Good afternoon (or morning depending where you are in the World!)
Praying and hoping that you are all well.
It has been a little while since I have done a blog - so without further ado, lets get to it!
Paediatric history taking has all the same structure that you may be familiar with - we start with history of presenting complaint (SOCRATES vs SQITARPS), then past medical history … etc etc. As with most systems, there are a few additional questions that you will need to take into account. Below is a list, which I will then follow with a little more detail.
*As always stated, this is a reminder and not revision notes (I imagine you have enough notes). Nor is it meant to be detailed (you can sign up for one to one revision for that!).
1) Fluid intake
2) Bowels and urine
3) Rash
4) Fever
5) Up to date with immunisations
6) Antenatal + birth history
7) Developmental milestones
This list is not exhaustive and just to get you thinking.
Fluid intake
It is required that you quantify how much the child usually drinks (bottle or breast) versus how much they are drinking now. Is it more or less than half?
Parents worry about lack of solids (understandably) but from a medical point of view, due to the large surface area of a child- we worry more about fluids, due to risk of dehydration being higher and more detrimental in babies/children.
Bowels and urine
Again, quantify this - how many times are they opening their bowels and how much urine? How many wet nappies have they produced? Are the nappies wet? More or less than half normal? We need numbers!
This is will give us an idea of whether we should be worried about dehydration and also allows us to get an insight into the general wellbeing of the baby - if they are refusing feeds, this may be a red flag.
Rash
This one should be obvious. A rash in a child has to be looked at and palpated. Is it blanching or non blanching? Non blanching being more worrying.
Some rashes are common in benign viral illnesses, some are due to serious viral infections i.e. mumps (see ‘immunisation section’). You should be able to differentiate between a worrying and non worrying rash.
Immunisations
Is the child up to date with their immunisations? You may not be able to recite the whole immunisation schedule, but asking mum or dad whether they are up to date is enough. *Remember there are parents who have decided not to vaccinate their children, so don’t assume.
Antenatal and birth history
A general review of the antenatal history will give an insight into the ‘risk’ of the pregnancy, The way to work this out may be simply to ask the mum whether it was ‘high or low risk’ or ask about the pregnancy generally, i.e. did they see only their GP + midwife, or was the consultant involved to? What were the scans like? Was the mum in and out of hospital? With birth history, was it a vaginai or c/section? (if c/section, was it elective or emergency?).
Developmental milestones
Ask the parent whether they are doing what is expected at their age (taking into account all children do things at different times). Be aware of the red flag cut off age, i.e. walking being 18 months.
Ask if there are any concerns from the health visitor/nursery/school. Collateral history is always valid.
Hope this summary was useful and has given you some tips and tricks for the OSCE (and real life).
If you would like to have any one to one tutoring, please get in touch via email.
Look after yourselves :)