How To Take a Paediatrics History

Summary

In 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

00:00

👶 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.

05:01

🤒 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.

10:02

👨‍👩‍👧‍👦 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.

Keywords

💡Pediatric history

Pediatric history involves gathering comprehensive medical, social, and developmental information about a child from birth to adolescence. It is crucial for diagnosing and managing children's health conditions. In the script, Dr. Erwin emphasizes the importance of understanding the unique aspects of pediatric history to effectively treat young patients.

💡Neonate

A neonate refers to a newborn child, specifically one under 28 days old. This stage is critical as newborns are highly vulnerable and require careful monitoring. The video script outlines different age categories, highlighting neonates as the youngest group requiring special attention.

💡Developmental history

Developmental history tracks a child's growth milestones in areas like gross motor, fine motor, speech, hearing, and social interactions. It helps identify any delays or abnormalities. The script mentions key milestones like smiling by six weeks and walking by 18 months, stressing the importance of monitoring development.

💡Vaccinations

Vaccinations are immunizations given to children to protect them from various infectious diseases. Ensuring that children are up-to-date with their vaccinations is a vital part of pediatric care. The script advises healthcare providers to inquire about the child's vaccination status during history taking.

💡Presenting complaint

The presenting complaint is the primary symptom or issue that brought the child to medical attention. Understanding this is the first step in diagnosis and treatment. In the video, Dr. Erwin explains the importance of gathering a detailed history of the presenting complaint, including onset, development, and changes.

💡Feeding history

Feeding history includes information about a child's diet, feeding patterns, and any issues related to feeding. It is essential for assessing nutritional status and identifying feeding-related problems. The script details questions about breastfeeding, bottle-feeding, and dietary intake to gather a thorough feeding history.

💡Birth history

Birth history covers details from the prenatal period, delivery, and immediate postnatal period. It includes information on complications during pregnancy, mode of delivery, birth weight, and any neonatal issues. The script suggests a chronological approach to documenting birth history, starting from antenatal to postnatal events.

💡Parental concern

Parental concern refers to the worries or issues expressed by the parents regarding their child's health. These concerns are taken seriously as they can provide critical insights into the child's condition. The video emphasizes addressing parental concerns empathetically during the pediatric history-taking process.

💡Seizure

A seizure is an abnormal electrical activity in the brain leading to various physical and behavioral symptoms. Seizures in children can be particularly alarming for parents. The script highlights the importance of obtaining a detailed history of seizures, including their nature, duration, and frequency, to aid in diagnosis and management.

💡System's review

System's review is a comprehensive examination of all body systems to identify any other symptoms or issues not initially mentioned. It ensures a holistic understanding of the child's health. The video advises including a system's review either during or after the history of the presenting complaint to ensure no critical information is missed.

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

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