Approach to Assessing Children Flashcards
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 - astute observers
- Play is essential and clinically helpful
- Specialised nursing staff (different ratios, 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
Important questions to ask about history of presenting complaint
- Onset, progress, variation, effects, observations
- Chronological stages (Including GP/ A+E/ Ward)
- General/ systems enquiry may be appropriate here
Important questions to ask about parental social history
- smoking
- alcohol
- drugs
- occupation
- stress
How much weight should a baby gain?
- 150-200g 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
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 - keep the parents close
- 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
- Skin: 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
What do you observe in children?
General
Appearance, play, interaction, obs
What do you observe in children?
Respiratory
Effort, noise, rate, recession, O2, nebs
