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BAHAGHARI ‘15
Basic Pediatrics: Pediatric History 2 of 5
Lecturer: Dr. Matheus
October 7, 2015
D. General trend
B. Intensity and frequency • in the history, it is typical we place
C. Factors that aggravate or relieve the
medications, i.e. paracetamol, for fever,
symptoms then subsequently, state “lysis of fever”
• emphasis is put in the characteristics of the • according to lecture, this is not informative
symptoms; for many clinicians because it is already an
• a major mistake is mentioning symptoms expected result, and therefore may not be
without qualifying or characterizing the mentioned in the history
symptom E. Other symptoms
• character of symptoms help us in ruling in
and ruling out differential diagnoses PRENATAL HISTORY
• para and gravida
• mother’s age at time of birth of child
• age may be associated with some congenital
[in-lec examples] anomalies
• wanted/unwanted pregnancy
Characteristics of fever
• consider congential anomalies may be
• low-grade secondary to medications taken by mother
• high-grade • maternal illness/es during pregnancy
• remittent • rubella, during 1st trimester, is a critical risk
• fever that does not disappear, with temp factor for several malformations of the
that is always above normal developing fetus
• cut-off for normal temp is 37.5, according to • drugs taken during pregnancy
IMCI
• exposure to xray, injurious toxins i.e. tobacco smoke
• intermittent and alcohol
• fever that touches normal values within the • term of pregnancy
day, i,.e. 37.2 deg cel, then 37.8 deg cel,
• closely associated to developmental milestones
then 38.5 deg cel, then goes down to 37.1 and growth parameters
deg cel.
• late developers may be associated to pre-term
• on-and-off fever birth; they may just be catching up from delay
• fever on a particular day, disappears, then
another bout of fever the following day NATAL OR BIRTH HISTORY
• spontaneous breathing of patient at birth
Characteristics of abdominal pain: PQRST
• APGAR
P - precipitation
Q - quality
R - radiation
S - severity
T - time
BAHAGHARI ‘15
Basic Pediatrics: Pediatric History 3 of 5
Lecturer: Dr. Matheus
October 7, 2015
• “how well the baby is doing outside the • gravida and para
womb” • length of stay in the nursery
• Score of 7 and up is normal • complications: infection, convulsion, jaundice
• Score of 9-10 is excellent • phototherapy done?
• blood transfusion done?
• Mothers are generally not knowleddgeable about • presence of bleeding problems?
APGAR. In order to acquire APGAR during history
taking, ask the ff: NUTRITIONAL AND FEEDING RECORDS
• positive spontaneous cry? • type of feeding
• can you describe to me the color of your baby? • quantity of feeding
• was the baby vigorous? • if bottle-fed infant, ask:
• If APGAR is more or less 9, we can assume good • what type of milk is used
pulse, good grimace • preparation done
• Low APGAR more or less if no cry, bluish baby, limp • proper dilution of milk depends on the
manufacturer of milk
According to the lecture, last to go in the APGAR is the • usually 1 scoop:1 ounce or 1:2
cardiac rate. If only pulsation is present (i.e. bradycardia), • how frequent feeding is
more or less APGAR is 1. If without cardiac rate, then • we expect feeding to be done 8x/day, with a
APGAR is 0. [in-lec] cycle of 2-3 hours, especially in the first
week of life
Pink torso with blue extremities ( Appearance = 1) is also
• small, very frequent feeds
termed as acrocyanosis.
