Paediatric History Taking &
Examination
STEPP Teaching, Dee Aswani, SpR
Overview of Session
Principles of Paediatric History
Taking
Practical Exercise
Examination Tips
Baby Checks
A smart mother makes often a better diagnosis
than a poor doctor.
August Bier (1861–1949)
Differences to adult
practice & General
Principles
Children are not small adults
LISTEN CAREFULLY to what the mother is telling
you - she knows her child best and intuitively knows
when something is wrong. She is RIGHT unless
proven otherwise
Useful to quote verbatim, but ask to define terms for
eg - what does ‘diarrhoea’ actually mean?
Additional important features of the history
Always consider CHILD PROTECTION issues
Components of
History
Presenting complaint
History of presenting complaint
Past medical history
Incl feeding history & growth
Birth History
Developmental History
Immunisation History
Drug History
Family History
Social History
Inadequate History
Cough x 3 days
Off feeds x 2 days
Wheeze x 1 day
Temperature x 1
Vomit x 2
70% of paediatric
diagnoses will be
obtained by history
alone
Peter, age 7 years,
referred by GP
“difficulty
breathing”
History of presenting
complaint
Coughing since started at school 2 years ago
‘always has a cough’
Worse since last night teatime
Vomited x 1 last night, cough induced
No fever
Has been breathless
Breathing sounds noisy
Cough sounds productive
Complaining of tummy ache
Cough wakes him at night, often needs a glass of water to settle
down
Coughs approx 5 nights out of 7
Tired and difficult to wake in the morning
Missing a lot of school
Difficulty keeping up with peers at PE
General lack of energy, prefers to sit and watch telly rather than
playing outside with friends, complains that ‘chest hurts’
No history of choking or foreign body
Came back from holiday in Turkey a week ago
Still in same school trousers as in reception, one of the smallest in
class
Good appetite
Past Medical History
One previous A&E attendance - was
wheezy, had ‘steam medicine’ then
went home
Frequent chest infections treated by
GP with antibiotics
No operations or admissions
Has mild eczema
Birth History
Born at 34 weeks
Emergency Section , 4lb 8oz, foetal distress
Spontaneous labour and PROM
Pregnancy and scans fine
Was on SCBU for 3 weeks
Needed CPAP for 1 day and then some
oxygen for a while
No oxygen when went home
Developmental
History
Smiled at 10 weeks
Sat at 6 months
Never crawled
Walked at 13 months
Started talking around 18 months
No problems with hearing or vision
Average progress at school
Immunisation History
‘up to date’
didn’t have MMR - cousin with
autism
Medication
Oilatum in bath for eczema
allergic to Penicillin
had it when 2 years and ‘was sick’
Tixylix
Family History
Dad got eczema and hay fever
Maternal grandma has diabetes
Paternal Grandfather had TB
Mum and Dad separated
Younger 2 year old brother also has eczema
Mum works in retail. Suffers with depression
No consanguinuity
Social History
2 Pet cats at home
Mum smokes “outside”
Dad also smokes
Goes to a childminders 3 times a
week
Child spends every other weekend
at Dad’s house
Examination
General Principles & Tips
Get down to their level
A lot of information can be gained by
INSPECTION alone, before you lay an hand
on the patient
Beware of asking the child’s permission
Know a conversation topic / latest craze / TV
characters / films relating to different age
groups
Examination needs to involve play and be
opportunistic but thorough
Keep Mum close at hand and in
child’s view or reach
Keep child in the position in which
they are comfortable. No need to lie
them down unless you have to children are very vulnerable in this
position
Save the nasty things to the end so
that you don’t lose trust (eg ENT)
Baby checks
To assess general condition
To establish normality
To detect major abnormalities
Useful in finding eye, hip and heart
problems
Read Mum’s notes first
Pregnancy history
Paediatric Alerts
Delivery notes
Ask Mum if any concerns
Family History
Who does baby look like?
OBSERVATION
Appearance / Dysmorphia
Alert / Drowsy
Colour - anaemia / jaundice
Bruising
Posture
Birth Marks
HEAD
Shape of skull - moulding,
sutures
OFC
Fontanelles
Eyes and ears
Mouth - look and feel for cleft
Range of neck movements
RESPIRATORY SYSTEM
Respiratory distress or increased
work of breathing
CARDIOVASCULAR SYSTEM
Pulses including femorals
Heart sounds
Oxygen saturation - post-ductal
ABDOMEN
Shape
Palpation - masses
BO / BNO in first 24 hours
Genitalia / PU
HIPS
Barlow /Ortolani manouvres
LIMBS
Position - talipes
Movement
Palmar creases
NEUROLOGICAL SYSTEM
Tone
Posture
Primitive reflexes
Spine
EYES
Red reflexes
Hip Examination
Ortolani
Barlow
Primitive Reflexes
SUMMARY
Good Paediatric history taking needs to be
through and takes practice
70% of diagnoses can be made on the history
alone
ALWAYS listen to the mother
Children are quite often unco-operative and
examinations can be difficult
Be prepared to PLAY
Children will
respond much
better to you if
you actually
LIKE them