L6: Pediatric History Flashcards
Who are histories obtained from in the following situations? 2 week old, 3-8 yo, 9-12 yo, 12-18 yo?
- 2 week old: parent (don’t ignore infant)
- 3-8 yo: ask child basic Qs, more detail from parent
- 9-12 yo: more info from child than parent, parent gives fill-in
- 12-18 yo: adolescent gives most of info, parent fills-in if needed
When establishing CC for pediatric pt, what is important?
- establishing latent fears underlying CC (if any) by both parent and child
How can HPIs be potentially different for pediatric pts in comparison to adults?
- Degree and character of reaction to problem / CC between both parent and child should be noted. Investigate the discrepancy and know who you are really treating. Patient’s perspective is very important.
What are sometimes relevant questions for PMHx of pediatric patients depending on their age, their current complaint(s), that are different to adult PMHx?
- General health and strength of child
- Mother’s health during pregnancy (prenatal care, diseases/conditions, meds etc, fetal movements, emotional/behavioral status, radiation exposure, illicit drug use)
- Birth (pregnancy duration, place of delivery, labor, delivery type, condition of infant at delivery, birth weight)
- Neonatal period (1st month)
- Feeding
- Developmental milestones
- Toilet training
- School
- Dentition
- Growth
- Sexual development
- Communicable disease exposure
- Hospitalizations
What is a pitfall when assessing developmental milestones?
- Asking parent, “Has patient’s X development been normal?”
- Make sure you explore all of the 4 developmental milestones (motor, personal/social, language and cognitive)
What are the categories of developmental milestones?
- Motor (gross, fine)
- Personal/social
- Language
- Cognitive
What are differences seen in FMHx in pediatric pts vs adult pts?
- Maternal gestational history
- Ages of parents at birth of child
- Paternal / maternal relation
- Two generations of history from each side
What is different in social history in pediatric pts vs adult pts?
- Ask about personal status (what is a normal day in life for pt from parents and childs perspective)
- These include: school adjustment, nail biting, rituals, pica, bed wetting etc.
- Ask about home conditions
- HEADDS if necessary
What are components of HEADDS exam?
- H: home, health
- E: education
- A: activities
- D: drugs, depression, diet
- S: suicide, sexuality, social media
When are HEADDS exams necessary? Who are these questions asked to? What is the setting for asking these questions?
- These exams are used on adolescent children when situation lends itself to it (ie. during school physical or when situation where pt is coming in related to these topics).
- Ask these questions when parents/SO are out of the room.
What is an appropriate way to initiate the HEADDS exam?
- Say to parents: “I am going to ask your child questions that they may or may not feel comfortable answering with you in the room. Can you please step out?”
After HEADDS examinations, what are mandatory things that parents must be told about?
- Physical abuse (unless they are the abuser)
- Sexual abuse (unless they are the abuser)
- Suicide
- Homicidal
- Life threatening illness
- NOT sexual behavior unless it falls under one of the above categories
How are ROS questions different for pediatric pts than adults?
- Tailor questions appropriately
What are common pitfalls in pediatric documentations?
- Not including prenatal and birth history in younger children and where any complications have had lasting effectsperson
- Documenting growth as normal (use of percentiles is appropriate where possible)
- Documenting normal development (must use specifics related to milestones)
What are areas of the pediatrics history that differ to adult history?
- Informant: patient vs parent vs both (dependent on age)
- PMHx/PSHx: general health, strength, birth, neonatal period, feeding, milestones, toilet training, dentition, communicable disease exposure, hospitalizations
- Medications: typically have less, but dosages are crucial
- Allergies: distinguish intolerances vs reactions
- FMHx: maternal gestational history, ages of parents at birth of child, paternal/maternal relation (adoption etc), two generations of history from each side
- Personal/social history: personal status (day in life, school adjustment, rituals etc.), home conditions, HEADDS if necessary
- ROS: tailor questions appropriately