• in order to sterilize bottles once a day,
family needs to have more than 8 bottles,
• birthweight assuming we need to have spare sterilized
• apperance of umbilical cord and placenta bottles
• complications such as cord coil and meconium • introduction of solid food
staining • starts at 6 months
• in times of stress, baby may pass meconium • in order for nutritional history to be
intra-uterine adequate, history needs to be extended up
• the clinician may be able to know if stress is of to present age of the patient
prolonged onset or a recent one by observing • assess for
for a positive stain of the cord: • technique
• if prolonged stress: there is yellow • type of foods
discoloration of cord • adequacy of food/milk intake
• if acute or recent stress: there is positive • let patient have a recall of food taken,
meconium, but no staining of the cord noted and preferred food
• manner of delivery
• was the labor induced? reasons for If this is a bottle-fed child with presenting diarrhea, we
inducement? should be very meticulous as far as nutritonal history is
• NSD? CS? Forceps? Indications for non-NSD concerned. We want to know why there is diarrhea. There
delivery? may be problems in the preparation of milk that can be
• presentation corrected, and thefore preventing subsequent episodes of
• presence of oligo-/poly-hydramnios diarrhea. [in-lec]
• oligohydramnios - deficient amniotic fluid
• may indicate renal agenesis (Potter PAST MEDICAL HISTORY
syndrome)
• look for details of any prior illness and
• premature rupture of membranes hospitalizations
(PROM) A. signs and symptoms if remembered
• polyhydramnios - excessive accumulation B. surgery
of amniotic fluid
• diagnosis
• may indicate intestinal atresia • procedure done
• problems at the level of esophagus • when performed
• complications
NEONATAL HISTORY C. accidents
• part of general history of neonatal hx consist of:
• mother’s name ADOLESCENTS
• baby’s name • use HEADSSFIRST assessment tool
• birth weight • sensitive information may be the ff:
• APGAR • sexual habits
• manner of delivery
BAHAGHARI ‘15
Basic Pediatrics: Pediatric History 4 of 5
Lecturer: Dr. Matheus
October 7, 2015
• contraceptives used FAMILY HISTORY
• pregnancies • parents
• venereal diseases
• names
• health status
Such information are not easy to collect because this • natural parents?
particular age group has issues about privacy and • occupation/educational attainment
independence. As such, such sensitive information may not • siblings
be given to you during the first meeting. Before attempting • number, age, sex
to get these pieces of information, always establish good • illness (past and present)
rapport. Often, sa next few meetings pa makukuha ang • health status
sensitive info, or basta nakapag-build up ka ng good • others
relationship with your patient. Doc says to emphasize the • history of grandparents
need for this info because they are needed for proper • health history of baby sitters
management of patient’s conditions
Family history should always be tailor-made as with the
particular case of the patient. Fashion history in such a way
IMMUNIZATION information is relevant to the case. For example, if the case
• written immunization records are more reliable than is a communicable disease, ask for history of present
informant’s recall illness of family rather than merely focusing on hereditary
disease such as HTN or DM. I.e. If patient is suffering from
pneumonia, family hx is relevant if we ask about another
family member suffering from respiratory tract infection
(RTI) prior to child’s RTI.
SYSTEMS REVIEW
• pertinent info as regards to per system:
• cardiac: chest pain, easy defatigability, etc.
• respi: apnea, dyspnea, SOB, etc.
• should come from the patient; subjective
• usually done during adult histories
• but not done to all pediatric patients (especially the
very young)
• while children may have these problems
included in the systems review, they may be
unable to verbalize symptoms
• suppose a pediatric patient complains about
dizziness, we are not really certain if it is
dizziness that he or she means
• therefore, we reserve systems reserve for pediatric
patients that are already school age, i.e. 7 years old;
much more so if patients are already in the
adolescent age group.
REGIONAL EXAMINATION
• generally, we do not go from head to foot; as you talk
to the mother, we already do the PE by simply
DEVELOPMENTAL MILESTONES observing the child
• playful touching of the child is already a form of
SOCIAL/PERSONAL HISTORY physical examination
• personality characteristics • a tap on the head is already an assessment of
• personal habits the anterior fontanelle
• feeding • feel for bulge, pulsation, and tension
• sleeping • (Bahaghari: Wait, we’re talking about
• toleting which head again?)
• games • bulge, pulsation and tension may suggest
• cognition (?} meningitis, especially if complaint would be
• sources of support convulsions
• school history • Do inspection first. Do not look at the orifices yet, as
• strengths and weaknesses of child doing so will have you end up having to assess a
BAHAGHARI ‘15
Basic Pediatrics: Pediatric History 5 of 5
Lecturer: Dr. Matheus
October 7, 2015
crying child throughout exam. This makes
auscultation difficult and unreliable.
• calm them down first before proceeding to
assessment if child cries
Chest:
Inspection
Palpation
Percussion
Auscultation
[in-lec]:
if patient is quiet, go for auscultation before percussion.
Percussion may elicit pain and may therefore cry prior to
auscultation
Abdomen:
Inspection
Auscultation
Percussion
Palpation
- END -
BAHAGHARI ‘15