1. PROFESSOR IFEOMA EMODI DEPARTMENT OF PAEDIATRICS

2.  Introduction  BiodataPresenting complaints  History of presenting complaints  Past medical historyObstetric history  Immunisation Milestones  Family and social history Drug history  Review of systems  Physical examination

3.  In the next few minutes we are going to go through history taking and examination in paediatrics  This will be added upon while doing your rotation in the wards and clinics  Relatively easy but you need to practice  The mother is very important in this process  A lot of information may be obtained watching the child while taking the history

4.  Greet and introduce yourself  Name  Sex  Age  Informant  Religion  Domicile/Address  Place of Origin  ? Referral

5.  What brought you to hospital?  How long is the symptom?  Chronological order

6.  Expand on PC-each symptom  Treatment given  Hospitals attended  Improvement / deterioration

7.  Prior admissions  Blood transfusions  Surgery  Frequent illnesses  Prior diagnosis  Regular hospital visits

8.  Normal aspects of children life and development with need to ask  WHY  There was deviation from the usual

9.  Ante natal care  Delivery  Neonatal period

10.  Breast feeding ◦ Exclusive or not  Weaning age,what type of food  Family diet ◦ When and what ◦ Who feeds the child  24 hr meal recall  If child is malnourished

11.  National program of Immunisation  Obtained/ missed

12.  Head control/ social smile  Sitting with/without support  Crawling  Standing  Walking  Pincer grip  menarche

13.  Number in family  Mother/father  Other siblings  Domicile  Facilities  Similar illness  Inherited disease  Death in family

14.  Regular medication  Drug reactions if any

15. Hematologic Digestive Respiratory Cardiovascular Renal Endocrine Neurologic musculoskelatal

16.  Joint pain/swelling  Bone pains  Abnormal gait  paralysis

17.  Pallor  Easy fatiguability  Purpura  Epistaxis  Yellow eyes  Leg ulcers  Angular stomatitis

18.  Weakness  Oedema  Palpitation  Cough  Chest pain  Fast breathing  Dyspnoea on exertion Orthopnea  Paroxysmal nocturnal dyspnoea

19.  Catarrh  Cough  Sore throat  Noisy breathing  Haemoptysis  Fast breathing  Sneezing

20.  Excessive weight gain / loss  Coarse voicePolyuria  AmenorrhoeaTetany  Cold/heat intoleranceIncreased appetite  HirsutismNeck swelling  Polyphagia  polydypsia

21.  PolyuriaHaematuria  DysuriaUrgency  Loin painOedema  Urgency of micturition  Frequency of micturition  Abnormal urinary stream

22.  Abdominal pain /swelling  NauseaVomiting  DiarrhoeaConstipation  Weight lossAnorexia  DysphagiaTenesmus  Yellow eyes  Loss of appetite

23.  HeadacheDizziness  IrritabilitySeizure  Loss of consciousnessDiplopia  ParesisParasthesia  NauseaVomiting  Neck stiffnessFainting  AphasiaEchopraxia  SomnolenceTremor

24.  ‘If a child cries when you examine him/her it is your fault’  Gain their confidence  Older child – adolescent  Younger child – on mums lap  Always talk to the child no matter the age

25.  General examination  Systemic examination

26.  General examination ◦ Introduce patient ◦ Pallor, jaundice, clubbing, dehydration ◦ Temperature, oedema, cyanosis ◦ Anthropometry – weight, height/length Mid Upper Arm Circumference, head circumference with comments ◦ Vital signs

27. Massive cervical lymphadenopathy HIV Encephalopathy National Paediatric ART Training Slides Unit 3 20 Clinical Features and Associated Conditions …cont…

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29.  Always start with the system you feel has the problem or diagnosis  Inspection  Palpation  Percussion  Auscultation  Thank the patient and/or care give

30.  Any questions  Thank you