Paediatric History Taking Flashcards
Paediatric History Taking
- Chief complain (Open question)
- Why your child needs to see a doctor? / What happened to your child? / What are the problems of your child? / Why was your child admitted? / What illness does your child have?
- Follow-up questions
- Associated symptoms: Rash, Cough, Diarrhoea etc. (FEVER CUD Seizures PAM IF BIG DEALS) - HPI
- Timing, duration, severity
- Associated symptoms
- Pertinent negatives
- Disease patterns / phenotypes - PMH
- Major medical, surgery, medication, hospitalisation
- Drug allergy - Review of systems
- Organ system-based evaluation
—> Avoid shotgun approach
—> Can ask a general question to cover related system
—> Not ask questions like checklist - Family history
- Specific illness and relation to patient - Social history
- Living situation, work history, support system
- Drug / substance abuse - Prenatal + Birth history
- Maternal
- Prenatal
- Birth
- Neonatal - Feeding history
- Nutrition, progression, supplements - Developmental history
- Milestones
- School
- Behaviour - Immunisation history
- List + Date
- Adverse effects - Expanded genetic / environmental assessment
- Relevant to current problem list
NB: Historian
- May not be the patient
- Reliability, historian-child interaction, non-verbal cues
- Non-judgmental, not imply guilt
Fever + Rash Mnemonics
Very Sick Person Must Take Double Tablets / No Exercise
- Day 1: Varicella
- Day 2: Scarlet fever
- Day 3: Smallpox
- Day 4: Measles
- Day 5: Typhus (斑疹傷寒) (by Rickettsia prowazekii, Orientia tsutsugamushi, Rickettsia typhi)
- Day 6: Dengue / No disease
- Day 7: Typhoid (傷寒) (by Salmonella typhi) / Enteric fever
痘猩天麻:
- Day 1: Chickenpox (水痘)
- Day 2: Scarlet fever (猩紅熱)
- Day 3: Smallpox (天花)
- Day 4: Measles (麻疹)
USMLE mnemonics for Paed history taking (FEVER CUD Seizures PAM IF BIG DEALS)
FEVER CUD Seizures PAM IF BIG DEALS
- Fever
- Ear pulling
- Vomiting
- Ear / Eyes discharge
- Rash
- Chest + Cold symptoms
- Urination
- Diarrhoea
- Seizures
- Past medical, surgical, hospitalisations
- Allergies
- Medications
- Ill contacts
- Family history
- Birth history
- Immunisations
- Growth and development, height, weight, milestones
- Day care
- Eating habits, feeding
- Appetite
- Look of baby
- Sleep
History taking in Asthma (Junior Tutorial)
- SOB
- Onset
- Recurrent
- Duration
- What time more severe, Seasonal variation
- Associated symptoms: Cough, SOB, Wheeze, Chest tightness, Cyanosis
- Severity: Speak in full sentence, Chest tightness
- Triggers: Exercise, cold air, smoke, incense, stuff animals, pets, bed sheet, viral infections, pollutants
- On any medication
- Bronchodilator effective? Age group? (Differentiate from bronchiolitis) - Cough
- How long
- Frequency
- Sputum, Colour
- Noctural waking patient up? (2-3 hours after sleep) (vs Postnasal drip 1 hour after sleep) - Exacerbation
- Frequency of mild / moderate / severe attacks
- Number of course of systemic steroid / mechanical ventilation
- Previous hospitalisation
- Triggers: Exercise, cold air, smoke, incense, stuff animals, pets, bed sheet, viral infections, pollutants - Control of Interval symptoms
- Daytime symptoms
- Nocturnal symptoms + Sleep disturbance
- Exercise-induced symptoms
- Frequency of using bronchodilator
- Activity limitation - Medication
- Inhaled steroid prophylaxis
- Other regular asthma drugs
- Compliance
- Technique + Spacer
- Recent change
- Who help patient to administer drug -
Quality of life
- School
- Sick leave
- Participation in sports
- Sleep disturbance - Other symptoms
- Chest pain
- Rash
- Eczema
- Allergic rhinitis
- Food allergy
- Drug allergy - DDx
- URTI (Fever)
- Allergic rhinitis
- Cardiac asthma (Cardiac symptoms) - Feeding history
- Frequency
- Amount
- Breastfeeding: Feeding duration, Each breast emptied every time? - Vaccination history
- PMH
- Food allergy
- Angioedema - Family history
- Atopy
- Asthma
- Allergic rhinitis - Developmental history
- Birth history, Antenatal history
- Social history
- Smoker around baby
- Living environment
- School environmental
- Parent age + occupation
- Carpet
- Pet
- Blankets + how often wash
- Siblings
History taking in Fever without Localising sign (Junior Tutorial)
Definition:
- Acute <1 week of febrile illness which careful history do not illicit the etiology
Causes:
- Viral infection (most common, self-limiting)
- Occult bacterial infection
—> Neonates:
1. Bacteraemia
2. Meningitis
3. UTI
4. Pneumonia
5. Enteritis
6. Osteomyelitis
7. Septic arthritis
—> 1-3 months:
8. Pyelonephritis
Pathogen:
< 2 months:
- GBS
- Strept pneumoniae
- Salmonella
- E. coli
- Neisseria meningitidis
- H. influenzae type B
3 months - 3 years:
- Strept pneumoniae
- Neisseria meningitidis
- H. influenzae type B
- Staph aureus
- Strept pyogenes (GAS)
- Salmonella
History taking in Epilepsy (SpC Paed Senior Tutorial) + SpC Paed Sophelia Chan + Spotting The Sick Child Online Module
- Onset
- Duration
Pre-ictal:
- Aura
- Febrile symptoms
- Provocative factors (e.g. flashing lights)
- Prodromes (e.g. abnormal sounds, mood disturbance, confusion)
