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History Taking - Peds Day Lecture


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History Taking - Peds Day Lecture

  1. 1. INTRODUCTION TO THE PEDIATRIC INTERVIEWStephanie KayPGY2 PediatricsMcMaster UniversityApril 28, 2012
  2. 2. OBJECTIVES Review questions to ask on a pediatric history, including neonates and adolescentsACKNOWLEDGEMENTS Mohammed Zubairi, PGY3
  3. 3. THINGS TO REMEMBER Most babies don’t talk Caregivers are right (majority of the time) Language and culture play a role in child upbringing
  4. 4. THINGS TO REMEMBER Lay eyes on the child first* Focus your history in complex situations Confidentiality
  5. 5. LAYING EYES ON A CHILD: SICK ORNOTSICK? Look at their level of activity Look at their breathing Look at their color
  6. 6. BUILDING RAPPORT Ignore young children at first Ask non-threatening questions Comment on t-shirt/toy Bring toys/stickers Stay calm
  7. 7. HISTORY OF PRESENTING ILLNESS? Location Onset (activity at symptom onset, environment) Duration Precipitating/Palliating Quality Radiation Severity Timing Happened before? What do you think?
  8. 8. PAST MEDICAL HISTORY Illnesses? Surgeries? Hospitalizations? ER visits?
  9. 9. PAST MEDICAL HISTORY Accidents/Injuries? Immunization? Medications? Allergies? *Pubertal changes*
  10. 10. PREGNANCY HISTORY GTPAL Maternal serology and blood type* Infection, fever, antibiotics Medications U/S IVF
  11. 11. BIRTH HISTORY Vaginal delivery vs C/S ROM APGAR Birth weight Need for oxygen, resus
  12. 12. NEWBORN PERIOD Feeding Respiratory problems Jaundice Stay in hospital
  13. 13. NUTRITION, SLEEP, AND TOILETING Breast fed or not?  How long? Present intake  G-tube? # of meals, # of snacks Bed time? Anxiety? Toileting?
  14. 14. BEHAVIOUR & DEVELOPMENTMore than one setting… Cognitive/Language  Television/Computer/Videogaming Adaptive Skills/Fine Motor Gross Motor Social/Emotional/Behavioral
  15. 15. FAMILY & SOCIAL HISTORY Parents (ages/occupations/medical conditions) Consanguinity? Siblings (ages/medical conditions) Extended family? Supports? Housing? Recent travel?
  16. 16. HEADDSSS INTERVIEW INADOLESCENTS H=home E=education A=activity D=drugs D=disordered eating S=safety S=sexual activity S=suicidality*confidentiality
  17. 17. REVIEW OF SYSTEMS Head Toe Constitutional symptoms
  18. 18. CLINICAL PEARLS Which hand do you pick your nose with? ADHD: how long can you focus on something you like that doesn’t involve a screen Constipation: characterize the poop. Large logs are constipation too!
  19. 19. THANKS!