1 - History Taking and Communications with the Child Flashcards
How do adults differ to children in medicine?
- Different fluid requirements
- Different drug doses
- Different observations
How much fluid do children require in a day?
What points do you need to cover in the history taking of a child?
https://geekymedics.com/wp-content/uploads/2020/10/OSCE-Checklist-Paediatric-History-Taking-.pdf
- Name and Age
- PC
- Systems review
- Birth & Perinatal History (BFGD)
- Feeding History
- Growth
- Immunisation History
- Developmental History
- PMHx including surgical
- DHx and allergies
- Social Hx
- FHx
- ICE
How can you explore the presenting complaint in a paediatric history?
How do you do a systems review in a paediatric history?
Ask about any changes to:
- Dietary and Fluid intake
- Urine output (changes in wet nappies)
- Stool
- Vomiting (projectile? how much? consistency?)
- Fever (with thermometer or subjective?)
- Rash
- Coryzal symptoms (runny nose, or sounded ‘sniffly’)
- Cough (triggers, any sputum)
- Work of breathing
- Weight change
- Behaviour (their usual self?)
- Pain
How do you ask about pre-natal, birth, neonatal and developmental history?
What should you ask in family history for paediatrics?
- Anyone in the household experiencing similar symptoms?
- Any diseases that run in the family?
What do you need to ask about in the social history for paediatrics?
- Any input from social services?
- Any child protection plans?
- HEEADSSS
What is the HEEADSSS acronym for?
Addressing health risk behaviours and resilience factors in adolescents. Reassure confidentiality unless worries about safety
- Home and Relationships
- Education and Employment
- Eating
- Activities and Hobbies
- Drugs alcohol and tobacco
- Sex and Relationships
- Self harm, depression and self image
- Safety and abuse
How do you enquire about feeding history?
What immunisations do you have at each of these ages?
What is the definition of the following?
- Embryogenesis
- Fetal period
- Perinatal period
- Neonatal
- Infant
- Toddler
- Pre-school
Embryogenesis: first 8 weeks after fertilisation
Foetal period: 3 month to 9 months
Perinatal period: 22 weeks to 7 days
Neonatal: 0-28 days
Infant: birth to 1 year
Toddler: 1-3 years
Pre-school: 3-5 years
What are the four domains of development in children?
- Does HV have any worries?
- Does school have any worries?
What are some differentials for a ‘fit’ in children?
Always remember breath holding seizures!!
How do you take a full developmental history of a child?
- Obstetrics history (e.g infections in birth, any medications, any extra scans)
- Delivery history (e.g gestation, mode, any admission to HDU?)
- Developmental milestones
- Communication mode
- Any family history of developmental delay (inc siblings)
- PMHx of child
- DHx and allergies
How should you present a history in paediatrics?
History of Fever (5/7), Headache (3/7) and Vomiting (1/7)
Always write negatives e.g not sepsis because, not SOL because, no bilious vomiting
What is a good tool to use for constipated children?
ERIC programme
What is important to check when a child develops tourette’s?
Social circumstances
What are some tips for mother’s to help with colic?
- Reassurance that should resolve by 6 months of age
- Holding, rocking, bathing the infant, ensuring optimal winding
- Appropriate support such as friends, family, health visitor
- Encouraging mother to continue breastfeeding wherever possible
How do you measure the head circumference of a baby?
- Placed above the ears and midway between the eyebrows and the hairline to the occipital prominence at the back of the head
- Should be recorded to the nearest millimetre and repeated 3 times
- The maximum of these 3 is recorded
- Plot accurately on the growth chart
What is the difference between a baby with IUGR and LBW?
- Low birth weight when fulfilling potential and on projection e.g small parents
- IUGR when not fulfilling potential (think about graph doctor showed us in F1 induction)
How many ml of bottle milk is given to neonates?
~150mL/kg/24h (30mL=1oz) over 4–6 feeds
If small-for-dates up to 200mL/ kg/day, if large-for-dates, <100mL/kg
When taking a feeding history in A and E what is important to ask?
If poor feeding how poor e.g how many bottles, how much being taken
If <50% feeds in bronchiolitis this is automatic admission
How can you tell a child has Ricket’s by their hand x-ray?
