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Pediatric Diagnosis • Observation – Eye contact – Establish rapport with the parents & the child • History taking – Investigation – Asking “relevant” questions Personal History Taking • Active listening – silence – non-verbal indications of interest • facilitation – “door openers” – “rocking” – “repeating” • Questioning – probe & seek clarification • reflection • confrontation History taking – Outline of history • General Data • Chief complaint • History of present illness • Past medical history • Family history • Maternal & perinatal history • Developmental history • Nutritional history • Immunization history • Personal & Social history Pediatric Diagnosis – Review of the Systems – Physical Examination – Assessment General Data: – – – – – – – – – – – Patient’s name Religion Date of birth Age of the patient Sex Patient’s address Birth place Nationality Admission (First, 2nd, or third) Informant Reliability Chief Complaint: – What is the problem of the patient? Respiratory – Cough? – Colds? – Difficulty of breathing CNS Dizziness? Headache? Drowsy? Gastrointestinal disorders – vomiting? – Difficulty of swallowing? – diarrhea General Fever? Loss of appetite? History of Present Illness: – – – – – Nature and date of onset time of manifestations describe the signs and symptoms occurrence and progression inquire about recent exposure to infectious disease Past Medical History – State the previous illnesses of the patient – Age of occurrence • Example: – Had measles at 2 years old – Previous hospitalization • Example: – He was admitted at fatima medical center due to bronchial asthma on August 8, 2005 Family History: – – – – Birth order of the patient Number of living siblings Total number of siblings Heredo-familial disease • (+) PTB-father (+) diabetes-mother – Are parents alive and healthy? – Size of the family? – Health and problems of the other children • To known if there’s any history of associated congenital/genetics disorder in the family Maternal & Perinatal History: – – – – Chronological order of pregnancies Illnesses during pregnancy X-ray exposure during pregnancy Drug intake during pregnancy – – – – – Age of gestation – full term? Pre-term? Post-term? Place of delivery – hospital? Home? Type of delivery? Complications? Apgar? Birth weight? Developmental History • Developmental milestone of the patient – At what age the patient started to Sit? Walk? Talk? – Secondary sexual characteristics (adolescent) Nutritional History • Type of feedings – Breast feeding? – Artificial feeding? – Supplementary feeding? • Example: Patient was breastfed until 6 months old then shifted to Promil Gold at 1:2 dilution up to 1 year old Immunization History • Type of immunization • Age immunized Example: Patient received 1 dose of BCG at birth, 3 doses of DPT, 3 doses of TOPV at 2, 4 & 6 months old & 1 dose of measles vaccine at 9 months old. Personal & Social History • • • • Living condition Housing condition Educational attainment of the parents Family income Example: The family lived in a 10 X 8 sq meter house. Water supply by MWSS. Electricity by Meralco. Family income of 8,000 per month. Review of System Occurrence • • • • • • • Skin HEENT Chest & Lungs Heart Abdomen Genitalia Extremities Duration jaundice 1 month eye discharge 3 days wheezing 2 days chest pain 5 days epigastric pain yellowish discharge joint pain Examining a Pediatric Patient Keen Observation Physical Examination: • General Survey – ? Level of consciousness – ? Respiratory distress • Vital signs – Wt. (% percentile) Expected body wt. (EBW) – Ht. (% percentile) Temp. – CR RR BP • HEENT – ? Color of conjunctivae • pinkish/pale – ? Nasal/aural discharges – ? Cervical masses/lymphadenopathy – ? Conditions of the throat • color & sizes of the tonsils – congestion/pectechiea/swelling • Lungs – retractions – breath sounds-wheezes, rhonchi, rales • Heart – precordium-? bulging, adynamic/dynamic – heart sounds- ? Rate, rhythms, murmur • Abdomen – Symmetrical- ? Bulging – bowel sounds - normoactive, hypoactive, hyperactive – organomegaly • liver span, spleen & other palpable masses • Genitalia – ? Testis descended – ? Ambiguous genitalia • Extremities – ? Pulses e.g. full & equal – ? Capillary refill - </> 2 sec – ? Clubbing • Neurologic Examination Assessment • Diagnosis? • Impression?