Paediatric History
Framework
•
•
•
•
•
•
•
•
•
•
Personal Information + consent
Presenting Complaint
History of Complaint
Systemic Inquiry
Antenatal + Postnatal History
Feeding / Nutritional History
Immunisation / Vaccination
Development
PMHx / Drug Hx
Family / Social History
Personal Information
•
•
•
•
•
Name
Age
Sex
Nationality
Admission
Presenting Complaint
•
•
•
•
•
•
•
•
•
Chronological Order
Onset / Duration
Previous episodes
Relieving / Aggravating
Getting worse?
Associated symptoms
Lifestyle affected?
What was done about it?
What do they think it is?
Cardiovascular:
•
•
•
•
•
•
•
Healthy while pregnant
Received prenatal care
Routine US
TORCH
Phenytoin , Lithium, Warfarin
Growing along growth curve
Meeting development
Cardiovascular
•
•
•
•
•
•
Feeding problems
Cyanosis
Decreased exercise tolerance
Syncope / dizziness
Palpitations (skip beat)
FHX: unexplained death
Systemic Inquiry
•
•
•
•
•
•
General
CNS
Musculoskeletal
Cardiorespiratory
Gastrointestinal
Genitourinary
General
•
•
•
•
•
•
•
Wellbeing
Growth
Energy
Appetite
Weight
Sleep
Behaviour
CNS
•
•
•
•
Fits
Weakness
Visual
Hearing
• Headache
• Dizziness
• Numbness
OLDER CHILDREN
Musculoskeletal / Skin
•
•
•
•
•
•
Joint swelling
Mobility change
Skin Rash
Itching
Color spots
Joint Pain
Cardiorespiratory
•
•
•
•
•
SOB
Ankle swelling
Cough
Wheeze
Sputum
• Chest pain
• Palpitation
OLDER CHILDREN
GIT
•
•
•
•
•
•
Dysphagia
Vomiting
Hematemesis
Bowel habits
Stool
Jaundice
• Nausea
• Heartburn
• Abdominal pain
OLDER CHILDREN
GU System
•
•
•
•
•
•
Cry in micturition
Incontinence
Frequency “day/night”
Polyuria
Oligouria
Hematuria
• Flank Pain
OLDER CHILDREN
Birth History: Antenatal
•
•
•
•
•
•
Infections
Vaginal discharge
HTN / DM
Fits
Drugs / radiation
Smoking / Alcohol
Birth History: Natal
•
•
•
•
•
•
Duration of gestation
Mode of delivery
Prolonged PROM
Duration of labour
Bleeding
Placenta previa
Birth History: Postnatal
•
•
•
•
•
•
•
•
Birth weight
Cry immediately
Respiration
Cyanosis
Fits
Jaundice
Fever
ICU admission
Feeding
•
•
•
•
•
Exclusive breast feeding (6 mo)
Adding water
Formula
Which age supplementary food
Quality & quantity change during
illness
• Weaning: time / how
Immunization
•
•
•
•
Complete / Partial
No immunization: why?
Route
Against what?
Developmental Hx
•
•
•
•
•
•
•
Social smile
(8wks)
Hold neck
(8wks)
Respond
(3 mo)
Hold object
(3 mo)
Grasp: 1 hand (4 mo)
Transfer
(6 mo)
Roll over
(6 mo)
PMHx
•
•
•
•
•
•
•
•
Similar episodes
Hospitalisation
Surgical operation
Blood transfusion
Accidents
Poisoning
Known allergies
Long-term medications
FHx
•
•
•
•
•
Consanguinity
Family pedigree
Similar episodes
Chronic diseases
Inherited disorders
Social & Personal
•
•
•
•
•
•
Parent education / jobs
Health insurance
House conditions
Smoking in house
Happy child? Pets
Effect of disease on family
Examination
Initial Observations
Severity of illness
Measurements
•
•
•
•
•
•
•
Weight
Height
Head circumference
•
•
•
Temperature
Blood pressure
Peak expiratory flow rate
•
•
•
•
Respiratory rate
Accessory muscles
Stridor / wheeze
Cyanosis
Heart rate
Pulse volume
Peripheral temperature
Capillary refill
Consciousness
level
General Examination
• Dysmorphic features
• Attached objects around bed
• Infants
• Palpate fontanelle
• Palpate sutures
Respiratory System
Inspection
Dyspnea
•
•
•
•
•
Cyanosis
Clubbing
Tachypnea
• Chest shape
Barrel- asthma
Excavatum- hallow
Carinatum- pigeon
Harrison sulcus- asthma
Movement asymmetry
•
•
•
•
Nasal flaring
Expiratory grunt: ↑ expiratory
pressure
Accessory muscles: SCM
Retraction of chest wall
Difficulty speaking
Difficulty feeding
Palpate
Percussion
•
•
•
•
Seldom informative in infant
•
•
•
•
Localised dullness
Collapse
Consolidation
Fluid
Chest expansion (3-5cm)
Trachea location
Apex beat
Auscultation
•
•
•
•
•
•
•
•
Quality / Symmetry of breath sounds
Added sounds
Hoarse voice: abnormal vocal cords
Stridor: low-pitched, inspiratory, upper obstruction
Vesicular sounds: normal
Bronchial: high-pitched, inspiration > expiration
Wheeze: expiratory, lower obstruction
Crackles: discontinuous “moist” sounds
Cardiovascular
Neonatal Physical