Professional Documents
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Patient assessment
needs
s e rva tio n
good ob
Social and confident
• Age
• The family unit
• The environment
Dedicated
Adults Infants
Pediatric Characteristics in Basic Medicine
Physiology
• Heart rate, blood pressure, routine blood test
results and composition of body fluids are
variable according to age
• Limited kidney's ability leads to electrolyte
and acid-base disorders in children
• More liable to hypothermia, hypoglycemia,
hypoxia and dehydration
Pediatric Respiratory Rates
Infant (birth–1 year) 30–60/m
Immunology
• 3-5 months after birth, the diminished
concentration of immunoglobulin and other
immunologic factors and the decreased
function of neutrophils and other cells
involved in the response to infection put
infants at increased risk for infection.
• SIgA and IgG is not sufficient , thus the
infants are vulnerable to respiratory and
gastrointestinal infections.
Pediatric Characteristics in Basic Medicine
Pathology
Infants Adolescents or
Adults
Streptococcus bronchopneumonia Lobar pneumonia
pneumoniae
Vitamin D Rickets osteomalacia
deficiency
Stress hematopoiesis bone marrow
occurs in the yolk hematopoiesis
sac and liver
Clinical Characteristics of Pediatrics
• Pattern of Diseases
• Clinical Manifestations
• Diagnosis
• Treatment
• Prognosis
• Prevention
Clinical Characteristics of Pediatrics
Pattern of Diseases
• Neonates : asphyxia of newborn, trisomy 21
• Infant-toddler age: febrile convulsion
• Cardiovascular disorders:
– congenital heart disease in children
– coronary heart disease in adults
• Malignancy: Age of 4 yr and above
– Acute leukemia
– Brain tumors
Clinical Characteristics of Pediatrics
Clinical Manifestations
• Onset of illnesses is very rapid.
• Atypical presentations:
– Neonate with severe infection is always weak in
response, apathy, rejects feeding, but has neither
fever, nor increase in WBC counting or other
obvious clinical manifestations.
• May easily miss the diagnosis!
Clinical Characteristics of Pediatrics
Diagnosis
• History given by the parents.
• Varies with age:
– Convulsion in children:
• Neonatal Period--obstetric injuries, asphyxia,
congenital diseases, intracranial hemorrhage.
• <6 mo old--intracranial infection, tetany of Vitamin D
deficiency.
• 6 mo - 3 yr old: high fever, intracranial infection.
• > 3 yr old: epilepsy, intracranial tumor or infection.
Clinical Characteristics of Pediatrics
Treatment
• The pediatric drug dose varies in different age
groups and given according to body weight or
surface area.
• Fluid therapy is critical in amount and
composition.
• Nutritional support is important
• Efficient nursing is essential
Clinical Characteristics of Pediatrics
Prognosis
• The clinical manifestations change rapidly.
• They have good potential for recovery.
POSITIVE!
• But when they decompensate they crash
suddenly and rapidly. NEGATIVE!
• Early diagnosis and prompt treatment are very
important.
• Rapid tissue recovery.
Clinical Characteristics of Pediatrics
Prevention
• Prevention in the health care of infants, and
children is at the core of the field of pediatrics.
– Planned immunization (vaccination)
– Genetic consultation and screening test
– Injury prevention
– Parents counseling
– Examples
• Treat urinary tract infection renal dysfunction.
• Treat rheumatic diseases in childhood is to prevent or reduce
organ damage
Pediatrics - Stages by Age
• Fetal period
• Neonatal period
• Infant period
• Toddler age
• Preschool age
• School age
• Adolescence
Pediatrics - Stages of Children by Age
Fetal period
• This period is from formation of embryo till birth.
• First trimester of pregnancy is the first 12 weeks.
– This period is very important for development and
organogenesis . Thus, infection, radiation,
chemotherapy may give rise to congenital
malformation of organs.
• Second and third trimester; fetus increase in size
and get stores.
Pediatrics - Stages of Children by Age
Neonatal period
• From umbilical ligation to 28th day after birth
• Features: beginning of independent life
• The physiological regulation ability and
adaptation to circumstances are challenging.
• The morbidity and mortality are very high
• Health care:
– enough nutrition
– proper nursing care
– prevention of diseases
Pediatrics - Stages of Children by Age
Infancy period
• Rapid growth period.
• Baby weight increases 3 times more than the
birth weight.
• Height increases 1.5 times compared with the
birth height.
• Head circumference increases from 35-47 cm.
• Every organ system continues developing and
completing, most importantly the brain.
Pediatrics - Stages of Children by Age
Toddler period
• From 1 to 3 year-old
• Features:
– growth becomes slower
– more vigorous, contact more objects, intelligence
develops faster
– poor ability of identifying damage.
• Health care:
– enough nutrition
– Prevention of diseases
– Prevention of accident
Pediatrics - Stages of Children by Age
Preschool age
• 3 years old until 6-7 years old
• Features:
– growth becomes slower,
– more mature intelligence.
