[01.02] CMD - Approach to the Pediatric Patient V2.1.pdf

Children are not little adults

How does the source characterize children in comparison to adults?

Breathe more air, consume more food, and drink more water in proportion to weight

Why are children often more vulnerable than adults to environmental hazards?

Undeveloped organ systems

What explains why children can easily crash from stable to low blood pressure?

Grow and develop

Besides physical differences, how else do children differ from adults?

Less control over environment

Why might children be unaware or unable to make choices that protect their health?

Observation

How do you understand a child who cannot yet talk?

Veterinary medicine

To what field of medicine is pediatric medicine sometimes compared because patients cannot talk?

Parental agenda and clinician agenda

What are the two main agendas when taking a pediatric history?

Reason for consult or chief complaint

What is the primary agenda of the parent during history taking?

Pattern recognition

What is the primary agenda of the clinician during history taking?

Parents, older children, yaya, and lola

Who are the potential historians for a pediatric patient?

Empathy

What trait should a clinician have for both the child and the parents?

Lola

Who is often the decision maker in families where they are paying for the medicine?

Layman terms

In what terms should you explain your findings thoroughly?

Filipino

In what language should you converse if patients are not comfortable with English?

Informant words and duration

What should be included in the brief account of the chief complaint?

Halak

What is the Tagalog term for phlegmy sounds in children who cannot spit?

Poop

Where can you ask if phlegm appears to see if a child is swallowing spit?

Extensive or complete review

What type of history taking is preferred in YL7 over a focused history?

When was the patient last entirely well

What is the key question to ask to establish a baseline before the current illness?

Pertinent negative data

What type of data must be obtained because parents may not volunteer it?

mg per kg per dose or mg per kg per day

What are the two common ways pediatric medications are dosed?

mg per mL

What is the unit of measurement for syrups?

mg per 5mL

What is the common unit of measurement for liquid antibiotics?

100mg per mL

What is the common unit of measurement for pediatric drops?

Day of consultation

What is used as the reference point for the timeline of present illness?

Review of Systems

Which section acts as a screen to discover symptoms missed in the HPI?

Do not repeat it

What is the rule regarding information already given in the HPI when doing the ROS?

Health maintenance visits

What can the ROS include besides organ systems?

Dental, eye, and hearing screens

What are three examples of health maintenance screens mentioned in the ROS section?

Birth and maternal history

What usually distinguishes pediatric patients from adult patients in the medical history?

Antenatal or maternal history

Which history section covers illnesses, drugs, infections, and diet during pregnancy?

Fetal Alcohol Syndrome

What can alcohol intake during the second trimester cause?

Natal history

Which history section covers duration of pregnancy, birth weight, and type of delivery?

State of infant at birth, resuscitation, first cry, and onset of respiration

What are four factors to record regarding the infant's state at delivery?

Neonatal history

Which history section includes the APGAR score and nursery stay details?

Umuwi po ba siya kasabay niyo

What Tagalog question should be asked to identify if a baby stayed in the NICU?

Red flag

What is it considered if a baby stays in the nursery longer than the mother?

Past illnesses

Where are all acute and chronic diagnoses like asthma and malnutrition recorded?

Accidents and injuries

What section can reveal if parents are potentially neglectful?

Hospitalizations

What must include the diagnosis, hospital name, and duration?

Medico-legal case

What can prescribing a medication a patient is allergic to lead to?

Dose, formulation, route, and frequency

What four details should be recorded for current medications?

Drug-drug interactions

What should you be careful of when prescribing new medications alongside current ones?

Fully immunized

What is the term for a child who has received all prescribed doses of a particular vaccine?

Philippine Pediatric Society, PIDSP, and PFV

Which three organizations release the yearly Childhood Immunization Schedule?

Philippine National Immunization Program

What do the green boxes in the immunization schedule represent?

Local health centers and private practice

Where are vaccines with polka dots in the schedule given?

