How to elicit a paediatrics history?

How to elicit a paediatrics history?

Taking a paediatrics history can be daunting if you are not accustomed to work with children. Paediatrics include patients from neonate to adolescent, ranging from the age of 0-16 years old. 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 paediatrics history.

Neonate <28 days

Infant 1-12 months

Toddler 1-3 years

Pre-schooler 3-5 years

School age 5-12 years

Adolescent 13-17 years

The child is generally accompanied by a parent/carer. In very young children who do cannot 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 the child early on. Children like to play. Do not ignore the child and talk only to the parent. Greet the child, be playful if appropriate. Interact with the child and address your questions to the child who is your patient. Communication is key to gather a good paediatrics 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 the problem from both the child and the parent. With older teenagers, maintaining autonomy without offending the parent can be tricky. Sometimes, teenagers might feel uncomfortable to share personal information if their parents 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 personal questions about sexual behavior, smoking or alcohol.

The paediatrics history consists of specific elements not generally explored in a traditional medical history.

First thing first, you need to introduce yourself and gain permission to take a history from the child and parent as appropriate. If your patient is a newborn, you might want to congratulate the parents before you jump in the history.

What bring you today?

How can I help?

Establish the reason for the consultation

Presenting complaint

symptoms that brought the patient in

History of presenting complaint

When did the problem start?

How did it develop? Has it changed? Chronological order

Fever, breathlessness, rash, coryzal symptoms, pain, seizure

Aggravating or relieving factors

Have there been any previous episodes of similar illness?

Any contact with similar illness in others/siblings

Any recent overseas travel

Has the child been kept from going to nursery/school?

Feeding history

Intake of food/feed, bottle/breast milk, oral fluid

If formula, which one? How much?

Wet and dirty nappies

Toilet trained

ICEpatient and parent

Birth history

Antenatal

Gestation 37-40 weeks, birth weight 2.5-4.5kg

Mode of delivery & birth complications

Passed meconium

Developmental history

Gross motor, fine motor and vision, speech and hearing & social

Smile by 6 weeks

Sit by 9 months

Speech first words by 18months

Walk by 18 months

Growth history

Weight and height

Red book

PMH
Immunization history
Drug/ allergies

Family history- who lives at home with child, siblings, medical conditions in the family

Social history- parental occupation, smoking, involvement with social services

Systems review

A review of all systems