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
