Approach to Assessing Children Flashcards
What is the general approach to paediatrics?
Holistic multi-system approach
- More than one problem may exist
- More than one system may be involved
Why is age important to consider in paediatrics?
- Guides approach to history taking and examination
- Common pathologies differ
- Conditions manifest differently at different ages
What is different from adults in the approach to children?
- Parents/carers will be present
- Play is essential and clinically helpful
- Specialised nursing staff ( different rations, understandably protective, experienced at recognising sick children)
- Treatments may differ by weight and age
What questions may you think about when preparing for a paediatric encounter?
- 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?
Why is it important to take a good history?
- Key step to making a diagnosis
- Gather important information
- Potentially rule out significant pathology
- Help target examination
- Facilitates in dealing with concerns and anxieties
What are the key stages of a paediatric history?
- Introduction
- Presenting complaint
- History of presenting complaint
- Birth history
- PMH
- Immunisation
- Development
- Drugs and allergies
- Family history
- School and nursery
- Parent social history
How much weight should a baby gain?
- 100g per week for 1st 6 months
- 20-30g per day
- Up to 10% loss in the first few days is common
How much feed should a baby take?
Probably 140-180ml/kg per day
What should you ask about a baby/child’s poo?
- Nappies vs toilet trained
- Frequency
- Size, shape, appearance and consistency
- Difficulties passing
- Pain on passing
- Blood or mucus
What are the 2 ends of the Bristol stool chart?
- Type 1 is hard pellets
- Type 7 is entirely liquid
How can concerns be addressed and a closure to a consultation be achieved?
- What made them come to see you today?
- What concerns do they have?
- What were they looking to understand?
- Summarise key features
- Check understanding and safety net
- Document history and discussions
- Note date, time, who was present/ gave history
What should be examined in paediatrics?
- ABCDE and baseline observations/ vital signs
- General condition and peripheries
- Respiratory system
- Cardiovascular system
- Alimentary system
- Neurological and musculoskeletal systems
- ENT and skin
- Developmental skills
- Measurements and centile
How can an examination be commenced in paediatrics?
- Observation first
- Be friendly and smile
- Get down to child’s level
- Speak to the child
- Be careful moving them
- Gentle handling and gradual exposure
- Show interest in toys and play
What do you observe for in paediatrics?
- 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
What examination of the hands and arms is done in paediatrics?
- Warmth, cap refill, radial/brachial pulses (rate/ rhythm)
- Clubbing, nail changes, hand skills, pen marks
What examination of the head and face is done in paediatrics?
- Eyes (jaundice), Lips (Colour, moisture), Tongue, Nose
- Scalp changes, Bruises, Rashes, Fontanel
What examination of the neck is done in paediatrics?
- Rashes and Nodes (easier from the front); size, shape, mobility, position, consistency, symmetry
- Tracheal tug (Don’t push for carotid pulse or trachea)
What examination of the chest and back is done in paediatrics?
- 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
What examination of the abdomen and groin is done in paediatrics?
- 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)
What examination of the legs and feet is done in paediatrics?
- 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
