Pediatric History: Tips

1. Pediatric History: Tips John Schmidt, MD Pediatric Hospitalist

2. The Pediatric History • General Tips • Remember to address the patient and parents by name • Introduce yourself by name • Use open-ended questions • Keep the interview organized • Under stress, it will help you keep your focus • Decreases the chances of you forgetting something

3. General Tips (continued) • Avoid medical jargon • Occasionally summarize sections of your history • Helps you to identify aspects which may not make sense/things you missed and prompt further questioning • Lets the parent know that you have been paying attention

4. General Tips (continued) • A good portion of Pediatrics is not just the treatment of the patient, but also the parent • Parents are under stress and often feel guilt over their child’s illness (“Could I have done something different?”) • Acknowledge these feelings • Support positive behavior • Ask for whatever questions/concerns they may have

5. Chief Complaint/HPI • “What brings you in today?” • You are a reporter…literally. Your job is to objectively collect the facts • As a self check, have you asked enough questions to accurately portray the child’s story to your reader? Can they close their eyes and replay the child’s course? • Check your facts/source – Is the patient really sick? • E.g. How do you know your child had a fever? • E.g. What do you mean by feeding poorly?

6. Chief Complaint/HPI (continued) • Start at the beginning…. • When did the symptoms start? • What was the child doing? • Did the symptoms come on suddenly or gradually? • What happened then? • Have the symptoms been constant or intermittent? • If intermittent, how bad are the symptoms when they do occur • When they do occur, how long do the symptoms last? A few minutes? A few hours?

7. Chief Complaint/HPI (continued) • Associated symptoms • It is helpful to have your differential diagnosis in mind when you are asking questions – Every positive or negative answer should provide focus to your assessment • Start with broad categories/systems and then fill in what might fit the story within that system

8. Past Medical History • Learn from the past – is there a clue to what is going on now and what is going to happen? • Has this happened before? If this happened before, when? Did you see an MD? What did they think? • Is the patient a setup for something? • Did the patient miss immunizations? • Previous surgeries? • Is there an underlying disorder that could be playing a role?

9. Past Medical History (continued) • Your “crystal ball” - How bad was it in the past? Do we need to worry now? • Were they sick enough that they needed medications? If so, what? • Were they sick enough that they had to come into the hospital? • Were they sick enough to need an ICU? • Were they so sick that we had to support them? • Don’t reinvent the wheel • What worked in the past? Certain meds (e.g. steroids)? Certain procedures?

10. Medications • May be a clue to his symptoms • Helps guide your intervention • What is the patient on/received already? – May get past medical history that was already missed • Has the patient already started treatment? • Have the interventions helped? – CLUE! • Example: Did he just complete a course of antibiotics? • Example: Did he already receive his max- dose of Tylenol today? • Example: Has he already received NMTs? How often? • Allergies

11. Family/Social History • Might increase your pre-test probability for a diagnosis • Think through your differential and anything which may have a genetic component • Who is at home? • What is at home/in their life i.e. exposures – Pets? Smoking? • Do you have a complete picture of his day?

12. Next Steps – Diagnostic Workup/Treatment • Is he symptomatic now? Do you want to do anything about it? • Think about your differential – Does your work-up address the most likely suspects? • Lab work • Diagnostic studies • Procedures