Peds Hx and Physical

Question 1

what is the purpose and important of well child visits

Answer 1

1)prevention
2)tracking growth and development
3) Opportunity for parents to express concerns/ask questions
4) Opportunity for physician (or other health care professional) to perform and
address
• Abnormal physical exam findings
• Abnormal routine screening results
• Vision
• Hearing
• Complete Blood Count (CBC): performed at 1-year-of-age
5)Establish a medical home

Question 2

what is a good resource for preventative peds health care

Answer 2

bright futures/ american academy of pediatrics

-tells you what to do from newborn to 21 yrs age

Question 3

what should you do if seeing a new baby

Answer 3

-ask how mom is doing (post partum depression)

Question 4

what is a big difference when it comes to hx during a peds encounter

Answer 4

much of the information comes from the
parent
• The younger the child, the more difficult it is for them to express themselves clearly (what hurts, what happened, feelings, etc)
• parent know their child best..trust them..occassionally
-some parents may be overly concerned
• Some parents may be under concerned or seemingly unaware of things that are going on: it is our job to educate, reassure, explain

Question 5

what is a imp addition to ped hx esp if less than 5 and have chronic illness, developmental delay, syndromic features, resp issues etc

Answer 5

Pregnancy (prenatal) history
• Medications
• Complications
• Prenatal care

Question 6

what are parts of delievery (perinatal) hx you should ask about?

Answer 6

• complications
• Need for resuscitation/oxygen/NICU
• Apgar score if known

Question 7

what is the apgar score

Answer 7

• Named after Dr. Virginia Apgar
• Numerical score assigned to a newborn at 1- and 5-minutes-of-age based on:
• Heart rate
• Breathing
• Muscle tone
• Reflex response (grimace, response to stimulus)
• Color
• doesn’t predict outcome, but guides care just after delivery

Question 8

what parts of nursery (postnatal) hx should you ask about

Answer 8

• NICU history (if any)
• Well baby nursery history
• If ƚhe baby got to go home with mom assuming mom didn’t have an extended stay iƚ
usually means that everything went OK.
• Parent may know if they passed their oxygen saturation test
• Done prior to DC on all babies
• Screen for possible Critical Congenital Heart Defect (CCHD)

Question 9

developmental hx

Answer 9

• one of big differences from adult encounter

- discuss age appropriate milestones (Denver)

Question 10

PE: longitudinal assessment

Answer 10

• Longitudinal assessment
• height (plot on growth curve)
• weight (plot on growth curve)
• blood pressure
• sexual maturity

Question 11

what should you use for immunizations

Answer 11

CDC immunization schedule

Question 12

what are PE tips?

Answer 12

• open the door slowly
• Be gentle
• Approach slowly
• dont be big because they are small 
•read the room
• Is the child timid?
• Have they met you before?
• Are they ready to rock & roll?
• Ask the parents how the child will be more comfortable
• On the exam table?
• On mom or dads lap 
• Sitting next to parent?
• Lap exams are your friend. Listen to heart and lungs 
-enlist help of parent or caregiver 
-dont be too persistent (can document no exam”
-restraint may be necessary
-genital exam is essential part of well child check up (have parent join, good touch/bad touch discussion,older children have chaperone, protect modesty)