An Approach to Assessing Children Flashcards
1
Q
Whats the best thing to help with diagnosing children?
A
Start with the age:
- Guides approach to history taking and examination
- Common pathologies differ
- Conditions manifest differently at different ages
2
Q
What is different in the paediatric history from the adult?
A
Anticipate what is different to adult consultations:
- Parents observers
- Play is essential and clinical helpful
- Specialised nursing staff
- Treatment differs by weight and age
3
Q
What are the key stages of the history?
A
- Introduction
- Introduce yourself, identify patient and who is with them
- Generate rapport
- Presenting complaint
- History of presenting complaint
- Onset, progress, variation, effects, observations
- Chronological stages (including GP, A and E, ward)
- General/systems enquiry may be appropriate here
- Birth history
- Details depends on age and presentation
- Past medical history
- Immunisations
- Up to date, missed
- Development
- What can they do
- Basic enquiry essential (walking, words, support)
- Drugs and allergies
- This illness, regular, previous
- Family and social history
- Recent and related health issues
- Parents/siblings (age and health)
- Relationship dynamics
- School and nursery
- Parental social history – smoking, alcohol, drugs, occupation, stress
- Addressing concerns and closure
- ICE
- Summarise
4
Q
What does take an age appropriate apprach mean?
A
- Consider the age and developmental stage
- Consider language and intellectual skills
- First engage in non-medical talk such as toys to get an idea
- Most questions directed to parents, but some for child
5
Q
What questions should be asked when exploring history of presenting complaint?
A
- Details depends on age and presentation
6
Q
What is asked about immunisations?
A
- Up to date, missed
7
Q
What should be asked about development?
A
- What can they do
- Basic enquiry essential (walking, words, support)
8
Q
What should be asked about drugs and allergies?
A
- This illness, regular, previous
9
Q
What should be asked about family and social history?
A
- Recent and related health issues
- Parents/siblings (age and health)
- Relationship dynamics
- School and nursery
- Parental social history – smoking, alcohol, drugs, occupation, stress
10
Q
What unit do we measure weight in?
A
kg and g, but parents often use lb and ounces
11
Q
What is:
- 1lb in kg
- 1 ounce in lb
- 1 ounce in g
- 1 stone in lb
A
- 1lb is 0.4536kg
- 1 ounce is 1/16 of 1 lb (28.35g)
- 1 stone is 14 lbs
12
Q
What is the normal weight gain of infants?
A
- About 150-200g/week from week 1 to 6 month
- Which is an average of 20-30g per day
- Up to 10% loss in first few days common
13
Q
What do we measure feed volumes in?
A
ml, but parents often measure in ounces
14
Q
What is:
- 1 ounce in ml
- 1 ounce in pint
- 1 pint in ml
A
- 1 ounce is 28.4ml
- 1 ounce is 1/20th of a pint (568ml)
15
Q
How much feed should a baby take if:
- well
- unwell
A
- Probably 140-180ml/kg/day
- 100ml/kg/day if ill
16
Q
What should you ask about stool?
A
- Frequency
- Size, shape, appearance and consistency
- Difficulties passing
- Pain on passing
- Blood or mucus
17
Q
What are you trying to examine in paediatric examination?
A
- ABCDE and baseline observations/vital signs
- General conditions and peripheries
- Respiratory system
- Cardiovascular system
- Alimentary system
- Neurological and MSK systems
- ENT and skin
- Developmental skills
- Measurements and centile
18
Q
What are some tips for paediatric examination?
A
- Observe first
- Be friendly and smile
- Speak to the child (even if they are weeks old)
- Get down to their level
- Be careful moving them
- Show interest in their toys and play
19
Q
Describe the method for examination?
