Pediatric History

1. Pediatric History Adapted from Davies’ Pediatric Chiropractic, Ch. 2 & Mosby’s Guide to Physical Examination, 6th Ed., Ch. 1

2. Fundamentals of Diagnosis • Skillful history-taking • Careful physical exam • Keen powers of observation • Wise selection of “other exams” • x-ray, labs, etc. • Good clinical judgment LOOK – LISTEN – FEEL…

3. “More errors are made because of inadequate history-taking and superficial exam than any other cause.”

4. Tips…Definite No-No’s • Never be critical of another practitioner’s diagnosis or treatment suggestions • Never allow a child who has been brought to you for care to leave without it • do what you have to do, despite protests from the child • Never allow a child to be rewarded for being sick

5. Discussing Difficult Subjects sexuality abuse serious disease psychological etiology suicide divorce drug addiction peer issues

6. “I need to ask you some personal questions, is that OK?” “I know some things are difficult to talk about and I really wish I didn’t have to ask but I need to know about…, is that OK?” “Take all the time you need, I know this is difficult for you.”

7. Be Aware… “I want to talk to you about something, but… I want to be sure that you will not tell anyone.”

8. Recording the Pediatric History Reliability of the Historian • “Historian” is any person providing historical data • describe by name and/or relationship to the patient • also record “reliability”

9. History • The history for an infant or child will be modified according to age The following is just an outline…

10. Chief Complaint • May be taken from a parent or guardian • Note the name, relationship & reliability of the person providing the history • The child should be included as much as possible • Appropriate for his/her age

11. Present Problem • Note the “degree and character” of the reaction to the problem • Both parent and child

12. Different aspects of the history assume or lose importance depending on the age of the patient or the nature of the problem. Reserve detailed questioning for those aspect s most pertinent to the child.

13. Past Medical History • General Health and Strength

14. Past Medical History • Mother’s Health During Pregnancy • General health, extent of prenatal care • Specific diseases or conditions • Infectious diseases (gestational month) • Weight gain • Edema, hypertension, proteinuria • Bleeding (approximate time) • Pre-eclampsia

15. Past Medical History • Mother’s Health (cont’d) • Medications hormones, vitamins, special or unusual diet, general nutrition status • Quality of fetal movement; time of onset • Emotional and behavioral status • Attitudes toward pregnancy and children • Radiation exposure • Use of alcohol or elicit drugs

16. Past Medical History • Birth • Duration of pregnancy • Place of delivery • Labor • spontaneous or induced • duration • analgesia or anesthesia • complications

17. Past Medical History • Birth (cont’d) • Delivery • presentation • forceps, vacuum extraction • vaginal or cesarean section • complications • Condition of infant, onset of cry, APGAR scores (if available) • Birth weight of infant

18. Past Medical History • Neonatal Period • Congenital anomolies • Baby’s condition in hospital, oxygen requirements, color, vigor, cry, feeding • Duration of baby’s stay in hospital; infant discharged with mother? • Bilirubin phototherapy • Prescriptions (antibiotics)

19. Past Medical History • Neonatal Period – First Month of Life • Jaundice, color • Vigor of crying • Bleeding • Convulsions • Other evidence of illness

20. Past Medical History • Neonatal Period – Early bonding • Opportunities at birth and during the first days of life for the parents to hold, talk to, and caress the infant • Opportunities for BOTH parents to relate to and develop a bond with the baby

21. Past Medical History • Feeding • Breast or bottle (type of formula) • Reason for changes, if any • Frequency of feedings • Amounts offered and consumed • Weight gain

22. Past Medical History • Feeding (cont’d) • Present diet and appetite • Age of introduction of solids • Age child achieved 3 feedings per day • Present feeding patterns • Elaborate on any feeding problems • Age weaned from breast or bottle • Type of milk and daily intake • Food preference • Ability to feed self

23. Past Medical History • Development • Commonly used developmental milestones NOTE: • Parents my have baby books which can stimulate recall • Photographs may be helpful

24. Past Medical History • Development (cont’d) • Age when able to… • Hold head erect when in sitting position • Roll from front to back; back to front • Sit alone; unsupported • Stand with support; without • Use words • Talk in sentences • Dress self

25. Past Medical History • Development (cont’d) • Age when toilet trained • Approaches to and attitudes toward toilet training • Dentition • Age of first teeth • Loss of deciduous teeth • Eruption of first permanent teeth

26. Past Medical History • Development (cont’d) • Growth • changes in rates of growth or weight gain • Sexual • Present status, any concerns • Female: breast development, sexual hair, acne, menstruation (description of menses) • Male: sexual hair, voice changes, acne, nocturnal emissions • School • Grade, performance, problems

27. Past Medical History • Illnesses • Vaccinations • Communicable diseases • Injuries • Hospitalizations

28. Family History • Maternal gestational history • List all pregnancies • Health status of living children • Deceased children: date, age, and cause of death • Miscarriage: dates and duration of pregnancies • Age of parents at the birth of this child *Review at least 2 generations on each side of the family.

29. Personal and Social History • Personal status • Nail biting, thumb sucking, breath holding, temper tantrums, pica, tics, rituals, etc. • Bed wetting, constipation, or fecal soiling of pants • School adjustment “A day in the life of the patient” is often helpful in providing insights.

30. Personal and Social History • Home Conditions • Father’s and mother’s occupations • Principal caretaker(s) of the child • Daycare? • Parents divorced or separated • Food prepared by whom • Sleep habits; sleeping arrangements

31. In addition to the usual concerns, inquire about any past medical or psychological testing of the child • First visit to the dentist? optometrist? • Hearing checks? • Speech therapist? • Etc.

32. Review of Systems • Skin • Eczema; seborrhea (“cradle cap”) • Ears • Otitis media (frequency and laterality) • Nose • Snoring, mouth breathing • Allergies • Teeth • Dental care

33. Adolescents • Use open-ended questions • Don’t force the adolescent to talk Sometimes, allowing an opportunity to write a concern may help.

34. Adolescents Common Issues H Home E Education A Activities, affect, ambition, anger D Drugs S Sex

35. Adolescents Common Issues P Parents, peers A Accidents, alcohol & drugs C Cigarettes E Emotional issues S School, sexuality