"Children are not little adults.

They
are unique."
History Taking
in Paediatric
Fundamentals of
Diagnosis
Skillful history-taking
Powers of observation
Careful physical exam
Wise selection of Investigations
Good clinical judgment
More errors are made because of inadequate
history-taking and supercial exam than any
other cause.
History Taking
Onset
Progression
Duration
Severity
Aggravating factor
Relieving factor
Associated factor
Site, Character & Radiation
After her visits to OPD SARA goes to
South Circular Road (SCR)
Component of History
Taking
Chief Complaint
HxPI
PMHx & PSHx
Antenatal & post natal history
Feeding/dietary
Growth & Development
Immunizations
Medications & Allergies
Family & Social
Summary
Chief complaint..
Chief complaint
Sara 1 year 2 month old.. vs Sara 14
month old..
Known case of.. vs underlying history of..
Was admitted to hospital on 5
th
July vs
was admitted to hospital 3 days ago
Chief complaint
Keep it simple
No medical jargon
Implies your working diagnosis..
Bad chief complaint
Sara a 1 year 7 month old girl from
Puchong, was admitted on 5
th
of July
complaining of fever, rashes, runny nose
& vomiting.
Sara a 1 year 7 month old girl from
Puchong, was admitted on 5
th
of July
with 3 days history of fever, vomiting &
runny nose and rashes on day 2 of fever.
Good chief complaint
Sara a 1 ! -year-old girl from Puchong,
was admitted to hospital following a 3
days history of fever & rashes.
Sara a 1 ! -year-old girl from Puchong,
was admitted to hospital with 3 days
history of facial pufness and leg
swelling.
History of presenting
illness
Simplied
What you have found rather than what
parents say.
CHRONOLOGICAL ORDER!
Summarizing, not reporting or story telling
Follow conventional format(OPD SARA
SCR)
Ask relevant associated symptoms
Bad reporter
Sara a 1 ! -year-old girl from Puchong,
was admitted to hospital following a 3
days history of fever & rashes.
After day 1 of fever mother brought her to
see a GP where she received PCM &
antibiotics.
As fever not settling, mum brought her to
another GP who said she should come
back on day 4 if fever persist.
Bad reporting
Good reporter..
Sara a 1 ! -year-old girl from Puchong,
was admitted to hospital following a 3
days history fever & rashes.
She was brought to Serdang hospital after
3 days of persistent fever following
several visits to GP & a private hospital.
Her feverOPD SARA
Her rashesOPD SARA
PMHx/PSHx
Important especially in recurrent/chronic
diseases
Might be related to HxPI
Chronological order!
If many events, summarize
Antenatal & post natal
Hx
Health and age of mother in pregnancy
Antenatal scans and tests
Birth - Gestation, Mode, BWt, AS(condition
baby at birth)
Any immediate health problems after birth
(Admission to NICU, prolonged stay in
hospital after birth)
Any health problems in rst few weeks of
life
Feeding/Dietary
Breast/bottle fed
How long breast feeding
Bottle feed - what type, how much/24 hr
Weaning what age
What type of solid food taken?
Growth
Assess child physical growth
Parent held record
details/plots of previous weight &
lengths/heights
For older children - onset of puberty
Development

Commonly used developmental milestones

Make a card to carry around

Younger children :

ask all 4 domains

Older children :

ask school performance

Parent forget :

compare with other siblings

Immunization
Missed dose - ask why?
Up to date
Completed up to age
vs
Last vaccination was at 12 month of age.
No problem occurred after each
vaccination.
Medications & allergies
Type, dosage, frequency
Specic drug allergies or sensitivities
Food allergies
family hx
Are you and your partner related? -
CONSANGUINITY
Family tree - 3 generations ( ages, health,
cause of death)
Social hx
Who makes up the household?
Size and type of accommodation
Parents occupation
Financial problems
Smoking/Drinking problems in family
Caretaker?
Childs school, school work, friends
Problems at school (bullying, teasing)
DIFFICULT & SENSITIVE - practice some clear Q to avoid
embarrasement
can medical students
give advice to parents
Yes & no !!!
SUMMARY
Bad Summary
In summary, Sara a 1 ! -year-old girl
from Puchong, was admitted to hospital
on 5
th
July 2010 with a 3 days history of
fever & 2 days history of rashes which
appeared on day 2 of fever which is
associated with vomiting, diarrhoea,
cough and poor oral intake. However she
does not have any abdominal distension
and has no urinary symptoms.
Summary is not telling story..
Summary
In summary, Sara a 1 ! -year-old girl
from a dengue endemic area in Puchong,
was admitted to hospital following a 3
days history of persistent fever &
generalized rashes.
In summary, Sara a 1 ! -year-old girl
from Puchong, was admitted to hospital
following a 3 days history of persistent
fever & generalized rashes.
presenting a history is
an art
Commentary.