Paediatric History & Examination Flashcards
Outline the different sections of paediatric history
- Introduction
- Hx presenting complaint
- Systems review (intake, output, vomiting, fever, rash, weight, behaviour etc…)
- PMH, medications & allergies
- Antenatal history (pregnancy complications, medications/drugs etc in pregnancy, birth, premature/term, weight, complications)
- Developmental history
- Immunisation history
- ICE
- Family history
- Social history (who live with, happiness at home/school, smoking status at home, pets at home)
When talking to an adolescent/young adult you important to address health risk behaviours that are more prevalent in this population. Use the HEEADSSS acronym to highlight key areas to discuss
- Home & relationships
- Education & employment
- Eating
- Activities & hobbies
- Drugs, alcohol, tobacco
- Sex & relationships
- Self-harm, depression, self-image
- Safety & abuse
You may do a specific system examination on a child (e.g. abdo exam) or you may just be asked/required to examine a child. Outline how you would perform a general examination of a child
- General inspection of child
- General inspection of surroundings
- Hands/wrists: inspect hands, check CRT, check temp, HR, RR
- Head: eyes (jaundice, anaemia), mouth, ears, cervical lymph nodes
- Chest: assess WOB, central CRT, auscultate for heart & lung sounds, do other aspects of resp/cardio if think relevant
- Abdo: palpate all quadrants, feel for organomegaly, listen to bowel sounds (anything else think relevant)
- Legs & everything else: check for any rashes, cuts etc…
When is the NIPE performed?
- 72hrs after birth
- Repeated at 6-8 weeks by GP
Outline steps of NIPE
- Introduction & general questions
- General appearance
- Head
- Shoulders & arms
- Chest
- Abdomen
- Genitals
- Legs
- Back
- Reflexes
- Others/investigations/obs (weight, length, OCP if not done in head, pre & post ductal saturations, RR, HR)
How do you want baby for NIPE?
Stripped down to nappy
What should you ask in the general questioning at start of NIPE?
- Ask parent if they have any concerns
- Ask briefly about pregnancy & birth (complications)
- Has baby passed meconium?
- Is baby feeding okay?
- FH of congenital heart, eye or hip problems?
What should you assess in general examination section of NIPE?
- Colour (pallor, cyanosis, jaundice)
- Tone
- Activity
- Cry
- Obvious abnormalities (e.g. malformations, syndromic appearances)
What should assess in the head section of the NIPE?
- General appearance of head & face (shape, injury, syndromic appearance)
- Feel head (caput succedaneum, cephalohematoma, overriding sutures, anterior fontanelle)
- Occipitofrontal circumference (OCP)
- Inspect ears (patent, low set, asymmetry, skin tags)
- Inspect eyes (epicanthic folds in Down’s, erythema & discharge, subconjunctival haemorrhage, fundal/red reflex, cataracts)
- Inspect nose (patent)
- Inspect mouth (cleft lip, cleft palate & sucking reflex, ankyloglossia)
What should you assess in the shoulders & arms section of the NIPE?
- Inspect neck (webbing, lumps)
- Shoulder symmetry (clavicle fractures)
- Arms (position & movement e.g. Erb’s palsy)
- Brachial pulses
- Palmar creases
- Digits (number, clinodactyly)
What should you assess in the chest section of the NIPE?
- Observe breathing (distress, asymmetry, listen for grunting or stridor)
- Auscultate heart sounds
- Auscultate lungs
What should you assess in the abdomen section of the NIPE?
- Shape (concave may indicate diaphragmatic hernia)
- Umbilical stump (discharge, infection, hernia)
- Palpate abdomen
- Auscultate bowel sounds
What should you assess in the genitals section of the NIPE?
- Femoral pulses
- General inspection of genitalia (ambiguity, obvious abnormalities)
- Palpate testes & scrotum (undescended testes, hernias, hydrocoele)
- Inspect penis (hypospadias, epispadias)
- Inspect anus (patent)
What should you assess in the legs section of the NIPE
- Inspect legs (equal movements, skin creases, tones, talipes)
- Examine hips (Barlow’s & Ortolani’s)
- Inspect toes (count number)
What should you assess in the back section of the NIPE?
- General inspection (curvature, hair, pilonidal sinus)
- Feel for spinous processes
What reflexes should you assess in the reflexes section of the NIPE?
- Moro reflex: when rapidly tipped backwards the arms and legs will extend
- Suckling reflex: placing a finger in the mouth will prompt them to suck
- Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
- Grasp reflex: placing a finger in the palm will cause them to grasp
- Stepping reflex: when held upright and the feet touch a surface they will make a stepping motion
What should you be looking for on skin when doing NIPE?
- Haemangiomas
- Port wine stains
- Mongolian blue spot
- Cradle cap
- Desquamation
- Erythema toxicum
- Milia
- Acne
- Naevus simplex (“stork bite”)
- Moles
- Transient pustular melanosis
What should do in the others/investigations/obs section of the NIPE?
- Weight
- Length
- OCP (if not done in head)
- RR
- Pre & post ductal saturations (pre on right hand, post on either leg)
- HR
What should you do after you have finished the NIPE?
- Discuss any abnormalities with senior
- Share any findings with parents
- Document examination in NIPE computer system and baby’s red book
- Ask parent if have any questions
- Make any relevant referrals
