History and Examination

Question 1

Key features of paediatric history

Answer 1

Name
Age
PC
HPC
Birth hx
Feeding hx
Immunisation hx
Developmental hx
PMH
DH and allergies
SE
SFH

Question 2

Features of birth history

Answer 2

Relevant antenatal hx
Mode of delivery
Was full term
Birth weight
Any resuscitation
Admission to neonatal unit

Question 3

Featuers of a feeding history

Answer 3

Enteral/parenteral
How much
How often
 - bottle fed baby needs 150ml/kg per day
When weaned
Any problems during feeding

Question 4

Fluid needs

Answer 4

Paediatrics
- first 10kg - 100ml/kg/day
- 10 -20kg = 50ml/kg/day
- >20kg - 20ml/kg/day
Term neonates
- Day 1 - 50ml/kg/day
- Day 2 - 75ml/kg/day
- Day 3 - 100ml/kg/day
- Day 4 - 120ml/kg/day
- Day 5+ - 150ml/kg/day

Question 5

Key features of developmental history

Answer 5

Gross motor
- red flag = no independent walking/steps by 18 months
- cerebral palsy = persistent moro’s reflex beyond 2-3 months, tip-toe walking
- muscular disorders - poor tone, excessive headlag, frog like posture
Fine motor
Vision
Hearing
Social skills/interactions

Question 6

NIPE examination

Answer 6

Head
- fontanelles
- sutures
- red pupil reflex
- facial dysmorphism
- hard and soft palate
- tongue/lip cyanosis
- sucking reflex
- rooting reflex
Shoulders/arms
- clavicle fracture
- arms movements - Erbs palsy
- brachial and radial pulses
- palmar creases
- check number and shape of digits
- sats probe
Chest
- observe breathing
- heart sounds 
- breath sounds
Abdo
- shape
- umbilical stump - discharge, infection, periumbilical hernia
- palpate for organomegaly
Genitals
- observe sex
- palpate testes and scrotum - present and descended, hernias and hydroceles
- penis for hypospadias, epispadias and urination
- anus patent
- ask about meconium
Legs
- equal movements, skin creases, tone and talipes
- barlows and ortolani manoeuvres
- count toes
Back
- inspect and palpate spine
Reflexes
- Moro reflex: when rapidly tipped backwards the arms and legs will extend
- Suckling reflex: placing a finger in the mouth will prompt them to suck
- Rooting reflex: tickling the cheek will cause them to turn towards the stimulus
- Grasp reflex: placing a finger in the palm will cause them to grasp
- Stepping reflex: when held upright and the feet touch a surface they will make a stepping motion