Pediatric History

1
Pediatric History

• Adapted from Davies Pediatric Chiropractic, Ch.
  2 Mosbys 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.

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TipsDefinite No-Nos

• Never be critical of another practitioners
  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

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• 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 didnt 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.

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Be Aware

• I want to talk to you about something, but I
  want to be sure that you will not tell anyone.

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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

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History

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

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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

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Present Problem

• Note the degree and character of the reaction
  to the problem
• Both parent and child

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• 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.

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Past Medical History

• General Health and Strength

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Past Medical History

• Mothers 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

• Mothers Health (contd)
• 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

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Past Medical History

• Birth
• Duration of pregnancy
• Place of delivery
• Labor
• spontaneous or induced
• duration
• analgesia or anesthesia
• complications

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Past Medical History

• Birth (contd)
• Delivery
• presentation
• forceps, vacuum extraction
• vaginal or cesarean section
• complications
• Condition of infant, onset of cry, APGAR scores
  (if available)
• Birth weight of infant

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Past Medical History

• Neonatal Period
• Congenital anomolies
• Babys condition in hospital, oxygen
  requirements, color, vigor, cry, feeding
• Duration of babys stay in hospital infant
  discharged with mother?
• Bilirubin phototherapy
• Prescriptions (antibiotics)

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Past Medical History

• Neonatal Period First Month of Life
• Jaundice, color
• Vigor of crying
• Bleeding
• Convulsions
• Other evidence of illness

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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

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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 (contd)
• 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

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Past Medical History

• Development
• Commonly used developmental milestones
• NOTE
• Parents my have baby books which can stimulate
  recall
• Photographs may be helpful

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Past Medical History

• Development (contd)
• 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

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Past Medical History

• Development (contd)
• 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

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Past Medical History

• Development (contd)
• 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

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Past Medical History

• Illnesses
• Vaccinations
• Communicable diseases
• Injuries
• Hospitalizations

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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.

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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.

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Personal and Social History

• Home Conditions
• Fathers and mothers occupations
• Principal caretaker(s) of the child
• Daycare?
• Parents divorced or separated
• Food prepared by whom
• Sleep habits sleeping arrangements

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• 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.

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Review of Systems

• Skin
• Eczema seborrhea (cradle cap)
• Ears
• Otitis media (frequency and laterality)
• Nose
• Snoring, mouth breathing
• Allergies
• Teeth
• Dental care

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Adolescents

• Use open-ended questions
• Dont force the adolescent to talk
• Sometimes, allowing an opportunity
• to write a concern may help.

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Adolescents Common Issues

• H Home
• E Education
• A Activities, affect, ambition, anger
• D Drugs
• S Sex

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Adolescents Common Issues

• P Parents, peers
• A Accidents, alcohol drugs
• C Cigarettes
• E Emotional issues
• S School, sexuality