Assessing childhood illness

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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1 Assessing childhood illness

Lisa Jackson, Nandu Thalange

Talking to children and their families

Talking to children and their families is the key to understanding any child’s health. It may be diagnostic. It can be therapeutic. It is extremely rewarding.

Working with sick children is challenging and difficult. A kind, thorough and systematic approach will give the child and parents confidence.

Taking a history is important for the development of the relationship between the doctor and child. It is an opportunity to put the family at ease. The history should naturally flow into, and overlap with, the examination.

What do families want?

Children are taken to see a doctor for many reasons. The parents’ concerns might be quite different from those of the doctor:

Parents’ thoughts	Doctor’s thoughts
‘Sam coughs at night’	‘Sam coughs at night’
‘It keeps all of us awake’	‘His brother has asthma’
‘He’s had chest infections before’	‘It’s probably viral-induced wheeze’
‘He needs antibiotics’	‘Maybe he needs an inhaler’
‘The doctor will give me a prescription’	‘I need to make a diagnosis’

It is important to think about the ideas, concerns and expectations that parents have about their child’s symptoms. If these are not established early on, they will feel dissatisfied or frustrated. Asking a family about their concerns focuses the consultation and helps to manage the problem.

The paediatric history

The traditional, structured history is important, but the order in which things are done in the consultation should be flexible.

The consultation needs to be interactive – try and involve children so that they feel a part of the process.

Be prepared

Read the referral letter

Look at the previous notes

Where appropriate, speak to other professionals who have had contact with the child

Record observations – temperature, pulse, respiratory rate

Plot the height and weight on a growth chart – do not forget to look at the Personal Child Health Record.

Environment

An appropriate environment is needed. Think about:

The consultation room – position the furniture appropriately

Safety in the room – are plug sockets, sharps bins and other medical paraphernalia safe?

Suitable toys – these need not be expensive or numerous; drawing paper and pens have magical properties.

General principles

Greeting

Be friendly – the family and child might be more frightened than you are. An appropriate introduction helps; tell them who you are and what you do. Find out who you are talking to.

Presenting complaint

Break down the history into a set of problems.

History of presenting complaint

Find out what has been happening. Sometimes the way parents describe a problem may be very illuminating:

‘Jimmy vomited over my new coat and I was so angry. I told him to tell me if he was going to be sick.’

Make sure you cover the:

Nature and duration of the symptoms

Relieving and aggravating factors

Impact of the illness on the family.

Sometimes you will be seeing a child with a chronic medical problem and then you will need to think about the everyday practical problems the family are facing. For example, how does the child get dressed? How does he go to the toilet? How does he get to and from school? Does the family receive any financial help?

Past medical history

Make sure you find out about:

Birth history – include place of birth

Illnesses/accidents/operations

Hospital/A&E visits

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