History Taking in Pediatrics PDF

History Taking in Pediatrics Dr. Nilüfer Güzoğlu Paediatric Age Categories Young Child ( 2 – 6 years ) Child ( 6 – 12 years) *the US FDA3 classification Systematic inquiry into the patient's life Patient or caregiver Purpose: make a diagnosis A good history and physical examination are critical to t...

History Taking in Pediatrics Dr. Nilüfer Güzoğlu Paediatric Age Categories Young Child ( 2 – 6 years ) Child ( 6 – 12 years) *the US FDA3 classification Systematic inquiry into the patient's life Patient or caregiver Purpose: make a diagnosis A good history and physical examination are critical to the diagnostic process Inadequate history and superficial examination Errors Learning objectives Differences in "history taking" between pediatric patients and adults The impact of children's age when pediatric history taking Paediatric Age Categories Role of parents during pediatric history taking Appropriate questions in taking a pediatric history Who is giving history Name Age DOB Gender Race Key areas to cover are History of presenting illness Past history – – – – – – Prenatal,natal, and postnatal history, Past medical history, surgical history, Feeding, diet, nutrition, Growth and developmental, Medications, allergies, Immunizations Family history Social history Similarities Listen to the patient, he is telling you the diagnosis “Sir William Osler 1904” Vital cornerstone of pediatric problem solving Similarities Why the patient came to see the physician or why the parents bring their child What the patient/parent is worried about most and why To make strong the physician/patient/parent relationship by – observing – listening – showing empathy Presenting complaint - Chief complaint In the patient's or informant's words Description of the presenting complaint in chronological order Duration of each complaint In a well-child visit, health and development of the child and a follow up What’s brought your child in today?” “What’s brought you in today?” Ask each syptoms – Runny nose, caugh History of Presenting llness Details of the chief complaint Onset, Timing Progress of the condition, Aggravating and alleviating factors, Associated symptoms, and if anything similar has happened to the patient before Relevant negatives information When did the current problem start? What was it like? Has the problem changed at all? – When-in what way? Has medical attention been sought before now? – what investigations-what treatments Have there been similar episodes in the past? Does anything seem to make the problem better or worse? Difference I. Content – Peri-natal history – Developmental history – Social history – Immunization history Difference II. Parents!! Parents tell us signs, symptoms >4 years migth explain their history by themself Observations can be varies parents to parents Ask correct question- adjust wording – “When did you first notice she was coughing”? instead of “When did his sore throat start”? Parental behaviors/emotions are important Mothers are excellent observers If you only listen to mother; she will try to tell you what was wrong – Start; ‘Tell me about your baby’, and then simply let the mother talk. – You need to establish that you are both talking about the same thing. What do you mean by... ? When was he last well? The past history establishes a complete picture of the child’s health – to date – prenatal period child’s current presentation The relative importance of these items depends on: – the age of the patient and – the reason for the visit Prenatal history Maternal age Number of previous pregnancies and the outcomes Natural conception /ART Prenatal care -abnormal results on routine screening Any complications in the pregnancy – e.g. infections, diabetes, hypertension, or bleeding Prenatal exposures including prescription medications, substances, and other toxins such as alcohol or drug Birth history Onset of labour Gestational age Intrapartum risk factors ( e.g. duration of rupture of membranes, maternal fever or fetal tachycardia, and mecounium stained amniotic fluid was) Mode of delivery Any complications during delivery Postnatal history APGAR scores if known Birth weight If any resuscitation was required If there were any health issues period Past medical history, surgical history Chronic conditions Past hospitalizations /emergency department visits Past surgical history Growth History Pattern of growth, not just the child’s measurement at the present Plot the child’s growth on a growth chart, and look at both numbers and percentiles. Developmental History Gross motor Fine motor Speech & language Cognitive Social /emotional development Medication-Allergies History Prescription / non-prescription medications (e.g. vitamins and supplements, herbal or homeopathic) Allergies – – – – – any drugs, foods environmental clarify the specific reaction required management Immunization history Essential part of the pediatric Routine immunizations Received any additional vaccines (e.g. influenza vaccine or travel immunizations) If a parent indicates that a child has not received any or all of their immunizations, one should ask the reasons Family History Ethnicity If any medical conditions have occurred in the family Pedigree Consanguinity – “Is there any way that you and your partner could be related other than by marriage’’ https://www.youtube.com/watch? v=BZfOYvPmcjo Clinical communication skills - communication with child patients version 1 https://www.youtube.com/watch? list=PLxsL_AWD5JPcjgIcZh9jzbST3t_iSQBw R&v=I7QiPXqL9pY Clinical communication skills - communication with child patients version 2 History taking with pediatrics case Case 1 A 6-year-old girl presented to the emergency room with a 3-hour history of left-side abdominal pain and fever. Her mother reported that the patient fell asleep after having dinner, which consisted of refried shrimp rice and broccoli left over from 3 nights prior. Nobody in the house ate the same food. About an hour and a half later, the patient woke up screaming in pain and holding her left side, saying it was hurting. In addition, the mother denied any vomiting, diarrhea, or dysuria. She stated that her last Case 2 A 2-month-old child you have followed since birth arrives for his routine “baby shots.” His mother’s pregnancy was uncomplicated, and he has been healthy without significant problems. Case FilesPediatric, Lange Case 3 A 4-year-old boy has a 2-day history of runny nose, productive cough, and wheezing. Subjective fever and decreased appetite also were noted today. He has no known cardiorespiratory disease, and his immunizations are current. His two younger siblings are recovering from “colds.” Case FilesPediatric, Lange Case 4 A 15-month-old boy whom you have followed since birth arrives for a well-child visit. The mother is concerned that the baby’s manner of crawling, where he drags his legs rather than using a four-limbed movement, is abnormal. She says that the child only recently began crawling and he does not pull to a stand. You noted at his 6-month visit that he was not yet rolling over nor sitting. Case FilesPediatric, Lange Case 5 A 5-year-old girl comes to your clinic for the first time with complaints of fever, malaise, and a cough for 2 days. She has a history of asthma for which she uses a steroid inhaler daily and an albuterol inhaler as needed. She has been tried on various over-the-counter cold and allergy remedies, but her respiratory symptoms have been worsening over the past several months. Her past medical history is notable for an episode of rectal prolapse and “sinusitis” during each of the past two winter Case 6 A mother brings her previously healthy 6-yearold son to your clinic because he has been limping and complaining of left leg and knee pain for 1 week. He has experienced no recent trauma, and his past medical history is unremarkable. Case FilesPediatric, Lange Case 7 The parents of a healthy 8-year-old boy are concerned that he is the shortest child in his class. His height and weight growth curves are shown in Figure. He was a full-term infant, has experienced no significant medical problems, and is developmentally appropriate. Other than being small, his examination is normal. Case FilesPediatric, Lange Case FilesPediatric, Lange Case 8 A 2800-g male is born at 36-weeks’ gestation to a 19-year-old mother via vaginal delivery. Delivery occurred 19 hours after membrane rupture. The mother’s pregnancy was uncomplicated, but her prenatal records are not available at delivery. At 6 hours of age he is “breathing hard” and refusing to breast-feed. His respiratory rate is 60 reaths/min Case 9 A mother brings her previously healthy 2-yearold daughter to your clinic because she has fever (38.6 C) and then rash for 2 days. She doesn’t have a known allergy. No family member is allergic.