Paediatric Hx symptoms Flashcards
Explore symptoms of diarrhea and vomiting
As for adults (amount, appearance, red flags) but to include hydration questions:
- wet nappies
- fluid intake
- drowsiness
Explore symptoms of enuresis/ soiling
- establish if primary/secondary (primary- they have always had it - since birth)
- toilet trained?
- school toilet behaviour
- any stressful events?
- soiling: consistency (diarrhoea/constipation), any painful anal conditions
- enuresis: have they ever had a dry night?
Secondary: urinary/GI infection, spinal cord compression symptoms
Explore the history of: failure to thrive/ weight loss
- see growth chart
- Input: detailed dietary history, feeding history, hunger
- Use: energy/ activity level/other conditions e.g. cardiac disease, respiratory
- Output: wet nappies, stools
- Other symptoms: chronic cough, infections (CF, Primary ciliary dyskinesia)
- Sweating/breathlessness while feeding -> cardiac
- general health
- behaviors, happiness, home situation
- associated GI symptoms: vomiting, nausea, dysphagia, reflux
Weight gain. What questions to ask?
- see growth chart
- input: detailed dietary intake
- use: activity level, energy
- output: stool, wet nappies
*differentials - another flashcard
Differentials with weight gain
- hypothyroidism: growth impairment, delayed puberty, mental slowness, constipation, cold intolerance
- Cushing’s syndrome: growth impairment, proximal weakness, central obesity
- Syndromes: Prader Willi (poor muscle tone, temper), Laurence-Moon (extra digits, intellectual impairment)
Walking/sitting delay - what further questions to ask
- age of other milestones
- mobility
- hand dominance
- balance problem
- behavioral problems
- associated neurological symptoms
Speech delay. What other questions to ask?
- age of other milestones
- senses: vocal, hearing, vision
- communication comprehension (response to voice, follows commands)
- non-verbal communication (pointing gestures, faces)
- social responses (how acts in new situations, playing, gestures, the uncontolled outburst of anger and frustration )
Early/late puberty, primary amenorrhoea, short stature. What further questions to ask?
- review of pubertal development: teste, breast, menarche, pubic/axillary hair, height, acne, mood changes
- Intracranial pressure symptoms: headache, vision problems
- FHx: stature, puberty (any delay?)
- Symptoms of other diseases: Crohn’s, anorexia, CF, thyroid problems
Behavioral problems. What further questions to ask? (3 different disorder + symptoms)
- ADHD: poor concentration, hyperactivity
- Conduct disorder symptoms: aggressive, cruel, hostile
- Autism: poor social interaction, mutual communication problems, restricted interests, repetitive behaviours, difficulty recognising/responding to the emotions
Allergies. What other questions to ask?
- pattern: frequency, duration, persistent, intermittent
- reaction: wheeze, rash, sneezing, itchy eyes, abdominal pain, diarrhoea, swelling of eyes/tongue
- anaphylaxis symptoms
- triggers/associations: pollen/season, chemicals, pets, latex, dust, food
- atopy in a child and family (eczema, asthma, hayfever), food allergies
- home situation: heating, pets, dampness
- social: smokers in the family, exposure to pollutants
Rash. What further symptoms to ask?
- duration, frequency, progression
- sites, size and shape
- description: how does it look like? any blisters/ raised area? Colour? Does it blanch?
- secondary features: itchiness, pain, crusting
- exacerbating/relieving factors
- associated rheumatological symptoms: joint (pain, stiffness, swelling), hair loss, eyes (redness, dry(, mouth dryness, SOB, IBD symptoms, GI discharge
How to inform parents that we need to make a referral to social services
’ Some of this type of injuries are not accidental. It’s impossible for us to tell which one is/which one is not - therefore we refer all cases’
