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Y3 paediatrics > assessing children > Flashcards

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

1
Q

what type of approach to take when assessing children

A

holistic multi-system approach

there may be more than one problem and more than one system may be involved

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2
Q

what to start with when assessing children

A

age

guides approach to hx and exam
common pathologies differ
conditions manifest differently at different ages

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3
Q

what is an age appropriate approach to taking a history

A

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

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4
Q

key stages of paeds hx

A

intro

PC

HPC

birth hx

PMH

immunisations

development

D+A

FHx, SHx

ICE and closure

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5
Q

paeds hx - intro

A

introduce yourself

identify the patient and who is with them (parents, carers, siblings etc)

generate rapport w/ child

note your ‘examination’ observations

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6
Q

paeds hx - HPC

A

onset, progress, variation, effects, observations

chronological stages (incl GP, A+E, ward)

general/systems enquiry may be appropriate here

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7
Q

what units do we measure child’s weight in

A

kg/g

parents typically want it in lbs/oz

lb = 453.6g
oz = 1/16th of a lb (28.35g)
st = 14lbs (6/35kg)
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8
Q

how much weight should a baby gain

A

~150-200g /wk for 1st 6mths

~20-30g/day

up to 10% loss in first few days is common

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9
Q

what do we measure feed volumes in

A

ml

parents often measure in fl. oz

oz = ~30ml
1/20th of a pint (568ml)

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10
Q

how much feed should a baby take

A

~140-180ml/kg/day

100ml/kg/day if unwell

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11
Q

asking about stools/bowel function

A

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

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12
Q

paeds hx - birth hx

A

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

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13
Q

paeds hx - PMH

A

admissions
similar problems

previous health issues etc

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14
Q

paeds hx - immunisations

A

missed - if so why

additional

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15
Q

paeds hx - development

A

what can they do

any concerns

basic enquiry essential - smiling, sitting, walking, words, support (age appropriate)

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16
Q

paeds hx - D+A

A

regular medication

OTC

prescribed

things for this illness

previous medications

name, dose, frequency, route, preparation

17
Q

paeds hx - FHx and SHx

A

recent and related health issues
parents/siblings (age and health)
who does the child live with
realtionship dynamics

school and nursery

  • common source of infective contacts
  • can give insight into developmental process

parental SHx impacts on child’s health
- smoking, alcohol, drugs, occupation, stress

18
Q

paeds hx - addressing concerns and closure

A

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 hx and discussions
note date, time, who was present/gave hx

19
Q

approach to examining a child

A

observations started during hx

age appropriate techniques
be sensitive to what will upset the child

20
Q

what are you trying to examine in a child

A

OBSERVATIONS!
ABCDE, baseline obs/vital signs
general condition and peripheries

resp
CVS
GI
neuro
MSK
ENT
skin
developmental skills
measurements and centile
21
Q

process of examination for a child

A

be flexible

ALWAYS start w/ observations
- pre assessment, during hx

think of each system
think of each area
age appropriate approach
generate rapport

22
Q

what to look for during observations

A

general: appearance, play, interaction, obs

resp: effort, noise, rate, recession, O2, nebs
CVS: colour, perfusion, posture

GI: feeding, vomiting, abdo distension/movement

neuro: alertness, interaction, play, posture, gait
MSK: mobility, limb movements, posture, splints, strength, mobility aids

other: rashes, bruises, infusions, tubes, lines; toys, pictures, cards, games etc

23
Q

what to look for in hands and arms

A

warmth, cap refill, radial/brachial pulses (rate/rhythm)

clubbing, nail changes, hand skills, pen marks (developmental stage)

24
Q

what to look for in the head and face

A

eyes - jaundice

lips - colour, moisture

tongue

nose - congestion

scalp changes, bruises, rashes, fontanel (depression, enlargement)

25
Q

what to look for in the neck

A

rashes and nodes - size, shape, mobility, position, consistency, symmetry

tracheal tug

carotid pulse and trachea can be uncomfortable so not always necessary

examine from the front

26
Q

what to look for and examine in the chest and back

A

murmurs - timing, pitch, quality, location, radiation

apex beat, thrills, chest expansion (limited in small children)

breath sounds - all areas, reduced/added sounds, symmetry

percussion - limited in infants and not routine BUT commonly forgotten in pneumonia

resonance and fremitus - difficult in young children

rashes and skin marks incl neuro-cutaneous

spine alignment, deformity, sacral dimples

27
Q

what to look for and examine in the abdomen and groin

A

tenderness - watch face and movement, light and deep palpation (can be challenging)

masses (esp stool) and organomegaly (can use thumb 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 PR (senior staf only)

28
Q

what to look for and examine in the legs and feet

A

mobility, changing posture, movements, tone

reflexes (easy when v. young), plantars, clonus

power, co-ordination, sensory assessment if older

pulses, warmth, CR, colour, mottling
rashes, bruises, markes

deformities and gait usually evident on inspection

29
Q

primitive reflexes in babies

A

plantar - extensor plantar responses

grasp reflex on foot when pressing and hold

30
Q

how to measure head circumference

A

front of head round occiput

repeat 2-3x to check

remove any hats etc

31
Q

play and examination

A

let the child continue to play as appropaite

age appropriate toys - use to illustrate, distract and as clinical tool

Y3 paediatrics (45 decks)

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