Paediatric sx exploration:

Question 1

Diarrhoea and Vomiting

Answer 1

As normal but inc hydration questions: (wet nappies, fluid intake and drowsiness)

Question 2

Soiling/Enuresis

Answer 2

Primary or secondary
Full account of toilet training.
School toilet behaviour.
Protest behaviour: stressful/chaotic life.
If Soiling: faeces consistency ( Diarrhoea/constipation – use Bristol stool chart) and any painful anal conditions.

If enuresis: have the ever had a dry night?
If secondary: urinary/GI infection symptoms, spinal-cord compression symptoms.

Question 3

Failure to thrive/weight loss.

Answer 3

Ask to see growth chart.
Input: do you tell dietary history, feeding history, hunger. Use: energy, activity level.
Output: wet nappies, stools.

Others: chronic cough, recurrent infections - (CF, Primary ciliary dyskinesia, immunological), Sweating/breathless when feeding (cardiac), behaviour, general health, happiness, parents’ health.

Associated GI symptoms.

Question 4

Weight Gain

Answer 4

Weight gain. As for failure to thrive see growth chart input use and output questions.

Hypothyroidism symptoms: gross impairment delay puberty mental slowness constipation cold intolerance.

Cushing’s syndrome symptoms: gross impairment, proximal weakness, central obesity.

Syndromic features: Laurance-moon (intellectual impairment, extra digits). Prader Willi syndrome: poor muscle tone, lack of eye co-ordination, distinct facial features).

Question 5

Walking/sitting delay.

Answer 5

Ages of milestone.
Mobility 
Hand dominance 
Balance problems 
Behavioural problems 
Associated neurological symptoms.

Question 6

Speech Delay

Answer 6

Ages of milestones. Senses: vocals, hearing, vision.

Communications: comprehension (follows commands, response to voice),
Non-verbal communications (Pointing, gestures, faces), Social responses (how acts in new situations, tantrums, playing, gestures).

Question 7

Early puberty/late puberty/primary amenorrhoea/short stature

Answer 7

Pubertal development review: testes, breast development, menarche, pubic/axillary hair, height, acne, mood changes.

Intracranial pressure symptoms: visual problems headaches.

Family pubertal/stature history.

Symptoms of other systemic diseases(CF, thyroid disorder, anorexia, crohn’s disease).

Question 8

Behavioural disorder

Answer 8

Attention deficit hyperactivity disorder symptoms: poor concentration, hyperactivity.

Conduct disorder symptoms: hostile, aggressive, cruel.

Autism symptoms: poor social interaction, reciprocal communication behaviour, restriction interests, repetitive behaviours, difficulties recognising/responding to emotions.

Question 9

Allergies

Answer 9

Pattern, frequency, duration, persistent/intermittent.

Reaction: Wheeze, rash, sneezing/itchy eyes, abdominal pain/diarrhoea, swelling of eyes/eyelids/tongue. Specifically ask about anaphylactic symptoms.

Triggers/associations: Pollen/season, chemicals, pets, latex, dust, foods (milk/eggs/wheat/peanuts/fish/shellfish).

Ask about atopy in child and family (Asthma, eczema, hay fever) and ask about food allergies.

Ensure you ask about home (heating, dampness, pets) and social (smokers and family, exposure to pollutants).