History Taking In Pediatrics ... !!!

History taking in PEDIATRICS is the most annoying thing that I have ever did. To be honest the child is too young to be asked and the mother is too sensitive and over protected regarding her child to answer it normally. Most of the time she will exaggerate things up.

Try to redirect your thinking towards the diseases that are most common in your areas in children. Furthermore this history is a bit different from other subjects like i.e this includes some extra domains that we are going to discuss later. When you will be taking history, just forget that the child will tell you that how does he feel or mother will be telling you what are the feelings of her child. 

KEEP IN MIND THAT SOMETIMES THE CHILD WILL BE CRYING AND YOU WILL HAVE TO JUDGE EVERYTHING ON YOUR MULTIDIMENSIONAL APPROACH. SO, SHARPEN YOUR SENSES AND LET'S START.

                                            Pattern

Personal Profile:-

                            Name, Age, Gender, Residence, Date of Admission, Mode of Admission.

Presenting Complaints:-

                                       Keep in mind that these should be in chronological order. They should be in the language of a person who is explaining and the should be precise and concise.

History of Presenting Complaints:-

                                                          Make a graph by picking up one complaint in chronological order and explaining it with it's characters.

For example if the child has fever then ask from mother; From how long fever is present. It is high grade or low grade. Is continuous or intermittent. Ask about diurnal variation. Ask how much it was if ever documented. Ask if any anti pyretics was taken and so on.

History of presenting complain is important in this regard that when the mother will tell you that her child has fever. You must built a list for of its causes. Now ask the related questions about the causes and try to narrow down the list of your differentials.

Systemic Inquiry:- 

                                Here systemic inquiry should be directed towards the aim of ruling out co-existent pathology. For example If the patient has been coming to you with recurrent episodes of infection then it may be wrong something with his immune system ( quickly make a list what can effect his immune system) or may be malignancies not letting his body defenses work properly or may be the child is malnourished.

CNS:- Ask about fits, unconsciousness, dizziness, recurrent falls, lethargy.

CVS:- Ask about if the child became cyanosed or any breathlessness during feeding, and if the child is a little older then ask about squatting in breathlessness.

Respiratory:- Recurrent sore throat, cough, wheeze, cyanosis, breathlessness, excessive sweating during feeding.

GIT:- Ask about appetite, loss of wight, vomiting, hematemesis, diarrhea, constipation, malena, PR bleed and fresh blood in stool.

Genitourinary:- This can be asked in this way that do you change the diaper of your child quite often? this will give you an idea about frequency. now for dysurea, ask that is your child cry during micturation. Specially ask about nocturia and incontinence.

Musculoskeletan:- Movement limitations joint swellings or redness.

Birth History:- Make 3 columns as Antenatal, Natal and Post Natal.

            Antenatal: visits were regular or not? Tetanus prophylaxis, Hx of GDM, HTN and Asthma,                                   ask if patient had Preterm Premature Rupture of Membranes, any PV leaking or                                   any PV discharge. Any history of rash?

            Natal: Was it a term pregnancy? Was it term? Where the child born? C-section or SVD?                                 Daee handling.

            Post Natal: Immediate cry and breathing? NICU admission? Immediate breast feeding?

Feeding History:- Ask if the child was breast fed or not? Was he exclusively breast fed? Is anything else was given to him along with breast feeding? If formula feed is given then for how long it was, what was the formula and what was the dilution ratio? If the child was top fed i.e with bottles then were you used to wash that bottle? How much and for how long milk was given with which dilution.

Weaning History:-

                              If the child is older then ask about weaning. You can ask like what was given for weaning and at which age weaning was started? Was there any hypersensitivity reaction to a specific weaning food? at the end never forget that for how long baby was breast fed.

Immunization:-

                          Was the baby properly immunized? Always check for the BCG scar in general physical examination.

Socioeconomic Status:-

                                        Ask the mother in a way that she may not get embarrassed. Keep in mind that socioeconomic status may have a drastic impact on child's health as a form of malnutrition.

Developmental History:-

                                       First of all ask about how's the growth of baby and physical changes. One must take the view of mother on weight and height. Then come towards baby's development. Development is basically functional acquisition of skills. Inquire from mother about Gross Motor, Fine Motor, Hearing, Vision and Language Skills and what is Psycho-social Status of the child. Here i am assuming that you know all the developmental milestones of the baby.

Now, if the child is elder then ask, does the child play with his age fellows? If he goes to school then how is the performance?

Family Tree:-

                        Make the family tree with the proper signs allocated. Don't forget to mention the ages.

These are the signs that are allocated for different conditions.

Here is an example of family tree of one case.

This concludes our history portion. Suggestions will be appreciated.