History Taking in Paediatrics Hamish Robertson

Paediatric Histories Mostly the same as adult histories Some important extra questions to ask Real Life: involve child as much as possible Exam: no child, talking with the parent

Basics Confirm the problem list and screen for anything else

General Questions Many paediatric conditions can present generally: How is their general health? Any concerns? Are they chronically unwell, or are they normally well and active? Specifically:

Systems Review

Respiratory AsthmaPneumoniaUpper Respiratory Tract Infection Allergic RhinitisBronchiolitisCystic Fibrosis

Cardiovascular CyanosisHeart FailureHeart Murmurs BreathlessnessFailure to ThriveCongenital Abnormalities

Gastrointestinal Diarrhoea / ConstipationAbdominal PainInflammatory Bowel Disease Allergy / IntolerancePyloric StenosisFailure to Thrive

Genitourinary UTIGlomerulonephritisHaemolytic Uraemic Syndrome EnuresisNephrotic Syndrome(Diabetes)

Musculoskeletal LimpInfectionArthritis HSPSUFEPerthes’

Neurological HeadacheSeizures Meningitis / EncephalitisNeuromuscular / Muscular Disorders

Past Medical History

Developmental History Any parental concerns with hearing or vision Any concerns with developmental milestones – any regression? Bladder and bowel control? Child’s behaviour Sleeping problems School concerns

Family History

Social History Who does the child live with? Who looks after the child? Parental occupation? Any pets? Smoking, alcohol, drugs? Family or child Everything okay at home? Involvement of a social worker?

Wrapping Up

Don’t forget… this is CCS! Confirm problem list and screen for anything else Signpost what you’re going to talk about Summarise occasionally (at least once and at the end) Pick up on cues (they may be obvious but more difficult in exam) Open – closed questioning Clarifies vague statements (tummy-pain, not themselves) Avoid jargon Empathy

Don’t forget… this is a Finals exam! Summarise your findings (1 - 2 sentences) Give a differential diagnosis What are you most worried about? How would you manage (investigation / treatment)?

Good Luck!

Febrile Child General – feeding, weight loss, rashes Resp – intercostal recession, added respiratory sounds, cough Neuro – photophobia, meningism, drowsy, seizures GU – unwillingness to pass urine, increased frequency, pain, haematuria GI – diarrhoea, blood, mucus MSK – limp, painful joint, swelling Family and siblings, immunisations, feeding, previous episodes