Social history

• Family unit: parents, siblings, who lives at home – draw family tree of who’s at home
• Does anyone smoke in the family (inside or outside)?
• Housing situation
• Social services involvement (child, parents or siblings) or any other safeguarding concerns
• Playgroup (2-5 years), nursery school (3-4 years) or school (5-16 years) – performing well?
• Other, e.g. hobbies, travel, pets

Ideas, concerns and expectations

• How has the illness affected the family?
• Have the symptoms kept the child from attending nursery/school?
• What are the parents’/child’s concerns, beliefs, hopes etc.?

Immunisation schedule  

• 2 months: 6 in 1, rotavirus, meningitis B
• 3 months: 6 in 1, rotavirus, pneumococcal
• 4 months: 6 in 1, meningitis B
• 1 year: MMR, pneumococcal, meningitis B, Haemophilus influenzae type B/meningitis C
• Preschool (3 years 4 months): MMR, 4 in 1 (diphtheria, polio, tetanus, pertussis)
• 12-13 years: HPV (two injections 6-12 months apart)
• 14 years: 3 in 1 (diphtheria, tetanus, polio), meningitis ACWY  

6 in 1: diphtheria, tetanus, polio, pertussis, Haemophilus influenzae type B, hepatitis B

MMR = measles, mumps, rubella   NB: influenza annual nasal vaccine is also offered to 2-10 year olds  

Reference: NHS ‘NHS vaccinations and when to have them’ 2019

Why don’t you test your knowledge?

Try some OSCE stations

1. Child vomiting
2. Neonate unwell
3. Failure to thrive
4. Rash
5. There’s more here!