Pediatric Assessment PN 3 November 2007
So, What’s the Difference? • Children are growing and developing both physically and mentally, values for parameters such as dietary requirements and prevalence of disease, expected normal laboratory values, and responses to drug therapy will be different from those observed in adults.
How Often? • Immediately after birth, at 2 weeks of age, at the times when immunizations are indicated (2, 4, 6, 12 and 18 months) and subsequently at 1- or 2-year intervals. • As necessary
Tips & Techniques History taking: • Children should be included in the hx taking with parents adding additional info • Adolescence should be offered privacy and confidentiality • Parents interviewed separately with adolescence permission
Setting the Setting • Establish rapport with child and parents • Show empathy and understanding • Use simple language • Remember…they are frightened • Use games or props such as puppets • Talk about hobbies, pets or toys
Alert…Alert • Keen observation for child abuse, neglect • You are responsible for reporting • What is the process in the agency for reporting? • Physical, mental, child, spousal etc.
What Should It Cover? • an appropriate history, physical examination and developmental assessment, and anticipatory guidance should be provided about the following topics: • Appropriate nutrition • Safety measures • Expected developmental and behavioral events • an assessment should be made of the quality of physical care, nurturing and stimulation that the child is receiving
Pediatric History In addition to the areas covered in an adult examination, the following should be added: • Pregnancy and perinatal history • Immunization history • Detailed dietary history for the first year of life, including history of vitamin supplements and fluoride use • Developmental history • Social history, including questions about any recent separations, deaths, family crises, friends, peer relationships, day-to-day care arrangements, progress in school
4 Key Questions • Mom’s disease/problem hx during pregnancy • Birth trauma or delivery difficulty? • Did child meet developmental milestones at the usual times? • Does child have any disease, current or previous injuries or known congenital anomalies?
Pediatric Physical Exam • Examiner should be aware of body size differences to adults i.e. head relatively larger, limbs relatively smaller and, in small children, ratio of surface area to weight relatively larger.
Physical Exam Observe the child during the history taking Without touching the child, observe: • Gait • Breathing frequency and pattern • Responses to sound • Grasp patterns • Colour • Responses to parental comforting measures
Developmental Milestones • Achieved at different ages in different children; • Attempts should also be made to assess responses to sound and ability to see. • See handout for stages/ages