How To Take a Paediatrics History
Summary
TLDRIn this informative video, Dr. Erwin discusses the intricacies of taking a pediatric history, emphasizing the importance of understanding developmental stages and effective communication with both children and their parents. He outlines key areas to explore, including presenting complaints, birth and developmental history, feeding habits, immunization status, and family medical background. The video is a valuable resource for healthcare professionals seeking to improve their approach to pediatric care.
Takeaways
- 👶 Pediatric patients range from neonates to adolescents, covering ages from 0 to 16 years old.
- 📝 Taking a pediatric history requires empathy and understanding, especially when dealing with anxious parents or shy children.
- 👶🏻 Age-specific nomenclature is crucial: neonate (<28 days), infant (1-12 months), toddler (1-3 years), preschooler (3-5 years), school-age child (5-12 years), and adolescent (13-17 years).
- 🤝 Communication is key in gathering a comprehensive pediatric history, involving both the child and the parent when appropriate.
- 🔍 It's important to explore the child's presenting complaint in chronological order to understand symptom development and any changes.
- 🌡 Common pediatric symptoms include fever, breathlessness, rash, cough, runny nose, sore throat, pain, and seizures.
- 👨⚕️ The pediatrician must consider serious conditions like Kawasaki disease when a child presents with a persistent fever and rash.
- 🍼 Feeding history is vital, including details on breastfeeding, bottle-feeding, and the child's food intake and preferences.
- 👨👩👧👦 Family history and social history provide insights into the child's environment and can indicate potential health risks or concerns.
- 💉 Immunization history is essential to assess whether the child is up-to-date with vaccinations and to understand any reasons for missing vaccines.
- 🏥 Past medical history, including hospital visits and chronic conditions, helps in understanding the child's overall health status.
Q & A
What is the age range of patients typically included in pediatrics?
-Pediatrics includes patients from neonate to adolescent, ranging from the age of zero to 16 years old.
Why can taking a pediatric history be challenging?
-Taking a pediatric history can be daunting if one is not accustomed to working with children due to the need for empathy, understanding, and different communication techniques compared to adults.
What is the significance of identifying the age of a child in pediatric history?
-Identifying the age of a child is key in pediatric history because it helps in understanding the developmental stage and the specific medical nomenclature associated with different age groups.
What is the term used for a child aged under 28 days?
-A child aged under 28 days is referred to as a neonate.
How should a pediatrician approach a shy or embarrassed child during history taking?
-A pediatrician should be friendly, engage with the child early on, and use play if appropriate to make the child feel more comfortable.
Why is communication important in gathering a good pediatric history?
-Communication is key to gather a good pediatric history because it helps in getting the full account of a problem from both the child and the parent, which is vital for accurate diagnosis and treatment.
What is the importance of understanding the feeding history in pediatrics?
-Feeding history is important in pediatrics as it helps assess the child's nutritional intake, which is crucial for their growth and development, and can indicate potential issues like malnutrition or allergies.
How can a pediatrician ensure they do not miss any important information during the history taking?
-A pediatrician can ensure they do not miss any important information by conducting a systematic review of the child's health, covering areas such as feeding, birth, developmental, growth, immunization, and family history.
What is the purpose of the developmental history section in pediatric history taking?
-The developmental history section is key in pediatrics to assess whether a child is attaining developmental milestones on time or if there are any delays, which can indicate potential developmental disorders.
Why is it important to ask about the child's vaccinations during the pediatric history?
-Asking about vaccinations is important to determine if the child is up-to-date with their immunizations, which can impact their health and susceptibility to certain diseases.
How should a pediatrician handle the situation when a teenager feels uncomfortable sharing personal information with parents present?
-A pediatrician may need to invite the parent to leave the room to achieve privacy, allowing the teenager to feel more at ease when answering personal questions about sexual behavior, smoking, or alcohol use.
Outlines
👶 Pediatric History and Patient Interaction
Dr. Erwin introduces the complexities of taking a pediatric history, emphasizing the importance of understanding the developmental stages of children from neonates to adolescents. He highlights the necessity of empathy and communication when dealing with anxious parents or shy children. The video covers the specific terminology for different age groups and stresses the importance of direct interaction with the child as the patient. It also touches on the need for privacy when discussing sensitive topics with teenagers.
