Paediatrics: Principles Of 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
Kaiser Permanente 4 Habits Model
The Kalamazoo Consensus Statement Framework
Kaiser Permanente 4 Habits Model
1. Investing in the beginning (Listen)
- Create rapport quickly
- Elicit the patient’s / parents’ concerns
- Plan the visit with the patient
- Elicit the patient’s perspective (Inquire)
- Ask for the patient’s/parents’ idea
- Elicit specific request
- Explore the impact on the patient’s / family life - Demonstrate empathy (Care)
- Be open to the patient’s/parents’ emotions
- Make an empathic statement
- Covey empathy nonverbally - Invest in the end (Inform + Help)
- Deliver diagnostic information
- Provide education
- Involve the patient in making decisions
The Kalamazoo Consensus Statement Framework
1. Build a relationship (throughout the interview)
- Greet and show interest in patient as a person
- Use words that show care and concern
- Use non-verbal means to show care and concern
2. Open the discussion
3. Gather information
4. Understand the patient’s / parents’ perspective
- Ask about life events, circumstances, other people that might affect health
- Elicit patient’s beliefs, concerns, and expectations about illness and treatment
- Respond explicitly to patient statements about ideas, feelings, and values
5. Sharing information
6. Reaching agreement
7. Provide closure
Children’s cognitive development + Concepts of illness at different ages
Preschool children (3-5 yo):
Cognitive development:
- Magical thinking, circular reasoning
- Sees 1-2 aspects at a time; may ignore the whole situation
- Does not differentiate between self and outside world; lives in the immediate environment
Child’s concept of the cause of illness:
- Does not conceptualize the internal parts of the body
- Illness results from wrongdoing; medical procedure are seen as punishment
- Illness is caused by external concrete phenomenon; i.e. magic, sun, rain
School-Aged Children (6-12 yo):
Cognitive development:
- Begins to think relationally + generalize
- Emergence of clear differentiation between self and others
- Begins to integrate variables in causal relationship
Child’s concept of the cause of illness:
- Can distinguish what is internal + external to self
- Cause of illness is a person, object or action outside of the child. “get a cold for not wearing enough cloth”
- Cause of illness is the presence of “germs”
Adolescents (>=13 yo):
Cognitive development:
- Capable of cognitive problem solving and decision making
- Can think abstractly and hypothetically
- Use generalization to fill in gaps in knowledge
Child’s concept of the cause of illness:
- Integrates multiple factors / causes in understanding illness; imagine alternative possibilities
- Cause of illness lies in internal physiologic organ or process
- Understand illness as internal systems that dysfunction and cause external symptoms
Fever characterisation
- How high (Definition of fever: 38oC)
- Means of measurement
- Pattern
- Temperature-pulse dissociation (Relative bradycardia)
—> Typhoid fever
—> Brucellosis
—> Leptospirosis
—> Factitious fever
—> Acute rheumatic fever with cardiac conduction abnormality
—> Viral myocarditis
—> Endocarditis with valve ring abscess affecting conduction - Temporal profile
- Days / Weeks - Respond to medications
- Antipyretics / Antibiotics - Associated symptoms
- Cough
- Rash - Background information
- First time?
- Frequent?
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
