An Approach to Assessing Children Flashcards
approach to peadiatrics
• Holistic multi-system approach essential
o More than one problem may exist
o More than one system may be involved
• Start with age
o Guides approach to history taking and examination
o Common pathologies differ
o Conditions manifest differently at different ages
• Consider common differential for the presenting problem
what is different about a paediatric consultation?
• Parent(s) will be there o Astute observers o Resident carers • Play is essential and clinically helpful • Specialised nursing staff o Different ratios o Understandably protective o Experienced at recognising sick children • Treatments differ by weight and age
how should you prepare for a paediatrics consultation
- Why have they come to see you or been referred to the hospital or clinic?
- Do you know the child’s name age and sex?
- Do you have an opportunity to observe the child before “starting” your assessment?
- What is the likely differential diagnosis?
- What conditions do you need to rule out?
- What information have the nurses gathered?
age appropriate approach in peads
- Consider the age and developmental stage
- Consider language and intellectual skills
- Typically, most questions directed to parents
- Some questions are appropriate for a child
- Different perspectives may be gathered from both parents or from parent and child
- Pre-verbal children communicate!
- Older children can be quiet
key stages of a peads hx
• Introduction
o Introduce yourself, identify the patient and who is with them (parents/ carers/ others)
o Generate rapport with the child
o Note your “examination” observations
• Presenting complaint (what’s already known?)
• History of presenting complaint
o Onset, progress, variation, effects, observations
o Chronological stages (Including GP/ A+E/ Ward)
o General/ systems enquiry may be appropriate here
• Birth History
o Detail depends on age and presentation
o Some features may be very relevant years later
• Past Medical History (Admissions/ Similar Problems)
• Immunisations (Missed?/ Additional?)
• Development
o What can they do? Any concerns?
o Basic enquiry essential (Walking, Words, Support)
• Drugs and Allergies (This illness/ Regular/ Previous)
how much should a baby be feeding?
140-180ml/kg/day
100 if ill
Poo in peads hx
- Children in nappies vs. independent toileting
- Frequency (per day, week or even month)
- Size, shape, appearance and consistency
- Difficulties passing
- Pain on passing
- Blood or mucus seen
- Parents are sometimes surprised
family and social hx in paeds
• Key stage in assessing patients
o Recent and related health issues
o Parents/ siblings (age and health)
o Relationship dynamics
• School and nursery
o Common source of infective contacts
o Can give insight into developmental progress
• Parental social history impacts on child’s health
o Smoking/ alcohol/ drugs/ occupation/ stress
what do you observe for? paeds: general
appearance
play
interaction
obs
what do you observe for? paeds: resp
effort noise rate recession O2 nebs
what do you observe for? paeds: CVS
colour
perfusion
what do you observe for? paeds: GI
feeding
vomit
abdo distension/movement
what do you observe for? paeds: neuro
alertness
interaction
play
posture
what do you observe for? paeds: other
rashes bruises infusions tubes lines toys pictures cards games caffeine books
what do you observe for? paeds: MSK
mobility limb movements posture splints mobility aids
