Paediatric history

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, breathing (breathlessness, stridor, croup, wheeze), cyanosis
  • Gastrointestinal: vomiting, abdominal pain, diarrhoea/constipation
  • Genitourinary: wetting nappies/toilet trained, dysuria, frequency
  • Neurological: headaches, seizures/funny turns, abnormal movements
  • ENT: sore throat, earache/discharge

Birth

• Pregnancy: scan results (dating and anomaly; if had extra scans – why?), any problems (e.g. maternal illness/alcohol/drug use)
• Birth history
  • Mode of delivery, gestation (term = 38-42 weeks), birth weight (normal = 2.5-4.5kg)
  • Birth complications, e.g. prolonged labour, resuscitation required, birth injury
  • Neonatal problems, e.g. jaundice, infections, 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, specialised formula), volume and frequency, feeding difficulties (e.g. latching difficulties, reflux)
  • 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 for younger children, ask when:
  • Smiling
  • Turns to sounds
  • Sitting
  • First words
  • Walking
  • Short sentences

Normal developmental milestones

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Past medical history

• Medical problems
• Previous illness, accidents, surgery
• Previous hospital attendances

Drug history

• Immunisations: up to date? – see schedule below
• Current medication (including creams etc.): include dose, route, adherence
• Allergies: drugs, foods, others

Family history

• Anything relevant to HPC
• Unwell contacts
• Genetic conditions

Social history

• Family unit: parents, siblings, who lives 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
• Childcare setting attendance and performance: nursery if attends (preschool years) or school (5-16 years)
• Other, e.g. hobbies, travel, pets

Ideas, concerns and expectations

• Affect of illness on family, child, attendance at nursery/school
• Parental/child concerns

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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