– strong desire for knowledge
– imitating adult’s behavior
– poor ability to identify damage
• Health care:
– enough nutrition
– prevention of diseases
– prevention of accident
Pediatrics - Stages of Children by Age
School age
• From 6-7 years old until adolescence
• Features:
– growth becomes relatively steady
– more mature intelligence developed
– increasing desire for knowledge
– decreasing incidence of diseases
• Health care:
– enough nutrition
– prevention of problems in psychology, emotion and
behavior
Pediatrics - Stages of Children by Age
Adolescence
• From 2nd sexual character appearing until sexual
mature and growth stopped
– --Girl: from 11-12 yrs to 17-18 yrs
– --boy: from 13-14 yrs to 18-20 yrs
• Features:
– the second fastest period of growth and development
– neuroendocrine regulation unsteady
– having problems in psychology, emotion, behavior
• Health care:
– enough nutrition
– health care of adolescence
– education
History Taking in Pediatrics
History Taking - Definition
• History taking can be defined as a systematic
inquiry into the patient or client’s life.
• It is the process of obtaining relevant
information from the patient or patient’s
caretaker (such as the mother or father) for
the purpose of making a diagnosis.
Why??
• The pediatric history is the foundation upon
which the future physician/ patient/ parent
relationship is built.
• The main basis of diagnosis of a medical
condition lies in obtaining a good history and
physical examination.
“More errors are made because of
inadequate history-taking
and
superficial exam
than any other cause.”
Objectives
• To understand the content differences in
obtaining a medical history on a pediatric
patient compared to an adult.
• To understand how the age of the child has an
impact on obtaining an appropriate medical
history.
• To highlight the role of parents during taking
pediatric history.
Objectives
• To highlight the fact that modern technology
must be used when appropriate only to
enhance the clinical assessment of the
patient, not to replace it.
• Understand the appropriate wording of
questions in taking a pediatric history, and
appropriate use of questions.
• Children are not just small adults!
Goals of the history
• To determine why the patient/parent came to
see the physician.
• To determine what the patient/parent is
worried about most and why.
• To strengthen the physician/patient/parent
relationship and thus the therapeutic alliance
by observing, listening and conveying
empathy.
• Direct appropriate examination and
investigation
• Reach a correct diagnosis (or form a
differential diagnosis)
Pediatric History is Different?!
Pediatric History is Different
• History is usually given by parents
• Developmental level of the child
• The age of the patient
• Social issues
Differences of a Pediatric History
Compared to an Adult History
I. Content Differences
– Peri-natal history
– Developmental history
– Social history
– Immunization history
Differences of a Pediatric History
Compared to an Adult History
II. Parent as Historian
• Parent’s interpretation of signs, symptoms
o Children above the age of 4 may be able to provide
some of their own history
o Reliability of parents’ observations varies
o Adjust wording of questions - “When did you first
notice Johnny was limping”? instead of “When did
Johnny’s hip pain start”?
• Observation of parent-child interactions
• Parental behaviors/emotions are important
Dealing with pediatric patients requires
• Specific knowledge
• Creativity
• Patience
• Be careful of sarcasm and joking
Be careful of sarcasm and joking!!
So,
• Taking a history is an art that comes with
time.
• Watch how others do it,
• But find what works for you.
Listening to Mothers
Listening to Mothers
• A smart mother makes often a better
diagnosis than a poor doctor.
About 70 – 80 %
of pediatric diagnoses are based
mainly on history
A good history with the pertinent
points abstracted is the best
pointer to diagnosis in pediatrics
Key areas to cover are
• Presenting complaint -(chief reason for seeking advice)
• History of presenting complaint -(temporal sequence of
events leading to presentation)
• Past Medical History
• Prenatal : drugs, infections, fetal movements, maternal health
• Birth: labor, delivery, Apgar, resuscitation, percentiles.
• Neonatal ; medical and surgical problems
• Feeding, diet, nutrition
• Growth and Development status
• Progress at kindergarten , playgroup, school
• Immunizations
• Medications
• Allergies
• Previous medical problems,
• Life events , accidents , injuries, surgery
• Family History (pedigree) medical and psychiatric, drug and
alcohol
• Impact of child's illness on family/ siblings
• Occupation of parents.
Outline of the Pediatric History
History – General, Personal
• Date
• Patient's name
• Birth date……..Age
• Gender, be careful to use the correct gender
• Residence
• Person giving the history (relationship to
patient and perceived reliability)
• Pediatrics is a specialty governed by age
• Pediatrics is a specialty governed by age
• Pediatrics is a specialty governed by age
• Pediatrics is a specialty governed by age
• Pediatrics is a specialty governed by age
• Pediatrics is a specialty governed by age
• Pediatrics stretches from newborn infants to
adolescents.
• Whenever you consider a pediatric problem,
whether medical, developmental or
behavioral,
• First ask, 'What is the child's age?'
Presenting complaint - Chief complaint