A
- Use method for that age
- Start with observation
- General – appearance, play, interaction, obs
- Resp – effort, noise, rate, recession, O2, nebs
- CVS – colour, perfusion
- GI – feeding, vomit, abdominal distension/movement
- Neuro – alertness, interaction, play, posture
- MSK – mobility, limb movements, posture, splints, mobility aids
- Other – rashes, bruises, infusions, tubes, lines, toys, pictures, cards, games, caffeine, books
- Progress by area, think by system
- Hands and arms
- Warms, cap refill, radial.brachial pulses (rate/rhythm)
- Clubbing, nail changes, hand skills, pen marks
- Head and neck
- Eyes (jaundice), lips (colour, moisture), tongue, nose
- Scalp changes, bruises, rashes, frontanel
- Neck
- Rashes and nodes (easier from front) – size, shape, mobility, position, consistency, symmetry
- Tracheal tug – don’t push for carotid pulse or trachea
- Chest and back
- Murmurs (timing, pitch, quality, location, radiation)
- Apex beats, thrills, chest expansion
- Breath sounds (all areas, reduced, symmetry, added)
- Percussion (limited in infants, not routine)
- Resonance and fremitus
- Rashes and skin marks
- Spine alignment, deformity, sacral dimples)
- Abdomen and groin
- Tenderness – watch face and movement
- Masses and organomegaly (spleen, liver, kidneys)
- Bowwel sounds and bruits
- Femoral pulses
- Hernias (and testis)
- Genital/anal appearance (routine for children in nappies but not often appropriate for older children)
- DON’T DO RECTAL EXAM
- Legs and feet
- Mobility, changing posture, movements, tone
- Reflexes, plantars, clonus – babies have primitive reflexes
- Power, coordination, sensory assessment
- Pulses, warmth, capillary refill, colour, mottling
- Rashes, bruises, marks
- Deformities and gait
- Hands and arms
20
Q
What are you looking for in the initial examination?
A
- General – appearance, play, interaction, obs
- Resp – effort, noise, rate, recession, O2, nebs
- CVS – colour, perfusion
- GI – feeding, vomit, abdominal distension/movement
- Neuro – alertness, interaction, play, posture
- MSK – mobility, limb movements, posture, splints, mobility aids
- Other – rashes, bruises, infusions, tubes, lines, toys, pictures, cards, games, caffeine, books
21
Q
What are you looking for in the hands and arms?
A
- Warms, cap refill, radial.brachial pulses (rate/rhythm)
- Clubbing, nail changes, hand skills, pen marks
22
Q
What are you looking for in the head and neck?
A
- Head and neck
- Eyes (jaundice), lips (colour, moisture), tongue, nose
- Scalp changes, bruises, rashes, frontanel
- Neck
- Rashes and nodes (easier from front) – size, shape, mobility, position, consistency, symmetry
- Tracheal tug – don’t push for carotid pulse or trachea
23
Q
What are you looking for in the chest and back?
A
- Murmurs (timing, pitch, quality, location, radiation)
- Apex beats, thrills, chest expansion
- Breath sounds (all areas, reduced, symmetry, added)
- Percussion (limited in infants, not routine)
- Resonance and fremitus
- Rashes and skin marks
- Spine alignment, deformity, sacral dimples)
24
Q
What commens should be made about murmurs?
A
- Timing
- Pitch
- Quality
- Location
- Radiation
25
Q
What comments should be made about breath sounds?
A
- Reduced, symmetry, added
26
Q
What are you looking for in the abdomin and groin?
A
- Tenderness – watch face and movement
- Masses and organomegaly (spleen, liver, kidneys)
- Bowwel sounds and bruits
- Femoral pulses
- Hernias (and testis)
- Genital/anal appearance (routine for children in nappies but not often appropriate for older children)
- DON’T DO RECTAL EXAM
27
Q
What are you looking for in the legs and feet?
A
- Mobility, changing posture, movements, tone
- Reflexes, plantars, clonus – babies have primitive reflexes
- Power, coordination, sensory assessment
- Pulses, warmth, capillary refill, colour, mottling
- Rashes, bruises, marks
- Deformities and gait
28
Q
Describe the reflexes of babies?
A
Primitive reflexes
29
Q
Why is play important?
A
Play and examination is important:
- Creative approach needed
- Let child continue to play as appropriate
- Select age appropriate toys
- Use play to illustrate, as a distractor and as a clinical tool
30
Q
Why is knowing your children’s characters useful?
A
- Helps dialogue with child