🤒 Symptoms and Pediatric Assessment Techniques
This paragraph delves into the common symptoms seen in pediatrics, such as fever, rash, and seizures, and the importance of understanding their onset, development, and any relieving or aggravating factors. It discusses the need to inquire about the child's contact with similar illnesses, travel history, and school attendance to identify potential outbreaks or serious infections. The paragraph also covers the significance of a detailed feeding history, including breastfeeding or bottle-feeding specifics, and the necessity of exploring bowel habits and any issues related to urination or defecation.
👨👩👧👦 Comprehensive Pediatric History Components
The final paragraph outlines the comprehensive components of a pediatric history, including the patient's and parent's concerns and expectations, birth history, developmental milestones, growth history, past medical history, immunization status, and allergies. It also discusses the importance of family history, social history, including school and home environment, and a systematic review of various body systems to ensure a thorough assessment. The paragraph concludes with a reminder of the key elements to cover in a pediatric history and an invitation for feedback and suggestions for future videos.
Mindmap
Keywords
💡Pediatric history
💡Neonate
💡Developmental history
💡Vaccinations
💡Presenting complaint
💡Feeding history
💡Birth history
💡Parental concern
💡Seizure
💡System's review
Highlights
Paediatrics focuses on patients from neonate to adolescent, covering ages zero to 16 years old.
Taking a pediatric history can be challenging, especially for those not accustomed to working with children.
Children are resilient but can deteriorate rapidly, requiring careful identification of their age in history taking.
Nomenclature in pediatrics includes specific age groups such as neonate, infant, toddler, preschooler, school-age, and adolescent.
Parental anxiety when a child is ill should be acknowledged with empathy during history taking.
Engagement with children is crucial, using playfulness and direct address to facilitate communication.
Maintaining autonomy for teenagers during history taking can be achieved by ensuring privacy when discussing sensitive topics.
The pediatric history includes elements not found in traditional medical histories, such as developmental milestones.
Introduction and gaining permission are the first steps in taking a pediatric history.
Open-ended questions are used to initiate the conversation about the child's presenting complaint.
Chronological exploration of symptoms is essential to understand their development and any changes.
Feeding history is vital in pediatrics, including details about breastfeeding, bottle-feeding, and bowel habits.
Parental concerns and expectations should be taken seriously and addressed during the history taking.
Birth history includes antenatal, natal, and postnatal details, assessing for complications and prematurity.
Developmental history assesses if the child is meeting milestones on time and identifies any developmental delays.
Growth history involves checking if the child is growing and gaining weight normally, often using a growth chart.
Past medical history, including hospital visits and regular medication, is an important part of the pediatric history.
Vaccination history and any allergies should be assessed to understand the child's health background.
Family history provides insights into hereditary conditions and the home environment.
Social history, including parental occupation and school involvement, can affect a child's health.
Systematic review ensures that all aspects of a child's health are considered, from respiratory to neuromuscular systems.
