Chapter 34. The paediatric history
A paediatric history is made up of two elements:
• The account of what has happened
• Background information about the child which might affect the current or future situation.
The AMPLE format
If there is very little time to take a full history then the mnemonic AMPLE should be the basis of a very brief history:
A – Allergies
M – Medicines
P – Past medical history
L – Last food and drink
E – Events leading up to the current problem
Allergies
It is especially important to know about allergies if any drugs may be given. Occasionally, an allergic reaction to medicines or foods is the cause of the illness.
Medicines
The list of regular medication gives much information about known medical problems and the current state of health.
Past medical history
The medical history has a major bearing on the current problem. At this stage, just a list of important past illnesses is required. Even in young children, the past history can be surprisingly complicated.
Last food and drink
The presence of food and drink in the stomach is a major risk factor for regurgitation. This may lead to airway and breathing problems. To be forewarned is to be in a position to take action if necessary.
Events leading up to the current problem
Brief details of the course of an illness or the mechanism of an injury together with the nature of the present complaints are extremely helpful.
The story from the scene
At a child’s home, the normal living environment reveals much about the child’s daily life. The family’s social circumstances and habits may give useful clues as to the current problems. The apparent health and wellbeing of the other children in the household are also important.
The carer’s tale
Children are unique in often having someone in close proximity who is looking after them. This person, who is usually a parent but may be a relative, friend or teacher, can usually give a good account of what has happened.
What the bystander saw
People at the scene of an incident often give valuable information. Such people may include passers-by, neighbours or professionals such as police officers and fire-fighters. After the incident, all these people disperse and this part of the history may be lost for ever.
The child’s own account
Children often respond very well to appropriate questions. Their account of events can be extremely accurate. It should not be assumed that an adult’s story of events is any more credible than an older child’s.
The full medical history
The full history can be structured as follows:
• Presenting complaint and history of presenting complaint – why have they called an ambulance?
• Past medical history – past illnesses and operations
• Social history – the environment and the people that the child lives with
• Family history – medical problems of other family members
• Medications – the child’s current and past medication and known allergies
• Review of systems – a checklist of the different body systems involving inquiry into possible problems with each.
Never delay urgent treatment to collect unnecessary data
Relevant immediate questions
The depth of enquiry should vary with the immediacy of the situation and the questioning should be directed to the most appropriate person, be that the carer or the patient.
Breathing problems, fits, pain, injury and general symptoms of infection are responsible for the majority of paediatric emergencies. A systemic consideration of some useful urgent questions is helpful. These questions make up the E (events) and some of the P (past medical history) of AMPLE. The following lists are not exhaustive, but can be used as a guideline for questioning:
A – Airway
B – Breathing
C – Circulation
D – Disability
E – Environment
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