Paediatric Assessment

 

Emergency

 

Hx

Ex

Ix

Mx

 

Index

 

 

  

 

Paediatric History

 

Age

HPI

Feeds

PMH

Social

Family

Develop

Vaccination

 

 

  

Paediatric Age Notation

 

-  Gestational age (GA) = number of weeks gestation currently or at birth

-  Documented as: weeks + days = 37+3

-  Corrected age (CA) = gestational age + days old

-  Used for pre-term neonates 

-  Ie: GA 37+3 + 7 days old = CA 38+3

-  From birth

-  Can use number of days

-  < 1 month = neonate

-  < 3 months = newborn

-  3 months – 1 year = infant

-  1 – 4 years = toddler

 

 

 

  

Paediatric History of Presenting Illness (HPI)

 

-  Limp

-  Rash

-  Fever

-  Stridor

-  Vomiting

-  Bilious: bowel obstruction

-  Cough

-  Bronchiolitis

-  Nocturnal, on exercise, cold weather: Asthma

-  Barking: Croup

-  Bovine: Pertusis

-  Apnoea

-  Apnoea of prematurity

-  Breath holding spells

-  Pertusis

-  Bronchiolitis

-  Sleep

-  Hydration status

-  Wet nappies: normal >4/day

-  Number & quantity of feeds

-  Stool

-  Straining: constipation, infant dyschezia

 

 

 

  

Paediatric Feeding History

 

Oral Intake

-  0 – 6 months: 150ml/kg/day

-  6 – 12 months: 120ml/kg/day

-  1 – 5 years: 80ml/kg/day

-  5 – 10 years: 60ml/kg/day

-  10 – 15 years: 50ml/kg/day

 

Neonates & Infants

-  Typical newborn feeds 8-12 times per day

-  Initiate feeds at 60ml/kg/day

-  Target 150mls/kg/day

-  Feeding Babies

-  Breast Feeding

-  Premature Infants

 

Children

-  Nutrition

-  Dietary habits

-  Food allergies or intolerances

-  Bulemia, anorexia nervosa

-  Weight

 

 

 

  

Paediatric Past Medical History (PMH)

 

-  ADDING to History

-  Used esp in young children

-  Some info from BlueBook

-  Antenatal

-  Mothers health

-   Infections: HIV, HBV/HCV, CMV..

-   Serology: HBV, HCV, HIV, Syphilus, Rubella

-   Drugs/meds

-   Pre-eclampsia, GDM

-  GBS

-  Foetal health

-   Ultrasounds: NT, foetal morph

-  Delivery

-  Vaginal (NVD) or Caesarean section (LUSCS) +/- assisted: forceps, vacuum, episiotomy

-   IOL

-   Indication for LUSCS or assisted delivery

-  Gestational age

-   Prematurity: NEC, RDS, ROP, IVH, HMD..

-  Duration of rupture of membranes

-  Time in hospital, complications

-  Birth weight, HC, length (percentiles)

-  Resuscitation, APGARs

-  Meconium Aspiration Syndrome (MAS)

-  Newborn screening

-  Development

-  Immunisations

-  Complete schedule

-  Reactions

-  If not document why: parents, needle phobia..

-  Nutrition (Feeding Hx)

-  Breast feeding

-  Solids

-  Diet

-  Allergies

-  Growth

-  Weight: FTT

-  Height/length

-  Charts (%)

-  +/- head circumference

-  Hospital presentations & admissions

-  Asthma, bronchiolitis, UTI..

-  Nappy changes

-  Wet nappies: dehydration

-  Medications/supplements

-  Atopy: asthma, hayfever, ezcema, food allergy

 

 

 

  

Paediatric Social & Personal History

 

-  Parents, home life, care

-  TV Hx

-  Hrs/day, no. TVs in house, TV in bedroom

-  Pets

-  Cats, dogs: asthma

 

-  HEADSS assessment

-  Young person social assessment

-  Home

-  Who lives, where, own room

-  Family dynamics, jobs of parents/relatives, new people in home enviro

-  Recent moves, running away

-  Education & Employment

-  Missed school, like/dislike school, performance, favourite/worse subjects

-  Teachers, suspensions, truancy, changes at school

-  Work, future jobs/education

-  Activity

-  Fun w peers, where & when, acticities w family or clubs, sports, hobbies, reading, TV

-  Arrests/crimes

-  Drugs

-  Peers, family use

-  Tobacco, alcohol

-  Amounts, frequency, patterns

-  Source of drugs, how paid for

-  Sex

-  Orientation, masturbation, sexual/physical abuse

-  Degree & types of exp, number of partners

-  STDs, comfort, contraception

-  Suicide

-  Sleep problems

-  Appetite/eating changes

-  Withdrawal/isolation, hopelessness, suicide attempts, suicidal ideation, recurrent serious accidents, affect

 

 

 

  

Paediatric Family History

 

-  Smoking: asthma, low birth weight infant

-  Alcohol

-  Drugs

-  Atopy: asthma, eczema, food allergies

-  Sibling health

-  Consanguinity

-  Syndromes

 

 

 

 

Paediatric Examination

 

Vitals

General

Weight

Head

Arm

Chest

Abdo

Pelvis

Leg

New Born

Develop

Sexual

 

 

 

General Examination of a Child

 

