An Approach to Assessing Children Flashcards
Whats the best thing to help with diagnosing children?
Start with the age:
- Guides approach to history taking and examination
- Common pathologies differ
- Conditions manifest differently at different ages
What is different in the paediatric history from the adult?
Anticipate what is different to adult consultations:
- Parents observers
- Play is essential and clinical helpful
- Specialised nursing staff
- Treatment differs by weight and age
What are the key stages of the history?
- 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
What does take an age appropriate apprach mean?
- 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
What questions should be asked when exploring history of presenting complaint?
- Details depends on age and presentation
What is asked about immunisations?
- Up to date, missed
What should be asked about development?
- What can they do
- Basic enquiry essential (walking, words, support)
What should be asked about drugs and allergies?
- This illness, regular, previous
What should be asked about 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
What unit do we measure weight in?
kg and g, but parents often use lb and ounces
What is:
- 1lb in kg
- 1 ounce in lb
- 1 ounce in g
- 1 stone in lb
- 1lb is 0.4536kg
- 1 ounce is 1/16 of 1 lb (28.35g)
- 1 stone is 14 lbs
What is the normal weight gain of infants?
- 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
What do we measure feed volumes in?
ml, but parents often measure in ounces
What is:
- 1 ounce in ml
- 1 ounce in pint
- 1 pint in ml
- 1 ounce is 28.4ml
- 1 ounce is 1/20th of a pint (568ml)
How much feed should a baby take if:
- well
- unwell
- Probably 140-180ml/kg/day
- 100ml/kg/day if ill