1 - peds case history

when do you collect the case history with young pts?

1. survey prior to exam

2. BRIEF formal interview at beginning of exam

3. informal questions throughout exam

How can you estimate a child's grade based on age?

age - 6 = approximate grade level in school

how to build a rapport with young pts?

1. make eye contact with kid

2. ask about siblings, pets, school

3. compliments

Why is it important to build a rapport with your young patients?

helps alleviate anxieties that kids have

How do you get a chief complaint for a peds exam?

1. if child is old enough to sit alone in exam chair → ask them directly, otherwise can ask mom

2. always confirm with parents

what are some important case history questions?

1. what visual needs do they experience? computers, tablets, where they sit in classroom

2. what activities they do? need CL or sports goggles?

What should you ask a kid during the occupation part of social history?

1. What grade are they in?

2. How are they doing in school?

3. What is their favorite class?

What should you ask your younger than school aged kids/their parents for occupation/hobbies?

What fun new things are they doing? (walking, talking, climbing)

what are the patient activity levels that you should watch for?

are they a wiggler? explorer? hider? introverted?

If your peds patient has no chief complaint, what should you ask the parent?

1. do you see them squint?

2. do you see them rub their eyes when reading

3. do you ever notice a wandering eye

4. do they walk up close to the TV?

If your peds patient has no chief complaint, what should you ask the child?

1. do your eyes see well enough to see the board at school?

2. do you like to read?

3. do you ever see two things when you should only see one?

What questions are important to specifically ask about in ocular history for a peds patient?

1. eye injuries?

2. eye turn? history of patching?

3. watery/teary eyes? nasolacrimal duct obstruction as baby?

4. spectacle history

What are common medical problems to ask about during medical history for a peds patient?

1. asthma

2. congenital heart defects

3. hypertension

4. ear infections/tubes

5. broken bones

6. concussion

7. ADD/ADHD

8. developmental delays

9. hormone problems

When do you ask birth history questions?

If under 3 years old or if developmentally delayed

What are the birth history questions you should ask?

1. Full term or premature?

2. Problems with delivery?

3. natural or C-section?

4. birth weight?

5. APGAR score

what is the APGAR score?

score given at 1, 5 and 10 (if there's a problem) minutes after birth

What is usually higher, the 1 minute or 5 minute APGAR score?

5 minute APGAR score typically higher

What are factors of the APGAR score?

Activity (muscle tone)

Pulse

Grimace (reflex)

Appearance (skin color)

Respriation

What is a normal APGAR score?

7-10

What does an APGAR score of 4-6 mean?

some resuscitative measure may be necessary

What does an APGAR score of 1-3 mean?

emergence resuscitative measure necessary

What is a poor APGAR score correlated with?

greater ocular and systemic complications

when do you ask about tobacco and alcohol use?

once child turns 18 (for medical insurance)

What do you ask for the drugs/alcohol portion of a peds exam?

ask parent if there is secondary smoke exposure