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geekymedics.com/paediatric-history-taking/
Thom Finnerty
Taking a paediatric history can at first seem daunting due to the wide breadth of topics
to be covered. With experience, there are short-cuts, but it is wise for newcomers to be
thorough and work systematically through the history.
This guide provides a general overview of taking a paediatric history in an OSCE setting.
Download the paediatric history taking PDF OSCE checklist, or use our interactive OSCE
checklist. You may also be interested in our other paediatric OSCE guides.
As such, it is imperative to know this information before approaching the patient and
family, so that you can prepare a mental model for how you’ll structure the consultation.
Greet the child, their parents/carers and any other siblings who are present.
Make sure to maintain a comfortable distance from the child at the beginning of the
consultation, whilst trying to build rapport with the family as a whole. Young children
generally feel more comfortable and secure in their parent’s arms or lap and may require
some time to feel at ease.
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Observe how the child is playing and interacting with any siblings and their
parents/carers.
Make sure to address questions to the child when appropriate. Depending on the
child’s age, they will hold a wealth of knowledge about their current condition and their
history – but may feel too shy or embarrassed to add to the conversation you may be
having with their trusted adults. Be mindful to allow the child time to answer and do not
interrupt.
Negotiating both talking to parents/carers without the child present and talking to
the child alone requires tact and consideration. Generally, this is done to avoid
embarrassing older children or adolescents and to allow for the imparting of sensitive
information. This can be done by talking separately to each in turn, introducing the idea
through normalisation – “It is my usual practice to…”. It is a good idea to speak to the
parents first, then the adolescent or young adult – to provide some reassurance that the
confidential information imparted to the doctor is not going to be immediately disclosed to
the parents.
Presenting complaint
Use open questioning to explore the child’s presenting complaint, allowing the
parents/carers and child to recount the presenting symptoms in their own words and at
their own pace:
SOCRATES
If pain is a presenting complaint the SOCRATES acronym can be used to explore it
further.
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Site
Onset
Character
“How would you describe the pain?” (e.g. dull ache, throbbing, sharp)
“Is the pain constant or does it come and go?”
Radiation
Associations
Ask if there are other symptoms which are associated with the pain:
“Are there any other symptoms that seem associated with the pain?”
Time course
Severity
Assess the severity of the pain by asking the patient to grade it on a scale of 0-10:
“On a scale of 0-10, how severe is the pain, if 0 is no pain and 10 is the worst pain
you’ve ever experienced?”
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Ideas, concerns and expectations
A key component of history taking involves exploring the parent’s/carer’s and child’s
ideas, concerns and expectations (often referred to as ICE) to gain insight into how a
child and their parents currently perceive the situation, what they are worried about and
what they expect from the consultation. It can be challenging to use the ICE structure in a
way that sounds natural in your consultation, but we have provided several examples for
each of the three areas below.
Ideas
Concerns
Expectations
Summarising
Summarise what the child/parents have told you about the presenting complaint. This
allows you to check your understanding of the child’s history and provides an
opportunity for the child/parents to correct any inaccurate information.
Once you have summarised, ask the child/parents if there’s anything else that you’ve
overlooked. Continue to periodically summarise as you move through the rest of the
history.
Signposting
Signposting, in a history taking context, involves explicitly stating what you have
discussed so far and what you plan to discuss next. Signposting can be a useful tool
when transitioning between different parts of the child’s history and it provides the
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child/parents with time to prepare for what is coming next.
Signposting examples
Explain what you have covered so far: “Ok, so we’ve talked about your child’s
symptoms, your concerns and what you’re hoping we achieve today.”
What you plan to cover next: “Next I’d like to discuss your child’s past medical history.”
Systems review
A systems review involves performing a brief screen for symptoms in other body
systems which may or may not be relevant to the primary presenting complaint. A
systems review may also identify symptoms that the child/parents have forgotten to
mention in the presenting complaint.
Dietary intake: clarify what the child’s baseline dietary intake is and, if relevant,
how this has changed recently.
Fluid intake: calculate the child’s fluid intake over the last 24 hours.
Urine output: ask if there has been any change in the child’s urine output (in
younger children, ask if there has been a change in the number of wet nappies).
Stool: ask about the recent frequency and form of the child’s stools.
Vomiting: if the child has been vomiting, determine the frequency, volume and
consistency of the vomit (e.g. bilious, haematemesis). Ask specifically about
projectile vomiting if considering pyloric stenosis as an underlying diagnosis.
Fever: ask if the child has had a fever recently and if this was confirmed with a
thermometer.