-  APGAR

-  Arousal, alertness, activity, appropriateness

-  Weight

-  Height

-  Avg length at term 50cm

-  Increase by 25cm in 1st year (0-1yr)

-  Increase by 10cm in 2nd year (1-2yrs)

-  Increase by 7.5cm from 1-1.5yrs & from 1.5-2yrs

-  Preterm infants

-  1cm+/week growth

-  Half adult height at age 24-30/12

-  Adult height can be roughly estimated w Midparental Height (MPH)

-  Boys: father height + (mother height + 13) /2 +/- 7.5 cm

-  Girls: mother height + (father height - 13) /2 +/- 6 cm

-  Head Circumference

-  Preterm infants

-  1cm+/week growth

-  Sexual Development

-  Bone Age

-  State of physiological maturity

-  Assessed by x-ray

-  Jaundice 

-  Purpuric rash: meningitis, Henoch-Schonlein

-  High pitched scream: IICP

-  Hydration status

-  Skin turgor

-  Capillary refill: normal <2 sec

-  Mucus membranes

-  Sunken eyes

 

Primitive Reflexes

-  Moro (startle) reflex

-  Usually present up to 4-5 months old

-  Absence indicates profound motor disease

-  Absent unilaterally = hemiplegia, brachial plexus plasy, fractured clavicle

-  Persistance after 4-5 months indicates severe neurological disease

-  Galant

 

 

 

  

Paediatric Weight

<Paeds Ex>

 

-  Poor weight gain: FTT

-  Crossing >2 centiles down OR <3rd centile x2 occassions

-  Note: centile charts cross sectional (not longitudinal) & on Caucasion population

-  Term neonate +/- 3.5kg

-  <10centile: hypothermia, hypoglycaemia, jaundice

-  >90centile: hypoglycaemia, polycythemia, jaundice

-  May lose up to 10% body weight in 1st few days

-  Should regain birth weight by 10-14/7

-  Gain of 30g/day+/- until 3/12

-  Average weight gain

-  0-3 months: 180g/week

-  3-6 months: 120g/week

-  6-9 months: 80g/week

-  9-12 months: 70g/week

-  Preterm infants

-  Aim increase 15g/kg/day until 2kg

-  Then 20-30g/day

-  Infants gain 20g/day+/- from 3-6/12 then 10g/day+/- from 6-12/12

-  Double birth weight by 4/12

-  Tripple birth weight by 1yr

-  Children gain 2kg/yr between 2yrs-puberty

-  > 10 years: (age + 4) x 2 

 

 

 

  

Paediatric Head & Neck Exam

 

-  Port Wine Stain

-  Sturge-Weber syndrome

-  Upto 30%

-  Always effects upper eyelid

-  Seizure

-  Hemiparesis

-  Intracranial calcification

-  Mental retardation

-   Eyes

-  Cats eyes: coloboma

-  Sclera

-  Icterus: Jaundice, kernicterus

-  Blue: osteogenesis imperfecta

-  Discharge: conjunctivitis

-  Strabismus

-  Leukocoria: retinoblastoma, cataract

-  Orbital inflammation: preseptal or orbital cellulitis

-  Sunken eyes: dehydration

-  Fontanelles

-  Sunken: dehydration

-  Bulging, tense: IICP

 

 

 

  

Paediatric Upper Limb Exam

 

-   

 

 

 

  

Paediatric Chest Exam

 

-  Auscultation

-  Stridor: croup, foreign body, epiglotitis

-  Biphasic: acute airway obstruction

-  Grunting: pneumonia, precedes repiratory arrest

-  Wheeze

-  Increased work of breathing (WOB)

-  Nasal flare

-  Intercostals/subcostal recession

-  Accessory muscle use

-  Head bobbing

-  Tracheal tug

-  Tachypnoea

-  Chest expansion

-  Resp rate

-  Sexual Development

-  Breast exam

 

 

 

  

Paediatric Abdominal Exam

 

-  Scaphoid Abdomen (sunken/concave anterior abdominal wall): congenital diaphragmatic hernia

-  Visceral herniation: Gastroschisis, Oomphalacoele

 

 

 

  

Paediatric Pelvic Exam

 

-  Rash: Diaper dermatitis

-  Sexual development

-  Testicle exam

-  Newborn exam: genital exam

-  Anus: patent

-  Should pass meconium by 24/24 if not assess for imperforate anus

 

 

 

  

Paediatric Lower Limb Exam

 

-  Calf hypertrophy: Duchenes Muscular Dystrophy

-  Limp: DDH, Perthes, tranient synovitis, slipped capital femoral epiphysis

-  Foot position

-  Intrauterine posturing: talipes

-  Club foot

-  Pes Planus

-  In-toe gait

-  Bow legs: common bilateral up to 2yrs old, path if unilateral

-  Knock knees 

-  Hip Exam (Ortolani & Barlow tests): DDH

 

 

 

 

Paediatric Investigations

 

Vitals

 

Path

Imaging

Proc

Micro

 

 

 

 

Paediatric Management

 

Resus

Vaccinations

 

General

Meds

Surgery

Proc

 

PETS Retrival Service (Vic)

(03) 9345 7007 open 24/7

 

Royal Childrens Hospital Clinical Practice Guidelines (RCH CPG)