1 - History Taking and Communications with the Child Flashcards
How do adults differ to children in medicine?
- Different fluid requirements
- Different drug doses
- Different observations
How much fluid do children require in a day?
What points do you need to cover in the history taking of a child?
https://geekymedics.com/wp-content/uploads/2020/10/OSCE-Checklist-Paediatric-History-Taking-.pdf
- Name and Age
- PC
- Systems review
- Birth & Perinatal History (BFGD)
- Feeding History
- Growth
- Immunisation History
- Developmental History
- PMHx including surgical
- DHx and allergies
- Social Hx
- FHx
- ICE
How can you explore the presenting complaint in a paediatric history?
How do you do a systems review in a paediatric history?
Ask about any changes to:
- Dietary and Fluid intake
- Urine output (changes in wet nappies)
- Stool
- Vomiting (projectile? how much? consistency?)
- Fever (with thermometer or subjective?)
- Rash
- Coryzal symptoms (runny nose, or sounded ‘sniffly’)
- Cough (triggers, any sputum)
- Work of breathing
- Weight change
- Behaviour (their usual self?)
- Pain
How do you ask about pre-natal, birth, neonatal and developmental history?
What should you ask in family history for paediatrics?
- Anyone in the household experiencing similar symptoms?
- Any diseases that run in the family?
What do you need to ask about in the social history for paediatrics?
- Any input from social services?
- Any child protection plans?
- HEEADSSS
What is the HEEADSSS acronym for?
Addressing health risk behaviours and resilience factors in adolescents. Reassure confidentiality unless worries about safety
- Home and Relationships
- Education and Employment
- Eating
- Activities and Hobbies
- Drugs alcohol and tobacco
- Sex and Relationships
- Self harm, depression and self image
- Safety and abuse
How do you enquire about feeding history?
What immunisations do you have at each of these ages?
What is the definition of the following?
- Embryogenesis
- Fetal period
- Perinatal period
- Neonatal
- Infant
- Toddler
- Pre-school
Embryogenesis: first 8 weeks after fertilisation
Foetal period: 3 month to 9 months
Perinatal period: 22 weeks to 7 days
Neonatal: 0-28 days
Infant: birth to 1 year
Toddler: 1-3 years
Pre-school: 3-5 years
What are the four domains of development in children?
- Does HV have any worries?
- Does school have any worries?
What are some differentials for a ‘fit’ in children?
Always remember breath holding seizures!!
How do you take a full developmental history of a child?
- Obstetrics history (e.g infections in birth, any medications, any extra scans)
- Delivery history (e.g gestation, mode, any admission to HDU?)
- Developmental milestones
- Communication mode
- Any family history of developmental delay (inc siblings)
- PMHx of child
- DHx and allergies
How should you present a history in paediatrics?
History of Fever (5/7), Headache (3/7) and Vomiting (1/7)
Always write negatives e.g not sepsis because, not SOL because, no bilious vomiting
What is a good tool to use for constipated children?
ERIC programme
What is important to check when a child develops tourette’s?
Social circumstances
What are some tips for mother’s to help with colic?
- Reassurance that should resolve by 6 months of age
- Holding, rocking, bathing the infant, ensuring optimal winding
- Appropriate support such as friends, family, health visitor
- Encouraging mother to continue breastfeeding wherever possible
How do you measure the head circumference of a baby?
- Placed above the ears and midway between the eyebrows and the hairline to the occipital prominence at the back of the head
- Should be recorded to the nearest millimetre and repeated 3 times
- The maximum of these 3 is recorded
- Plot accurately on the growth chart
What is the difference between a baby with IUGR and LBW?
- Low birth weight when fulfilling potential and on projection e.g small parents
- IUGR when not fulfilling potential (think about graph doctor showed us in F1 induction)
How many ml of bottle milk is given to neonates?
~150mL/kg/24h (30mL=1oz) over 4–6 feeds
If small-for-dates up to 200mL/ kg/day, if large-for-dates, <100mL/kg
When taking a feeding history in A and E what is important to ask?
If poor feeding how poor e.g how many bottles, how much being taken
If <50% feeds in bronchiolitis this is automatic admission
How can you tell a child has Ricket’s by their hand x-ray?
What is the most common cancer in children?
Leukaemias
What is the most common cause of bacterial pneumonia in children?
S.Pneumoniae
What murmur do you get with a VSD?
Pan systolic loudest at left lower sternal edge
What conditions may have a third fontanelle?
- Downs
- Hypothyroidism
What do you see on x-ray with duodenal atresia?
Double bubble
What should you give to a child with HPylori first line?
Omeprazole, Amoxicillin and Clarithromycin
What are the features of an innocent murmur?
What EEG changes do you see in an absence seizure?
Bilaterally synchronous and symmetrical 3-Hertz spike-and-wave discharges that start and end abruptly
What EEG changes do you see in an absence seizure?
Bilaterally synchronous and symmetrical 3-Hertz spike-and-wave discharges that start and end abruptly