assessing children Flashcards
• Understand the components of a paediatric history • Recognise the key differences in assessing children • Develop a multisystem approach to children • Describe the range of techniques used to facilitate examination • Be able to make a basic assessment of each system
what type of approach to take when assessing children
holistic multi-system approach
there may be more than one problem and more than one system may be involved
what to start with when assessing children
age
guides approach to hx and exam
common pathologies differ
conditions manifest differently at different ages
what is an age appropriate approach to taking a history
consider the age and developmental stage
consider language and intellectual skills - start w/ non-medical Qs
typically most questions are directed towards parents; some questions are appropriate for child
pre-verbal children communicate; older children can be quiet
key stages of paeds hx
intro
PC
HPC
birth hx
PMH
immunisations
development
D+A
FHx, SHx
ICE and closure
paeds hx - intro
introduce yourself
identify the patient and who is with them (parents, carers, siblings etc)
generate rapport w/ child
note your ‘examination’ observations
paeds hx - HPC
onset, progress, variation, effects, observations
chronological stages (incl GP, A+E, ward)
general/systems enquiry may be appropriate here
what units do we measure child’s weight in
kg/g
parents typically want it in lbs/oz
lb = 453.6g oz = 1/16th of a lb (28.35g) st = 14lbs (6/35kg)
how much weight should a baby gain
~150-200g /wk for 1st 6mths
~20-30g/day
up to 10% loss in first few days is common
what do we measure feed volumes in
ml
parents often measure in fl. oz
oz = ~30ml
1/20th of a pint (568ml)
how much feed should a baby take
~140-180ml/kg/day
100ml/kg/day if unwell
asking about stools/bowel function
children in nappies vs independent toileting
frequency ( per week/day/month)
size, shape, appearance, consistency
difficulties passing
pain on passing
blood/mucus seen
use bristol stool chart and ask child/parents to compare
paeds hx - birth hx
detail needed depends on age and presentation
some features may be very relevant yrs later
gestation, birth weight, health during pregnancy, delivery, child’s well being after delivery
paeds hx - PMH
admissions
similar problems
previous health issues etc
paeds hx - immunisations
missed - if so why
additional
paeds hx - development
what can they do
any concerns
basic enquiry essential - smiling, sitting, walking, words, support (age appropriate)