Paediatrics - Geeky Medics History Flashcards
Presenting Complaint
Presenting complaint:
- Give the patient time to explain the problem/symptoms they’ve been experiencing.
- A paediatric history often relies on collateral information from the parents.
- It’s important to use open questioning to elicit the patient’s or parent’s presenting complaint.
- “So what’s brought your child in today?” or “What’s brought you in today?”
This can sometimes be difficult when talking to children and you may need to adopt an approach involving more direct questioning. So instead of saying “Tell me about the pain” you may need to ask a series of questions requiring only yes or no answers.
- “Is the pain in your tummy?”
- “Is the pain in your back?”
Allow the patient time to answer and do not interrupt.
History of presenting complaint
Onset – when did the symptom start? / was the onset acute or gradual?
Duration – minutes / hours / days / weeks / months / years
Severity – e.g. if the symptom is shortness of breath – are they able to talk in full sentences?
Course – is the symptom worsening, improving, or continuing to fluctuate?
Intermittent or continuous? – is the symptom always present or does it come and go?
Precipitating factors – are there any obvious triggers for the symptom?
Relieving factors – does anything appear to improve the symptoms e.g. an inhaler
Associated features – are there other symptoms that appear associated e.g. fever/malaise
Previous episodes – has the patient experienced this symptom previously?
Key paediatric questions
- *Feeding** – volume of intake / frequency of feeding
- *Vomiting** – frequency / volume / timing – projectile? / bilious? / blood?
- *Fever** – confirmed using thermometer vs subjectively feeling hot?
- *Wet** nappies / urine output – number of wet nappies a day – ↓ in dehydration
- *Stools** – consistency / steatorrhoea? (biliary obstruction) / red currant jelly (intussusception)
- *Rash** – any obvious trigger? / distribution? / blanching?
- *Behaviour** – irritability / less responsive
- *Cough** – productive? / associated increased work of breathing?
- *Rhinorrhoea** – often associated with viral upper respiratory disease
- *Weight gain or loss** – check baby book if the parent has it with them
- *Sleeping pattern** – more sleepy than usual?
- *Unwell contacts** – often children become infected from unwell siblings
- *Localising symptoms** – tugging at an ear/ holding tummy
Pain
- *Site** – where exactly is the pain / where is the pain worst
- *Onset** – when did it start? / did it come on suddenly or gradually?
- *Character** – what does it feel like? (sharp stabbing / dull ache / burning)
- *Radiation** – does the pain move anywhere else?
- *Associations** – any other symptoms associated with the pain
- *Time course** – does the pain have a pattern (e.g. worse in the mornings)
- *Exacerbating/relieving factors** – does anything make it particularly worse or better?
- *Severity** – on a scale of 0-10, with 0 being no pain and 10 being the worst pain you’ve ever felt
Ideas, Concerns and Expectations – often addressed to parents
Ideas – what are the patient’s / parent’s thoughts regarding their symptoms?
Concerns – explore any worries the patient/parent may have regarding the symptoms
Expectations – gain an understanding of what the patient/parent is hoping to achieve from the consultation
Summarising
Summarise what the patient/parent has told you about the presenting complaint.
This allows you to check your understanding regarding everything the patient/parent has told you.
It also allows the patient/parent to correct any inaccurate information and expand further on certain aspects.
Once you have summarised, ask the patient/parent if there’s anything else that you’ve overlooked.
Continue to periodically summarise as you move through the rest of the history.
Signposting
- What you have covered – “Ok, so we’ve talked about the symptoms”
- What you plan to cover next – “Now I’d like to discuss any previous medical history”
Past medical history
- Antenatal period – illnesses or complications during gestation – e.g. rubella
- Birth – delivery complications / prematurity / birth weight
- Neonatal period – illness /admission to a special care baby unit (SCBU)?
- Medical conditions
- Previous hospitalisation – when and why?
- Previous surgery
- Accidents and injuries – remain vigilant for signs of non-accidental injury
Drug history
Regular medication – e.g. inhalers for asthma
Over the counter medication
ALLERGIES
Developmental history
Current weight and height – weight is required to calculate drug doses
Developmental milestones (are they on track for their given age?):
- e.g. sitting up, crawling, walking, talking, toilet training, reading
Immunisations
Is the child up to date with their immunisations?
Dietary history
Type of food? – formula/breast milk/solids
Intake – e.g. how many ounces of milk?
Frequency of feeding – reduced or increased?
Special dietary requirements? – cow’s milk intolerance/coeliac disease
Family history
Family history of disease – e.g. coeliac
Genetic conditions – e.g. cystic fibrosis
Family tree – useful to draw out if considering genetic disease
Social history
Living situation – accommodation / main carer / who lives with child?
Second-hand smoke exposure – risk factor for otitis media/asthma
Parent’s occupation
Pets – important when considering allergies/asthma triggers
Schooling – stage of learning / any issues?
Foreign travel – may be important when considering certain diagnoses e.g. TB
Systemic enquiry
Cardiovascular – Chest pain / Palpitations / Dyspnoea / Syncope / Orthopnoea / Peripheral oedema
Respiratory – Dyspnoea / Cough / Sputum / Wheeze / Haemoptysis / Chest pain
GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal pain / Bowel habit
Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinence
CNS – Vision / Headache / Motor or sensory disturbance/ Loss of consciousness / Confusion
Musculoskeletal – Bone and joint pain / Muscular pain
Dermatology – Rashes / Skin breaks / Ulcers / Skin lesions
