Pediatric history taking


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Pediatric history taking

  2. 2. • The pediatric diagnosis relies mainly on a well-taken history and thorough physical examination. • Mothers are very good observers,obtain the history from them wherever possible. • History obtained from the relatives not looking after the child may not be reliable
  3. 3. • Supplementary questions are often needed during history taking • Many a times parents volunteer their own interpretation of child's symptom which may not be true
  4. 4. FORMAT • • • • • • • Cheif complaints HOPI History of Birth Feeding history Immunization Developmental history past history
  5. 5. • • • • family histor social history personal history environmental history
  6. 6. CHEIF COMPLAINTS • A list of main complaints of a child should be made in the chronological order of appearance. • Include all complaints whether they have been volunteered by parents or became apparent on your questioning
  7. 7. History of presenting complaints • History of all symptoms,,one by one • record the details of the treatment • A worried anxious mother may forget or ignore a symptom or detail of it.To avoid missing significant information about the child's illness,ask questions in the form of systemic inquiry,after the mother has finished her narration.
  8. 8. SYMPTOMATOLOGY • REMEMBER in a young child common symptom like crying,poor feeding,lethargy,vomiting,fever may be due to many different illnesses
  9. 9. Symptoms of serious illness • • • • inability to feed or drink vomiting everything lethargy or unconsciousness convulsions
  10. 10. FEVER • Most common symptom of disease in childhood and infections -localized or generalized-are the most commom cause • ASK ABOUT • -Duration -intensity -pattern -associated symptoms • with no localizing features malaria,UTI and Enteric fever likely possibilities
  11. 11. Feeding • Ask about -any change in milk intake -or food and water intake since illness started -any difficulty in feeding? • Refusal to feed is an important symptom in children and indicates theseverity of illness. • It can be due to severe repiratory distress,persistent vomiting or unconsciousness.
  12. 12. Vomiting • vomiting and diarrea together--GI infections - are one of the most common pediatric problems. • Vomiting is often associated with sore throat,fever or cough. • Persistent vomiting accompanied by distension of abdomen suggests intestinal obstruction or paralytic ileus. CONT...
  13. 13. vomiting • ask about - frequency and force of vominting -relationship of vomiting with feeding - colour and contents of vomitus • remember that effortless regurgitation of milk is common in normal newborns and infants, and should not be confused with true vomiting.
  14. 14. Bowel habbits • normal- 5 to 6 times a day to once in a couple of days • breastfed babies usually paas stool after every feed • ask about - duration of diarrhea frequency,quantity,consistency,color,odou r and contents of stools ,particularly the presence of any blood or mucus in the stools.
  15. 15. CRYING • Infants cry when they are hungry, thirsty, wet, warm, cold or lonely. • crying more than normal and without any obvious reason should be taken as symptom of disease • on the other hand..severely ill infant may be too weak to cry.
  16. 16. COUGH • RTI are very common in children and coughis an imporatnt presenting symptom • ask - is it dry or wet • is it worse at the particular time of the day? (late night and early morning cough may be due to asthma) -is there any relation with feeding( inflamed throat or incompetent swallowing) is it accompanied by wheeze or fever?
  17. 17. DIFFICULT BREATHING • IT may be acute or recurrent over a period of time.sometimes it may be chronic and persistent. • pneumonia ,asthma and heart disease(congenital or rheumatic) - are the important causes of respiratory distress in children • Ask - age of onset,relation with activity,relation with feeding- presence of cough,stridor,wheeze or cyanosis.
  18. 18. HISTORY OF BIRTH • It is particularly important in newborn and in children with congenital anomalies or neurological disorders. it is divided into 3 periods • ANTENATAL HISTORY • -dm • htn • swelling of foot • fits • infections
  19. 19. • • • • • • • • drud intake x rays NATAL -duration of gestation -place of delivery duration of labour mode of delivery complications
  20. 20. • • • • • • • postnatal --first cry type of onset of respiration after delivery birth weight birth injury feeding difficulty jaundice,fits,fever?