- Automatism
1. Fever?
2. Unwell recently?
3. Past medical history
4. Birth history
5. Developmental history
6. Did the child complain of anything prior to the fit?
7. Were they exercising? (cardiac syncope)
Ictal: (Head to toe)
- Types of seizure
- LOC / Response
- Cyanosis (breathing stop during tonic seizure)
- Pallor
- Eye uprolling
- Facial twitching
- Tongue biting
- Teeth clenching
- Limb stiffness / twitching
- Urine incontinence
- Witness
1. What were they doing when the fit started?
2. How did the fit start?
3. LOC
4. Incontinence
5. Movements in body parts
6. Eye rolling
7. Tongue biting
8. Tone
9. Colour
10. Duration
11. Self resolving / Alleviating factors
Post-ictal:
- Drowsiness
- Disorientation, Retrograde amnesia
- Paralysis (Todd’s paralysis)
- Drooling / Vomiting
- Injury
1. Drowsiness
2. Headache afterwards
3. Any injury
Common causes of fits:
1. Epilepsy
2. Febrile convulsion
3. Encephalitis / Meningitis
4. Head injury
5. Hypoglycaemia
6. Electrolyte disturbance (esp. Na, Ca)
7. Reflex anoxic seizure
Red flags:
1. Fits in babies
2. Aspiration
3. Hypoglycaemia
4. Status epilepticus
5. Pseudoseizures
Shortness of breath (SOB) (Spotting The Sick Child Online Module)
Causes:
1. Asthma
2. Croup
3. Bronchiolitis
4. Pneumonia
History:
1. Age
- Different illnesses at different ages
- Small babies get more ill more quickly
2. Past medical history
- Prematurity
- Cardiac / Respiratory disease
3. Fast / Noisy breathing?
4. Eating and drinking?
5. Level of activity?
6. Fever?
Characteristic stories:
1. Bronchiolitis: Baby with snuffly nose, wet cough, wheeze
2. Viral induced wheeze: Pre-schooler with runny nose then dry cough and wheeze
3. Asthma: Older child with recurrent wheezy episodes, atopy in family
Red flags:
1. Choking
2. Apnea
3. Status asthmaticus
Fever
- Minor vs Major
- Localised vs Septicaemia
History:
1. Fever
- Onset
- Duration
- Temperature
- Pattern: Continuous / Intermittent / Remittent / Relapsing (web)
- Provocative / Palliating factors
2. Associated symptoms
- Chills, Rigor
- Seizure
- Dehydration
- Rash (self notes)
3. TOCC
Causes:
1. Pneumonia
2. UTI
3. Meningitis + Meningococcal sepsis
4. Kawasaki disease
5. Influenza
6. Bone / Joint injection
7. Malignancy: Leukaemia (self notes)
8. Autoimmune: Systemic JIA, SLE (self notes)
9. Otitis media (self notes)
Rash
Types of rash:
1. Erythema
2. Urticaria / Eczema
3. Macular / Papular
4. Vesicular / Pustular
5. Petechiae / Purpura
History:
1. Well / Ill?
2. Is there an obvious cause of the rash?
Red flags:
1. Meningococcal sepsis
2. Kawasaki disease
3. Toxic shock syndrome
4. SJS
5. Henoch Schonlein Purpura (HSP)
6. Anaphylaxis
7. ITP
8. Leukaemia
Dehydration
History:
1. Quantify Vomits + Loose stools
2. GE
- Cough?
- Fever?
- Sore throat?
- Urinary symptoms
3. Blood in the stools? (infection vs intussusception vs food intolerance)
4. TOCC
5. Drinking / Feeding
6. Urinary output
- worrying to have no wet nappy for 12 hours) / passed urine if they are toilet trained
7. Recent weight
- for calculating fluid loss
Red flags:
1. Pyloric stenosis
2. Hypernatraemic dehydration
3. DKA
Abdominal pain
Differentiate Medical vs Surgical conditions
History:
1. Acute / Chronic
Causes:
1. Easy to miss
- UTI
- Intestinal obstruction
- Appendicitis
- IBD
- Rare but serious
- Neuroblastoma
- Wilms tumour
Causes of acute pain (hours to days):
1. UTI
2. DKA
3. Surgical problems
Causes of chronic pain (weeks / longer):
1. Constipation
2. IBD
3. Malignancy
Red flags:
1. Peritonitis
2. Intussusception
3. Abdominal mass
4. Bilious vomiting
5. Testicular torsion
Head injury
History:
1. Mechanism and force involved in the head injury?
2. Fall from standing height or from higher up?
3. LOC
- Did they cry immediately / in older children do they remember who was there and who called for help?
- Duration
4. Vomiting
5. Drowsiness
6. Seizure
7. Been their normal self since injury?
8. Irritable
9. Complained of headache since?
Red flags:
1. Vomiting
2. Drowsiness
3. LOC
Be aware of the possibility of Non Accidental Injury, particularly think of the possibility of an inflicted injury in a non-mobile, non-verbal child.
Adolescence History Taking
HEADSSS Approach:
- Adolescent Risk Profile Assessment
- Children’s Hospital of Los Angeles
1. H: Home
2. E: Education, employment, eating
3. A: Activities
4. D: Drug
5. S: Sex
6. S: Suicide
7. S: Safety (social media/online)
