General paediatric

Question 1

How do you relate to the parents?

Answer 1

Don’t regard over anxious parents as a nuisance and just reassure

Parent behaviours in the consultation often reflects their upbringing as well as excessive/lack of concerns with physiological functions

Try and disassociate fact from interpretation eg
Our baby has colic (interpretation) - > FACT = baby cries and draws her legs in to her tummy

Question 2

How do you relate to the child?

Answer 2

Children at age of 2 can hear, understand and say a lot

By 7-8 yrs they’re wise - don’t talk about them like they have no understanding

Can be useful, if everyone is in agreement, to speak to child and parents separately to allow them to express particular concerns

Question 3

How should you set up the history taking and what are the first pieces of information you should gather?

Answer 3

Address parents by name not by mum or dad

Find out what the child is called at home and use that name

Accurate age is important - in years/months

Name of school/nursery/clinic/health centre she attends

Consider the situation of the child:
Do they want to be on parents knee?
Do they want to play with toys - should be available
Older should be fully included in the discussion

Question 4

What is the standard template for taking a history?

Answer 4

name/age/sex/consultant/historian
PC
HPC
PMH
Birth Hx
DH - allergies
FH and SH

Question 5

What information is needed for a birth Hx?

Answer 5

Where
Delivery
Gestation
Weight
Ante/postnatal problems
Neonatal problems (jaundice, SCBU, ventilation, abx)
Maternal health - smoking and alc, meds, illnesses
Illnesses , operations and accidents
Feeding - neonatal, weaning, concerns about growth
Immunizations
Development

Question 6

What information is key in SH/FH?

Answer 6

Mother - name/age/occupation/health
Father - name/age/occupation/health
Siblings - name/age/health
Family composition - who lives with who, main carers, family pressures, draw out family tree with parents help 
Inherited and genetic conditions
Contact with common infections
Nursery/school
Pets
Housing - stability, space, specific needs, difficulties

Question 7

What else is important?

Answer 7

ICE

Impact on functioning -
Normal life - eg asthma what does it stop them doing
School - how much has been missed?
Social - is the child opting out of games or of leisure activities at home

Always make note of who gave u the hx, who referred and location

Question 8

What is the HEEADSSS model for social history taking in paeds?

Answer 8

Home and relationships:
- Who lives with you? What are relationships like at home? Any recent changes at home? Any violence at home?

Education/employment:
- Tell me about school/work, have you experienced any bulling? do you have friends? How is your performance?

Eating:
- Does your weight/body shape cause you any distress? Has there been any recent changes in your appetite or diet?

Activities and hobbies:
- What do you do for fun?

Drugs/alcohol:
- Do you or your friends or family use drugs, alcohol or tobacco?

Sex and relationships:
- Have you been in a romantic relationship? What is/was there gender? Have any of your relationships been sexual?

Self harm, esteem and mental health:
- Do you feel down, depressed or hopeless? How is your sleep? Your concentration? Do you enjoy things? Are you looking forward to anything? Do you have any thoughts of hurting yourself?

Safety:
- Have you ever met anyone you encountered online? Have you experienced any violence at home or anywhere else? Are you, your friends or family members involved in any gang activity? Have you ever been involved in fights?

Social media:
- Which social media platforms do you use? Do you feel you have been bullied online? Do you give out your personal details on social media?