1. Seeing Paediatric Patients in OPD Prof. Pushpa Raj Sharma

2. Why it is special? Common problem: fever (90%) Limited time Large number of patients. Not to miss the serious ones. Not to over prescribe drugs. Parents satisfaction Ethical

3. Serious conditions Not able to suck, swallow Unconscious, drowsy, lethargic Convulsion in this episode Neonate Chest indrawing Oedema Tachypnoea

4. History taking in OPD Write main presenting complaint Start examining while asking questions around the presenting complaint Commonest complaints Fever Loss of appetite Diarrhoea cough

5. Examples of questions for fever For how long? Usually 1-3 days Does he/she coughs? Any diarrhoea: blood in stools Any rash Any body at home/hostel having similar problem Ear discharge Any convulsion Any swelling or wound Any joint problem

6. Looking a child with fever Congested eyes Runny nose Congested throat/ulcers/enlarged tonsils Rash Tachypnoea observation Spleen and liver

7. Fever diagnostic appraoch Toxic look without any localising signs Paracetamol/ if more than 2 days ask for culture/TLC and DLC Follow up day with report Localising signs (red eyes/ runny nose/ congested throat.) Paracetamol Follow-up after 2 days Localising signs (liver/spleen_ Enteric/hepatitis/malaria/viral

8. Final prescription Presenting complaint and duration Principle findings: toxic/localizing signs Paracetamol Antibiotics Formulations costs