Rash: ask if the child currently has a rash, including its location, whether it appears
to be spreading and if it appears to be itchy.
Coryzal symptoms: ask if the child has recently had a runny nose, or sounded
‘sniffly’.
Cough: ask if the child has a cough and if they are bringing up any sputum with it.
Gain further details about the frequency of the cough, including associations with
particular triggers or times of the day (e.g. nocturnal cough).
Work of breathing: ask if the child’s breathing has appeared more laboured
recently.
Weight change: ask if the child appears to be gaining weight at an appropriate rate
and review growth charts if available.
Behaviour: ask if the child appears to be their usual self, including their level of
activity, mood and social interaction.
Pain: ask if the child appears to be in pain and further explore this using the
SOCRATES acronym.
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Past medical history
The scope and detail of this part of the history are determined by the nature and severity
of the presenting complaint as well as the child’s age. For example, if a young child
presents with delayed speech, a detailed birth and neonatal history, as well as details of
developmental milestones, would be required.
Medical conditions
If the child does have a medical condition, you should gather more details to assess
how well controlled the disease is and what treatment(s) the child is receiving. It is also
important to ask about any complications associated with the condition
including hospital admissions.
Surgical history
Ask if the child has previously undergone any surgery or procedures (e.g. heart valve
replacement, appendectomy):
Allergies
Ask if the child has any allergies and if so, clarify what kind of reaction they had to the
substance (e.g. mild rash vs anaphylaxis).
Prenatal history
Key questions:
Were there any obstetric problems including abnormal antenatal scans and
screening tests?
Were any medications taken during the pregnancy?
Birth history
Key questions:
Neonatal history
Key questions:
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Did the child require admission to a special care baby unit and if so, for what
reason?
Child development
Key questions:
Growth history
Key questions:
Is the child currently growing along an appropriate weight and height centile?
Immunisation history
Key questions:
Ideally, this should be checked using the personal child health record (identify any
reasons for missed immunisations).
Drug history
Ask if the child is currently taking any prescribed medications or over-the-
counter remedies:
“Is your child currently prescribed medications or are you giving any over-the-
counter treatments?”
Family history
Start by drawing a family tree or genogram which you can then annotate with key
details about the child’s family members (e.g. age, health conditions, social issues,
consanguinity).
Ask if any family members or friends have recently experienced similar symptoms to
those the child is presenting with:
Ask about conditions which appear to run in the family and clarify who has been
affected:
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“Are there any conditions which appear to run in the family?”
“Who has been affected by these conditions?”
If one of the child’s close relatives are deceased, sensitively determine the age at which
they died and the cause of death:
“I’m really sorry to hear that, do you mind me asking how old his brother was when
he died?”
Social history
Explore the child’s general social context to gain a more complete picture of their
wellbeing including:
Ask if the child is currently under the care of social services, subject to a child
protection plan or has previously had social services involvement:
“Are social services currently involved with the care of your child?”
“Is a child protection plan currently in place?”
“Have you ever had input from social services?”
HEEADSSS
When taking a history from an adolescent or young adult, it is important to address the
health risk behaviours that are more prevalent in this population, as well as the young
person’s resilience factors. The HEEADSSS acronym is a useful tool for exploring this
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area of the history. We have outlined the HEEADSSS structure below with examples of
questions to be asked in each section.
It’s important to reassure the adolescent that the content of the conversation will remain
confidential and that you will not discuss any aspect of it with their parents/carers
without their express permission. However, it’s also important that the young person
understands that confidentiality cannot be assured if they’re at risk of harm – to
themselves, or others. An opening statement similar may be helpful in establishing this
verbal contract:
“Anything we talk about today is confidential. That means I cannot tell others,
including your parents, about it without your permission. The only exceptions would
be if I thought you, or someone else was at risk of serious harm. In that case, I
would need to tell someone else.”
Eating
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What do you do to relax?
What kind of physical activities do you do?
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Summarise the key points back to the child and parents/carers.
Ask the child/parents/carers if they have any questions or concerns that have not been
addressed.
References
Lissauer, T., Clayden, G., & Craft, A. (2012). Illustrated textbook of paediatrics.
Edinburgh: Mosby.
Tasker, R. C., McClure, R. J., & Acerini, C. L. (2013). Oxford handbook of
paediatrics. Oxford: Oxford University Press.
Fozi & Wood (2016). HEEADSSS Assessment. Nottingham Children’s Hospital.
Nottingham University Hospitals NHS Trust. [LINK]
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