Transcripts
paediatrics include patients from
neonate to adolescent ranging from the
age of zero to 16 years old taking a
pediatric history can be daunting if
you're not accustomed to working with
children if you need this channel hi my
name is dr. Erwin I have high
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and successful life I publish new video
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subscribe and ring the bell today we're
going to look at the ethnic history
children are resilient and tend to
compensate when they are ill however
they can decompensate and deteriorate
rapidly identifying the age of a child
is key in pediatric history let's take a
look at the nomenclature a new net is a
child aged under 28 days an infant is a
child aged between 1 and 12 months a
toddler is a child aged between 1 and 3
years old a preschooler is a young child
aged 3 to 5 years old a child of school
age is between 5 to 12 years old and
lastly an adolescent is between the age
of 13 to 17 years old
also known as teenagers the child is
generally accompanied by a parent or
carer in very young children who do not
speak the history is taken through the
parent it is important to be aware that
parent with a sick young child might be
anxious when you take a history be
empathetic in older children the history
can be taken directly from them some
children are shy and might be
embarrassed to talk it's important to be
friendly and engage with your child
early on children like to play do not
ignore the child and talk on Isabel
perón greet the child be playful if
appropriate interact with the child and
address your questions your child with
your patient remember the child is your
patient and not the parent communication
is key to gather a good pediatric
history the child might not be able to
answer all your questions so you could
encourage the parent to pitch in the
history it is vital to get the full
account of a problem from both the child
and the parent if possible with all the
teenagers
maintaining autonomy without offending
the parent can be tricky sometimes
teenagers might feel uncomfortable
to share personal information if the
Penguins are in the room it might be
necessary to invite parent to leave to
achieve privacy the teenager might be
more at ease to answer a personal
question about sexual behavior smoking
or alcohol the pediatric history
consists of specific elements not
generally explored in a traditional
medical history first things first you
need to introduce yourself and gain
permission to take a history from a
child and parent as appropriate if your
patient is a newborn you might want to
congratulate the parents before you jump
in the history start with an open
question to establish the reason or
reasons why the parent brought the child
can you think of any question you would
ask to start the conversation you might
say what bring you today how can I help
make sure that you know who is
accompanying the patient you might also
child who's with you today the parent or
the patient might start telling you
about the presenting complaint the
symptom abroad the patient in the next
step is to explore the history of
presenting complain your aim is to get a
chronological order of how the symptoms
started how its develop and what there's
been change so you might want to ask
Wendy the problem start how did they
develop has it change common symptoms in
pediatric include fever breathlessness
rash Corozal symptoms runny nose and
sore throat pain and seizure it's
important to identify any aggravating
factors or relieving factors always ask
whether there's been any previous
episodes or similar illness let's go for
some examples let's say you have a child
who is two years old presenting with
fever and rash what do you want to know
you want to know when did the fever
start
how long has a fever been going how high
has a temperature be parents tend to
measure temperature at home and the
value the temperature was thirty-eight
point five if it represents will feed
for five consecutive days it's important
that you think about Kawasaki disease we
favor you need to ask whether the
patient has been taking any couple
paracetamol for children if the couple
has been helping with lowering the
temperature
you want to know the focus of fever
could it be an infection could it be an
upper respiratory tract infection a
urinary tract infection so you need to
be asking questions to help you make a
diagnosis Russia is common in children
with the rush you need to know how long
has it been going on whether the rash
has spread whether the child has any
allergies any recent change in fabrics
or lotion some parents may have
performed the glass tests were they
press on the skin to check whether the
rash disappears or not if the rash
doesn't fade when you apply pressure it
is in numb blanching rash an unrelenting
rash can be a sign of something more
serious infection is a common reason why
children become sick it is important to
inquire whether the patient has been in
contact with anybody with similar
illness or any of the siblings who have
been sick recently also check whether
there has been any recent overseas
travel has a child been kept from going
to nursery or school sometimes that can
be an outbreak at the nursery or school
some children may present with seizure
this presentation is frightening for
parents specially if it's the first time
it's important that you understand the
history and take a history of the
seizure procedure during the seizure and
precision make sure you assess for
meningitis or encephalitis which are
both life-threatening conditions feeding
history is important in Pediatrics you
want to know the intake of food or feet
whether the child is bottle-fed or
breastfed whether the child is taking
over fluid if the child is being
bottle-fed is it formula which one is it
how much is charming fat how frequently
if a child is feeling less than 50% or
the usual feet then you might want to
know whether there is anything else
going on if H is feeding then you would
expect the child to pass urine and to
poo you need to ask question about
whether the child has wet nappies and
dirty nappies if the child is toilet
trained then you could ask whether a
child is going for we normally whether
there's any other problem when they're
passing we with bowel motion sometimes
children can become Lou
and have diarrhea or constipation so
