Paediatrics - History Taking

Question 1

Paediatric

History

Answer 1

• name of person taking the history
• patient’s name, age, date of birth
• source of history: mother, father, other.
• emergency or planned admission
• history of presenting complaint
• past history
• family history
• general health
• systems review
• psychological history

Question 2

History of Presenting Complaint?

Answer 2

• mode of onset
• what happened since
• precipitating factors
• relieving factors
• associated symptoms

Question 3

Family History?

Answer 3

Family history in the paediatric clerking should be based on a drawing of a family tree and include details of:

• parents - age, health, height, occupation, whether they smoke
• siblings - age, health

Note that with some families the tree may become very complex; it is important to take time and space to do this properly. It is also worth asking the people present who they are; it may be slightly embarrassing to ask a person if they are the child’s parent, but it is more embarrassing to mistake a neighbour or grandparent for a parent.

• illnesses in the family, including tuberculosis, diabetes, epilepsy, and any condition likely to be related to the presenting complaint.
• details of housing
• schooling
• relationship with peers and siblings
• any pets at home

Question 4

Other aspects of the history

Answer 4

general health:

• appetite
• sleeping habits
• exercise tolerance

systems review - often omitted

• ENT - throat infections, ear infections, hearing
• CNS - headaches, dizziness, vision, walking steadiness
• respiratory - recurrent cough, previous chest radiology
• cardiac - exercise tolerance, cyanosis.
• genitourinary - urinary symptoms, dry by day/night, onset of menarche in females.

recent contact with infectious disease
psychological history

Question 5

HELP

Answer 5

The above can be summarised by the acronym HELP:

• H = history
• E = examination
• L = logical deduction
• P = plan of management.

Question 6

An approach to examining children

Answer 6

• Obtaining the child’s cooperation
• Adapting to the child’s age
• Undressing children
• Warm, clean hands

Developmental skills:

• watching the child play.
• If developmental assessment is the focus of the examination, it is advisable to assess this before the physical examination, as cooperation may then be lost

Question 7

Examination (1)

Answer 7

Initial observations:

• Severity of illness
• Measurements

General appearance:

• general morphological appearance may suggest a chromosomal
• In infants, palpate the fontanelle and sutures

Respiratory system:

• Cyanosis
• Clubbing of the fingers and/or toes
• Tachypnoea
• Dyspnoea
• Chest shape
• Palpation
• Percussion
• Auscultation

Cardiovascular system:

• Cyanosis
• Clubbing
• Pulse
  
  • rate
  • rhythm
  • Volume
• Inspection
• Palpation
• Percussion
• Auscultation
• Heart Sounds
• Murmurs
• Hepatomegaly
• Femoral pulses
• BP

Question 8

Examination (2)

Answer 8

Abdomen (5Fs):

• Fat
• Fluid (ascites – uncommon in children, most often from nephrotic syndrome)
• Faeces (constipation
• Flatus (malabsorption, intestinal obstruction)**Fetus (not to be forgotten after puberty)

Abnormal masses:

• Wilms’ tumour – renal mass, sometimes visible, does not cross midline
• Neuroblastoma – irregular firm mass, may cross midline; the child is usually very unwell
• Faecal masses – mobile, non-tender, indentable
• Intussusception – acutely unwell, mass may be palpable, most often in right upper quadrant.
• Percussion

Neurology/neurodevelopment

• Patterns of movement
• Coordination
• Inspection of limbs
• Muscle tone
• Truncal tone
• Power
• Reflexes
• Plantar responses
• Sensation
• Cranial Nerves

Bones and Joints:

A rapid screen to identify disorders of the musculoskeletal is pGALS (paediatric Gait, Arms, Legs, Spine

Neck:

• Thyroid
• Lymph nodes

Ear/Nose/Throat