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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

  • Explore each symptom (including further symptoms you elicit in system reviews)
    • Timeframe
      • Duration
      • Onset (sudden or gradual)
      • Progression
      • Timing (intermittent or continuous)
  • 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

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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 2-7 year olds  

Why don’t you test your knowledge?

At what age would you expect a child to be able to sit unsupported? At what age would you be concerned if they are unable to do so?

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What are the causes of global developmental delay?

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Name some causes of developmental delay in motor, language and social skills?

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What are the causes of cerebral palsy?

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Try some OSCE stations

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