make sure that you explore bowel habits
it is vital to get the idea concern and
expectation in a pediatric history as
you have two persons you have a patient
and the parent make sure that you ask
both of them if appropriate parental
concern in Pediatrics taken seriously
make sure that you inquire whether the
parent has any concern and that your
address they're concerned the next
section is birth history the way I
remember it is in a chronological order
starting with antenatal birth and
postnatal you want to know about the
upset with history of a mom whether
there has been any complication whether
the scan was normal
whether there's been any problem in
blood sugar control or high blood
pressure so this is what you would cover
in the antenatal part of the birth
history the next part is gestation you
need to know whether the child is
premature or full-term fat 7 to 40 weeks
is considered full-term babies what is a
birth weight normal birth weight ranges
between 2.5 to 4.5 kilogram how about
the mode of delivery was it normal
vaginal delivery was it for sap or van
toes or was it an emergency c-section
was any complication at birth did the
tripod meconium within 24 hours was any
problem will join this fever did the
child have to stay in special care baby
unit person Italy who was there any
problem establishing feed so these are
the question that you need to ask in the
birth history the next section is
developmental history this is key in
pediatric you need to know about the
development of a child whether the child
is attaining the milestone on time or
whether there's any delay in the
development the way to remember about
asking these questions is gfs s gross
motor fine motor envision speech and
hearing and social
H I normally smile by six weeks we'll
sit by nine month start speaking first
words by 18 months start walking by 18
months make sure you study the normal
development of my son this is very
important especially if you're assessing
a child
with cerebral palsy who has any problem
with a development the next section is
gruff history this is where you explore
whether the child is gaining weight and
growing normally in the UK children have
a red book on their bone and parents
will carry this red book at consultation
so you can have a look in the red book
whether the child is growing normally
and you can plot on that graph to see
which centre they are following next
section is past medical history you need
to know whether the child has been seen
previously in hospital in Annie or by
the GP whether the child has a medical
problem that requires regular visits to
the doctor a key element of the
pediatric history is to ask about
vaccinations whether the child has been
vaccinated and up-to-date with the
immunization if the child has not been
immunized then inquire was a reason for
that the next section is drug and
allergies you need to assess whether the
patient is taking regular medication any
over-the-counter medication Calpol
neurofen or supplements also also about
allergies whether the child has any
allergic reaction to nuts to some
medications antibiotics and if they do
have allergies then also what sort of
reaction do they get Wanda exposed to
these allergens some may have severe
reactions such as rash and swelling in
which case you need to make sure that's
documented in the notes and avoid these
allergens in family history you want to
know who is living with the child at
home whether there are any siblings
whether there's any medical conditions
that run in the family you might want to
draw a family tree social history is
important because it gives you an
indication of the environment and the
conditions in which the child is living
also about parental occupation also both
smoking stages of parents or anybody
living with a child whether the health
visitors have been involved asks whether
there has been any involvement with
social services how is the charging at
nursery or school has a child finding
school has there been any problem raised
at school is there any bullying problems
because bullying is quite common
at school and it can affect the child's
health other question you might want to
us in social history is whether a child
has any hobbies whether they enjoy doing
whether the child exposed to any pets
last but not least you need to cover the
system's review some doctors prefer to
do the systems review after the history
of presenting a plane others prefer to
do it at the end there's no right or
wrong here which other works for you
a systems review will allow you to make
sure that you don't miss anything in
particular in other systems generally
you would also Bob fever about behavior
in alefo G and in drowsiness rashes then
you would proceed by asking question for
specific systems such as called the
respiratory did the child have any cough
any noisy breathing parents might tell
you that they think the child is wheezy
AB Strider or have a croup barking cough
who was having some problem with a
breathing and the discoloration of the
skin so you need to ask this question in
the systems review following the cardio
respiratory system ask about the
gastrointestinal system whether the
child has any abdominal pain any
diarrhea constipation any vomiting any
reflux ent review is imported in
Pediatrics ask whether a child has any
so fraud any snoring
noisy breathing or in the air aches you
might also want to ask about the
genitourinary system whether the child
has any burning when they're passing we
whether there have been any problem
where they're going more frequently or
they wet in the bed last but not least
also by the neuromuscular system whether
the child has any headaches and the
abnormal movements and seizures or fits
as you can gather the pediatric history
contains a lot of sections that you
would not otherwise explore in a medical
history key elements to cover in
pediatric history include feeding
history birth history developmental
history
gruff history immunization history and
family history if you need to go back
and watch this video again to make sure
that you understand which sections that
you need to go through then go back and
watch it today I hope you find this
video useful let me know down in the
comments
if you have any suggestions for future
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thanks so much for watching take care
everybody see you in the next video
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