Introduction and orientation/history taken Presented by: Dr. naifa almeajel General pediatric consultant 13/10/2014

definition: Branch of medicine that deals with medical care of infants, children, and adolescents. Age limit

Pediatric: “Healer of children”; they derive from two Greek words: ( pais ” child” )and(iatros “doctor,healer”)

Pediatric as specialized field of medicine developed in the First generally accepted pediatric hospital is the Hopital des Enfants malades {French :Hospital for sick children} which opened in Paris in June 1802. Pediatric as specialized field of medicine developed in the Mid-19th century;

:Pediatric History Aim;, learning objectives; 1.To understand the differences in obtaining a medical history on a pediatric patient compared to an adult. 2.To understand all the ramifications of the parent as historian in obtaining medical history in pediatric pt. 3.To understand the appropriate wording of open-ended and directed questions ,and appropriate use of each type of question . 4.To obtain an accurate and complete history of ped. Pt. in different age gp. (<1, 1-5 y., >5y.)

Outline of pediatric history: I. Presenting complain, or C/C(chief complain (informant/Reliability of informant) Complain, duration . Words of the informant. II. Patient profile Good pt. p. eliminate the need for social hx. Useful for paramedical personnel. Summery of the ‘whole” child.(eligibility, medical insurance.)

Cont.History :III. Present illness When was the pt. last well?, how and when disturbance start? Health immediately before the illness. Progress of disease ; order and date of onset of new symptoms. Aggravating and alleviating factors. Significant medical attention and medications given and over what period. In acute infection ,statement of type and degree of exposure and interval since exposure.

IV. Past medical history: C.Neonatal: B.Natal: A.antenatal D.Growth and development E.Nutrition F.Past illnesses 1.infections:age,types, number,severity. 2.ContagiousDiseases;age ,complications 3.Past hospitalizations.operations age. 4.Allergies, to drugs ,type of reaction. 5.Medications patient is currently taking. G.Immunizations and test.reactions.

Continue Pediatric History; H. Accidentes and Injuries. I. Behavioral History; 1.Unusual behavior 2.Sleep disturbance 3.phobias. 4.Pica. 5.Abnormal bowel habits ,stool holding 6.Bed wetting.

Continue Pediatric History; V. Family History A. Father and mother (age and health) B.Marital relationship C.Siblings. Age,health,significant illnesses. D.Stillbirth,miscarriages,age of death and cause of death. E.TB.allergy,blood dis.,mental or CNS.,diabetes,cvs,kidney dis.,…..ect. F.Health of contacts.

Continue Pediatric History VI. Social history VII. Environmental HX. VIII. System Review; 1.Skin 2.Eyes 3.Ears 4.Teeth; 5.cvs. 6.GIT 7. Neuromuscular 8.Endocrine 9.Special senses. 10.General

Differences of a pediatric History compered to an adult History ; I. Content Differences ; A. Prenatal and birth hx. B. Developmental history C. Social history of family –environmental risks D. Immunization history II.Parent as Historian A.Parent’s interpretation of signs ,symptoms. 1.children above the age 4 may be able to provide some of their own history. 2.Reliability of parent's observations varies. 3.Adjust wording of questions varies. (pain vs .limping)

Continue hx. differences B.Observation of parent-child interactions 1.Distraction to parents may interfere with history taking . 2.Quality of relationship C.Parental behaviors /emotions are important. 1.Parental guilt –nonjudgmental/reasurance The irate parent ; causes 2.

Clinical care history; 2y,black ,male ,known with sickle cell anemia ,hemophilia b, had lethargy and decrease activity began 1day ago ,mother reported difficulty in arousing the patient on the day of admission .there nausea and vomiting on day of admission. Review of symptoms was negative for fever ,chills ,trauma, and recent ingestion of drugs or toxins. FH. ;brother and maternal grandfather with hemophilia.

Thank you