HepB-3

How would you report three doses of the hepatitis B vaccine?

One

How many doses are assumed to have been given if no number is mentioned in the report?

BCG, HepB, DTaP, PCV, RV, Influenza, OPV, and IPV

What vaccines should a completely immunized 6-month-old have?

Assume they are part of the NIP

What should you assume about a child's vaccines if the guardian only says they went to the health center?

BCG, monovalent HepB, Pentavalent, Bivalent OPV, IPV, PCV, and MMR/MR

What vaccines are included in the NIP?

MR, Td, and HPV

What vaccines are part of the school-based immunization program?

Growth and development

Which section includes menarche and pubertal developments?

Early puberty

What is suspected if a 6-7 year old exhibits secondary sexual characteristics?

WHO

Whose growth charts are used to check weight for age and head circumference?

CDC Evidence-based milestones 2021

What specific resource is used for developmental milestones?

Educational performance

How can you assess milestones if parents cannot recall them for an older child?

Enuresis

What is the medical term for the inability to control urination?

Encopresis

What is the medical term for fecal soiling?

2 years old

At what age can a child start toilet training and stay dry during the day?

3 years old

At what age should a child ideally be dry at night?

Type 1 diabetes

Besides nightmares, what medical condition can cause bedwetting at 7-8 years old?

Chronic fluid in the ears

What can cause hearing impairments in children?

Nutrition and Lifestyle

Which section provides a holistic approach to the patient's habits?

Breastfeeding and Formula

What are the two primary sources of nutrition for infants?

Full cream milk

What type of milk is recommended after the first year of life?

30 mL

How many mL are in 1 ounce?

1 scoop to 1 ounce

What is the standard ratio of formula scoops to water?

1 scoop to 2 ounces

What is the ratio for some specific formula brands?

Malnutrition

What will happen if a mother uses a 1 scoop to 8 oz ratio when the requirement is 1:1?

Whole food

What makes a child healthy rather than vitamin supplements?

6 months

At what age should semisolid food be introduced if the child is fully breastfed?

4 months

What is the earliest age semisolid food can be introduced if the child is mixed feeding?

Food diversity

Why do you want a child to eat many different kinds of food?

4-6 months

At what age can an infant begin to hold a spoon?

Passive eaters

What is the term for children who are not aware of satiety because they use screens during meals?

Virtual autism

What condition is characterized by a lack of speech or interaction due to excessive screen time?

20 hours

How many hours do babies typically sleep daily?

7-9 hours

How many hours do adults ideally sleep daily?

Decreased sensorium or lethargy

What is suspected if a 5-year-old sleeps as much as a baby?

Obstructive sleep apnea

What is suspected if a child snores non-stop while supine?

Laryngomalacia

What condition involving a soft larynx and poor muscle tone causes snoring in preemies?

Down syndrome

Besides preemies, what other group of children often has laryngomalacia?

Screen time

What can prevent a child from getting enough movement and exercise?

Three generations

How many generations are necessary when using a family tree?

Square

What is the symbol for a male in a family tree?

Circle

What is the symbol for a female in a family tree?

Fully shaded

How is an affected individual represented in a family tree?

Psychosocial history

Which section covers home environment and socio-economic conditions?

Tobacco smoke, water source, and pets

What are three home environment factors to document?

Philhealth

What membership should be checked as part of the psychosocial history?

Stakeholder analysis

What process determines who pays the bills and who makes the health decisions?

Allies

Which group in a stakeholder analysis does not need to be influenced because they already agree?

Temporal Profile

What is a visual representation of the symptoms being reported by the patient?

Functional Medicine Timeline

What is another name for the visual temporal profile used during history taking?

Antecedents, Triggers, and Mediators

What are the three categories in the Functional Medicine Timeline?

Antecedents

What are factors that predispose an individual to an illness, such as family history or birth history?

Triggers

What are factors that provoke the presentation of a symptom and have a distinct start and end?