Approach to Assessing Children

Question 1

Why is a holistic approach to paediatrics so important?

Answer 1

More than one problem may exist

More than one system may be involved

Question 2

Why is age important when assessing in paediatrics?

Answer 2

Guides approach to history taking and examination
Common pathologies differ
Conditions manifest differently at different ages

Question 3

In what ways is paediatrics different?

Answer 3

Parent(s) will be there

Play is essential and clinically helpful

Specialised nursing staff

• Different ratios
• Understandably protective
• Experienced at recognising sick children

Treatments differ by weight and age

Question 4

How do you approach history taking in paediatrics in an age-appropriate way?

Answer 4

Consider the age and developmental stage
Consider language and intellectual skills
Typically most questions directed to parents
Some questions are appropriate for a child
Different perspectives may be gathered from both parents or from parent and child
Pre-verbal children communicate!
Older children can be quiet

Question 5

How much weight should a baby gain?

Answer 5

~150(100)- 200g/ week 1st 6 months
= 20-30g per day (need to average time intervals)
Up to 10% loss in first few days is common

Question 6

How much feed should a baby take?

Answer 6

Probably 140-180 ml/kg/day (100ml/kg/day if ill)

Question 7

What questions might you ask about poo?

Answer 7

Children in nappies vs. independent toileting 
Frequency (per day, week or even month)
Size, shape, appearance and consistency
Difficulties passing
Pain on passing
Blood or mucus seen
Parents are sometimes surprised!

Question 8

What other factors are important in a paediatric history?

Answer 8

Birth History

• Detail depends on age and presentation
• Some features may be very relevant years later

Past Medical History (Admissions/ Similar Problems)

Immunisations (Missed?/ Additional?)

Development

• What can they do? Any concerns?
• Basic enquiry essential (Walking, Words, Support)

Drugs and Allergies (This illness/ Regular/ Previous)

Question 9

What are the aspects of family and social history that are important in a paediatric history?

Answer 9

Key stage in assessing patients

• Recent and related health issues
• Parents/siblings (age and health)
• Relationship dynamics

School and nursery

• Common source of infective contacts
• Can give insight into developmental progress

Parental social history impacts on child’s health
-Smoking/alcohol/drugs/occupation/stress

Question 10

What do you examine in paediatrics?

Answer 10

ABCDE and baseline observations/ vital signs
General condition and peripheries
Respiratory system
Cardiovascular system
Alimentary system
Neurological and musculoskeletal systems
ENT and skin
DEVELOPMENTAL SKILLS
MEASUREMENTS AND CENTILE

Question 11

What do you observe for in paediatrics?

Answer 11

General: Appearance, play, interaction, obs
Resp: Effort, noise, rate, recession, O2, nebs
CVS: Colour, perfusion
GI: Feeding, vomit, abdo distension/movement
Neuro: Alertness, interaction, play, posture
MSK: Mobility, limbs movements, posture, splints, mobility aids
Other: Rashes, bruises, infusions, tubes, lines
Other: Toys, pictures, cards, games, caffeine, books

Question 12

Why is play important in paediatric examination?

Answer 12

A creative approach is often needed
Let the child continue to play as appropriate
Select age appropriate toys
Use play to illustrate
Use play as a distracter
Use play as a clinical tool
The aim is to gather useful clinical information
Appropriate sensitivity needed at times