PEDIATRICS II

How to Pedia Wards #PaanoBaTo

Nelson, Bates, Malijan, Dinopol | 19 Aug 2018

FROM MAMA CIELO:

TRANSER’S NOTE: This trans is meant to give you a general overview on pediatric
APGAR Score:
assessment’s intricacies, which make it a little different from adult assessment. Take what you
• if hindi maalala, write unrecalled.
need and remember what you can for the wards. Galingan natin, batch! 😊
• Ask parent if malakas umiyak at birth, matagal ba bago umiyak, nangingitin ba nung
pinanganak, gaano katagal. ask if kailangan iresuscitate noon.
FAST FACTS ABOUT CHILD DEVELOPMENT • pwedeng narrative siya.
• predictable pathway (developmental stones)
• occurs in children at different rates FEEDING HISTORY
• affected by physical, psychological, social and environmental factors • Breastfeeding - frequency and duration of feeds, difficulties, timing and method of
• developmental level affects medical history & PE weaning; determine if baby is lactose intolerant
• Bottle-feeding: type, amount, frequency + side effects: vomiting, diarrhea
• Complementary feeding & eating habits: mahilig ba sa sweets? (follow-up question:
ESTABLISHING RAPPORT
may dental caries ba si bebe?); note the quality of food (i.e. mashed kamote,
The following tips are from Christine Alexis Dinopol, my friend who is a clinical clerk from UP blended/pureed pechay, etc)
College of Medicine. -- Joan • Intake of supplements - vitamins, minerals

• Establishing rapport with both the caregiver and the child is necessary, especially for DEVELOPMENTAL HISTORY
the child to visibly trust you.
• Bring a small toy (bright color, okay rin yung may sound). It will help kapag malapit ng FROM MAMA CIELO:
umiyak yung kid + if you need to keep the child busy while you interview the caregiver. • Pwede gamitin niyo yung nasa Nelson, yung milestones na tig-6 months, tapos
• Use high-pitched voice when talking to the child. It helps in establishing rapport with the interpret if in each stream of the development, the milestones were achieved on
kid. If hindi gumana ang high-pitched voice, try yung gentle, soothing tone, para di time.
magulat. • If you know how to do Denver II Development Screening, you may use the
• If takot yung child with the instruments, e.g. pulse ox, tapos ayaw talaga, usually milestones in this tool also. You may perform screening, if time permits, BUT if the
pinapakita ko sa child testing it on the mom. Para makita niya na hindi naman masakit patient is irritable… wag nalang.
yung instrument.
Table 1. Developmental History General Overview from Mama Bates
INTRICACIES IN PEDIATRIC HISTORY Domain Remarks
Physical Growth periods of slow/rapid growth.
The flow of history in a pediatric patient is similar to an adult patient. HOWEVER! Certain Gross Motor Devt ages child held head up, rolled over, sat, stood, walk
aspects have to be emphasized in a pediatric patient. They are as follows: Language/Fine Motor when did the child start talking, writing
GENERAL INFORMATION Dev’t
• Names of Parents/Caregiver Social Devt day and night sleeping patterns, toilet training, dressing up,
• If live-in: tanungin kung kaninong apelyido ang gamit ng bata. discipline problems

CHIEF COMPLAINTS FOR 0-2 YEARS OF AGE

• Are they concerns of the child? Or of the parent? Table 2. Developmental History for first 2 years of life. Nelson, Bates, Denver.
• Indicate primary reason for consult HOW TO USE THIS TABLE: Note the child’s age, look for the corresponding row here, and ask the milestones
in the same row. Pag walang laman yung particular column, tanungin yung item na nasa itaas ng row. At ayun,
pag di pa na-achieve, try to go one step back. Sa unang sabak sa wards, no need pa to memorize, ok, kalma
PRESENT ILLNESS tayo friends
• How does each family member show concern for the symptoms
• How does each family member respond to the symptoms? Ave. age Gross motor Fine Communication/ Cognitive/
Pwede tanungin kung ano yung ginagawa to alleviate the child’s discomfort, ganun attainment Motor Language Personal-
Social
BIRTH HISTORY 2 months Hold head steady Smile in response Stares
• Prenatal - number of prenatal visits, duration of pregnancy, medications, vices, weight while sitting to face, voice momentarily at
gain spot where
• Natal - manner of delivery (spontaneous vaginal delivery? CS?), birth weight, APGAR object
Score disappeared
• Neonatal - resuscitation efforts, cyanosis, jaundice, infections, bonding

