Paediatric History And Examination Flashcards
What things are important to consider when starting the consultation?
Most history will come from parent
Know who is accompanying the child
Clarify name, Date Of Birth gender etc.
Be aware of child protection concerns and know who to contact
What typical questions do you need to ask in the history of presenting complaint? (Same as adult)
Onset Duration Course Severity Precipitating/relieving factors Previous episodes Secondary symptoms
What are some key aspects to ask about in a paediatric history?
Feeding Vomiting Fever Wet nappies - urine output Stools Rash Behaviour Rhinorrhoea Cough Weight gain/loss Sleeping pattern Unwell contacts Localising symptoms
What do you want to know about a child’s feeding habits?
Volume of intake
Frequency
What do you want to know about if a child is vomiting?
Frequency and volume Timing Projectile? Bilious? Blood?
What do you want to know about a patients stools?
Consistency
How often they go
Steatorrhoea? - biliary obstruction
Red currant jelly - intussusception
What localising symptoms may a child show?
Tugging ear
Holding tummy
What do you want to know about in a child’s past medical history?
Immunisations up to date Past hospital admissions Birth Neonatal period for mother Accidents and injuries Any medical conditions - congenital Antenatal period
What do you want to know about in the developmental history?
Age at reaching milestones
Concerns about vision and hearing
What categories can a neonatal history be split into?
Pregnancy
Maternal infections
Birth
What do you want to find out about the pregnancy?
Maternal medical history Medications Alcohol and smoking Complications of pregnancy Results of any amniocentesis, chorionic villus biopsy and ultrasound reports
What infections are mothers in the UK tested for in the antenatal period?
HIV
Hepatitis B
Syphilis
Rubella
What are important facts to know about a child’s birth?
Duration or rupture of membranes Gestational age at delivery Mode of delivery Resuscitation (if req) Birth weight Any problems encountered after birth
What do you assess in a general examination of a child?
Weight and height - plot on growth chart with head circumference Temperature Colour Posture, movements and conscious level Rashes
What should you examine in a child?
Respiratory system Cardiovascular system Abdomen Nervous system ENT
What respiratory rate do you expect for different ages of children?
Neonate <60
Infant <40
Young child <30
Older child <20
What do you listen for when examining a child’s respiratory system?
Strider or wheeze
Cough and its nature
What does a barking cough indicate?
Croup
What do you look for on a respiratory examination?
Nasal flaring
Use of accessory muscles
Intercostal and subcostal recession
Chest shape abnormalities
When is percussion useful?
In children >5 years old
What pulse is mandatory to palpate in neonates and why?
Femoral pulse to detect coarctation of the aorta
What signs of cardiac failure are different in children to adults?
Hepatomegaly is seen
Sacral oedema and lung crepitations aren’t seen
For each age range, what heart rate is normal?
<1 year - 120-160
2 - 5 years - 90 - 140
5 - 12 years - 80 - 120
>12 years - 60 - 100
What should you observe about a a child’s abdomen?
Abdominal distension - alone this is not pathological
Jaundice
What do you palpate for on abdominal examination?
Abdominal masses Peristalsis Inguinal hernia Umbilical hernia Tenderness
What can give a good indication of a child’s mental status and nervous system function?
The way a child plays and interacts with their surroundings
What should be observed to assess a child’s nervous system?
Gait
Posture at rest
Alertness or conscious level
What is important to do in a child’s nervous system exam?
Measure head circumference
Palpate head sutures and fontanelles
Test primitive reflexes
What reflexes should be present in a newborn?
Rooting reflex Suck reflex Moro reflex Tonic neck reflex Grasp reflex Stepping reflex Babinski’s reflex
What is rooting reflex and how long does it last?
Baby turn head and open mouth when corner of mouth stroked
Last for 4 months
What is the suck reflex and when does it start?
If roof of babies mouth is touched, baby will begin to suck
Start 32nd week pregnancy (fully developed 36th)
Premature babies have weak suck reflex
What is the Moro reflex and how long does it last?
If baby is startled, they will throw head back and extend arms and legs before pulling them back in
It lasts for 2 months
How is Moro reflex tested and what can it be used to test for?
Hold baby a little above bed and allow to free fall backwards
Can be used to test for symmetrical response - asymmetry could be due to nerve injury
What is the tonic neck reflex and how long does it last?
If a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends at the elbow
Last 5-7 months
What is the grasp reflex and how long does it last?
Stroking the palm of a baby’s hand causes them to close fingers in a grasp
Hand - 5-6 months
Toes - 9-12 months
What is a stepping reflex and how long does it last?
Baby appear to take steps when their feet touches a solid surface
Last 2 months
What is babinski’s reflex and how long does it last?
When the sole of the foot is firmly stroked, the baby will extend their Hallucis
Normal for upto 2 years
What is done when examining the ear nose and throat of a child?
Neck palpated for lymphadenopathy
Then ears examined
Finally look into throat
Why is the throat examined last?
Most intrusive - may need wooden spatula for tongue
When should the throat not be examined?
Upper airway obstruction suspected - severe croup or epiglottitis
What features indicate a heart murmur is innocent?
Change with posture Localised Asymptomatic Normal cardiac examination Systolic only No thrill
