Approach to Assessing Children Flashcards
1
Q
How can we approach general paeds?
A
- Holistic multi-system approach essential
- More than one problem may exist
- More than one system may be involved
- Start with the age
- Guides approach to history taking and examination
- Common pathologies differ
- Conditions manifest differently at different ages
- Consider common differential for the presenting problem
2
Q
What is likely to be different in paediatrics?
A
- parents will be present
- they are astute observers
- resident carers
- Play is essential and clinical helpful
- Specialised nursing staff
- Treatments differ by age and weight
3
Q
What can we do to prepare for clinical encounter?
A
- Why are they coming to see me?
- Name, sex and age of child
- Do we have opportunity to observe child first?
- What are likely DDx?
- What conditions need ruled out?
- What info have the nurses already gathered?
4
Q
How can we take a good paeds history?
A
- Be calm and empathetic
- Show interest in what the parents are saying
- Facilitates dealing with concerns and anxietiesa
5
Q
How can we use an age appropriate approach?
A
- 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
6
Q
Paeds history
What do we cover in introduction?
A
- Introduce yourself, identify the patient and who is with them (parents/ carers/ others)
- Generate rapport with the child
- Note your “examination” observations
7
Q
Knowing your units
What do we normally weigh babies in?
A
Pounds and ounces
9lb = 4kg
8
Q
•How much weight should a baby gain?
A
- ~150(100)- 200g/ week 1st 6 months
- = 20-30g per day (need to average time intervals)
- Up to 10% loss in first few days is common
9
Q
•How much feed should a baby take?
A
- Probably 140-180 ml/kg/day (100ml/kg/day if ill)
10
Q
What questions need covered about jobbies?
A
- 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
11
Q
Paeds history
What needs covered in birth history?
A
- Detail depends on age and presentation
- Some features may be very relevant years later
12
Q
Paeds history
What needs covered in immunisations?
A
- Have they missed any
- Had any additional
13
Q
Paeds history
What needs covered in development?
A
- What can they do? Any concerns?
- Basic enquiry essential (Walking, Words, Support)
14
Q
Paeds history
What needs covered in FH/SH?
A
- Key stage in assessing patients
- Recent and related health issues
- Parents/ siblings (age and health)
- Relationship dynamics
- School and nursery
- Common source of infective contacts
- Can give insight into developmental progress
- Parental social history impacts on child’s health
- Smoking/ alcohol/ drugs/ occupation/ stress
15
Q
What are some questions we can use to address the parents concerns?
A
- What made them come to see you today?
- What concerns do they have?
- What were they looking to understand?
16
Q
How can we close the paeds history?
A
- Summarise key features
- Check understanding and safety net
- Document history and discussions
- Note date, time, who was present/ gave history
17
Q
Can we be expected to know paeds examination in year 3 osce?
A
Nope
18
Q
How do we start paeds examination?
A
- Observe first
- Smile
- Speak to the child (even if they are weeks old)
- Get down to their level
- Be careful moving them- keep parents close
- Gentle handling and gradual exposure
- Show interest in their toys + play
19
Q
What do we observe for in paeds examination?
A
- General: Appearance, play, interaction, obs
- Resp: Effort, noise, rate, recession, O2, nebs
- CVS: Colour, perfusion
- GI: Feeding, vomit, abdo distension/ movement
- Neuro: Alertness, interaction, play, posture
- MSK: Mobility, limbs movements, posture, splints, mobility aids
- Other: Rashes, bruises, infusions, tubes, lines
- Other: Toys, pictures, cards, games, caffeine, books
20
Q
What do we examine for on hands and arms?
A
- Warmth, cap refill, radial/brachial pulses (rate/ rhythm)
- Clubbing, nail changes, hand skills, pen marks
21
Q
What do we look for head and face?
A
- Eyes (jaundice), Lips (Colour, moisture), Tongue, Nose
- Scalp changes, Bruises, Rashes, Fontanel
22
Q
What do we examine for on the neck?
A
- Rashes and Nodes (easier from the front); size, shape, mobility, position, consistency, symmetry
- Tracheal tug (Don’t push for carotid pulse or trachea)
23
Q
What do we observe for chest and back?
A
- Murmurs (Timing, pitch, quality, location, radiation)
- Apex beat, thrills, chest expansion (limited if wee)
- Breath sounds (all areas, reduced, symmetry, added)
- Percussion (limited in infants, not routine, commonly forgotten when dealing with pneumonia)
- Resonance and fremitus? (most are pre-school!)
- Rashes and skin marks (inc neuro-cutaneous)
- Spine alignment, deformity, sacral dimples
24
Q
What do we observe for abdo and groin?
A
- Tenderness- watch their face and movement
- Masses (esp stool) and organomegaly (liver, spleen, kidneys). Thumb can be used to feel
- Bowel sounds and bruits (v.rare)
- Femoral pulses (essential in infants)
- Hernias (and testis)
- Genital/ anal appearance (routine in nappies but often not appropriate for older children)
- DON’T DO A RECTAL EXAM! (Senior staff only)
25
Q
What do we observe for in legs and feet?
A
- Mobility, changing posture, movements, tone
- Reflexes (easy when v. young), plantars, clonus
- Power, coordination, sensory assessment if older
- Pulses, warmth, cap refill, colour, mottling,
- Rashes, bruises, marks
- Deformities and gait usually evident on inspection
26
Q
How can we use play for examination?
A
- Let the child continue to play as appropriate
- Select age appropriate toys
- Use play to illustrate
- Use play as a distracter
- Use play as a clinical tool
- The aim is to gather useful clinical information
- Appropriate sensitivity needed at times
27
Q
What are Revolta’s top tips?
A
- Smile and make positive eye contact
- Engage with the child’s interests
- Recognise common toys and characters
- Develop your banter
- Soothing words to babies (parents notice)
- Nursery and school chat
- Counting fingers
- Activities and interests
- Always observe as much as you can