Special Edition | Two Beautiful Pedia Transers from 3B 2020 1 of 3

 PEDIATRICS II
FOR THE PRESCHOOLER
How To Pedia Wards
Table 2. Developmental History for first 2 years of life. From Nelson, Bates, Denver.
HOW TO USE THIS TABLE: Note the child’s age, look for the corresponding row here, and ask the milestones
in the same row. Pag walang laman yung particular column, tanungin yung item na nasa itaas ng row. At ayun,
pag di pa na-achieve, try to go one step back. Sa unang sabak sa wards, no need pa to memorize, ok, kalma
tayo friends

Ave. age Gross motor Fine Motor Communicatio Cognitive Personal/

attainment n/ Social
Language
3-4 Pulls to sit, no Grasps rattle; Imitates Stares at own hand, works
months head lag palmar grasp speech for toy
gone sounds
brings hand
together in
midline

asymmetric tonic
reflex gone
6 months Sit without Transfers Monosyllabic Feeds self
support object from babble
hand to hand
7-8 Rolls back to Thumb- Inhibits to “no”, Bangs 2
months stomach finger grasp follows one- cubes;
step commad uncovers toy
with gesture after it is
hidden.
9-10 Hold head Follows 1-step Stares Nakikipag
months steady while command, no momentarily -appear
sitting gesture. + at spot (beh FOR THE SCHOOL-AGE CHILD
“Mama/dada” where object gawin mo • Hobbies, interests (music, sports, etc)
disappeared na lang) • Concerns in school performance (note areas of difficulty)
12 months Walks alone Turns pages Speaks first Egocentric Indicate • Kailan nagsimula magsulat ang bata
of book real word symbolic wants • Discipline problems
play (e.g.
Pretends to FROM ALEXIS (UPCM CLERK):
drink from Minsan hirap yung parents mag-alala especially with developmental milestones, so
cup) what I do is usually nagbibigay ako ng remarkable event, example, first walk (nag
15-16 Walks Builds tower Speaks 4-6 Wave bye 1st birthday na ba siya nun o hindi pa, pwede rin gamitin yung events like- summer
months backwards of 2 cubes words bye break, pasukan, and Christmas as markers to help them remember the month and
17-18 Runs speaks 10-15 Uses stick to Helps in year of events)
months words reach toy + house
pretend play (mimic
with doll chores)
CURRENT HEALTH STATUS
22-24 Walks up the Builds tower Speech is half Removes Table 3. Current Health Status
months steps of 6 cubes understandabl garment
Domain Remarks
e
Screening Tests Newborn screening, anemia screening, vision, hearing, developmental
screening, TB, deworming, visits to the dentist
Allergies History of eczema. Food intolerance, recurrent wheezing, perennial
allergic rhinitis, urticaria
Immunizations Dates given, if complete yung vaccines for the child’s age, and if may
untoward reactions.

Special Ed “Just try your best… I know you will do well.” (Malijan, 2018) 2 of 3
 PEDIATRICS II
How To Pedia Wards
Note: Review of Child Immunization Schedule
Birth BCG, Hepa B
6,10,14 wks DTwP-HiB-HepB
OPV
Pneumococcal conjugate
6, 10 wks Rotavirus vaccine
9 mos Measles vaccine
12-15 mos MMR vaccine
18 mos HiB, oral/inactive polio,
pneumococcal, DPT
4-6 y/o Varicella, MMR, OPV, DPT
11-18 y/o Tdap
DPT: diptheria, pertussis, tetanus (equal doses)
HiB: Haemophilus influenzae vaccine
Tdap: more on tetanus, less @ diphtheria & pertussis

TRANSERS’ MESSAGE
To emphasize, these are just compiled tips from Dra. Malijan, Clerk friends, and Nelson just to
give us a bird’s eye view of the ward work for pedia ☺

For the physical examination of the newborn, kindly refer to the 2020 Pedia 1 Trans (Pedia 1.02
– EINC Part 2 – Physical Exam of the Newborn)

Never forget the kid at heart but also, don’t forget to put yourselves in the parents’ shoes ☺
#RoadToParenthood – Beibei

"Oo, hindi biro ang pag-examine ng bata. Mahirap, nakaka-frustrate, nakaka-discourage. Pero
isipin natin, no, iba ang hirap ng pag-aaruga ng isang bata. So I hope that this ward work will
make us realize how much care our parents & parent figures put into us. Cheesy man, pero after
Pedia wards, let's take time to thank them for all the love. Let's also show our appreciation for
those who raised us, by being sensitive to the caregivers we'll interview.” – Joan

Special Ed “Just try your best… I know you will do well.” (Malijan, 2018) 3 of 3