11/13/24, 8\:11 PM Guide | Paediatric history

Paediatric history

Table of contents

Introduction

Taking a paediatric history can seem daunting due to the range of possible presentations. This guide provides a general
overview of taking a paediatric history in an OSCE setting.

Before the consultation

Before starting, it is worth highlighting general considerations.
A paediatric history follows the same broad structure as an adult history, with a few additional topics. In practice, not all
questions will be relevant to every presentation, but it is wise for newcomers to be thorough and systematic.
Check the child or young person’s age, as this is key in determining what questions to ask and what areas to cover.
Make sure you address questions to the child or young person when appropriate. It is generally appropriate to address
questions to adolescents and supplement the history they provide with details from their parents or carers. Younger children
can usually contribute to the discussion if you adjust your language to match their age and developmental stage (e.g. “tummy”
instead of “stomach”). Be mindful to allow them time to answer, and do not interrupt.
Sometimes, you must speak to the child or young person and their parents or carers separately. This is particularly important
with adolescents and is often to discuss sensitive topics they might not want to discuss with their parents or carers (e.g. sexual
history, illicit drug use, bullying, abuse). Introduce the idea through normalisation (e.g. “I t i s m y u s u a l p r a c t i c e t o …
” or “ I o f t e n l i k e
t o s p e a k t o c h i l d r e n a n d t h e i r p a r e n t s s e p a r a t e l y” ). It is best to speak to parents or carers
reassuring them that con
Finally, but perhaps most importantly, never dismiss what parents or carers say – they know their child better than anyone.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself including your name and role.
Con
Establish the names of any adults or other family members present and their relationships to the child or young person. In
older children, this can be done by asking them,
“ W h o h a v e y o u b r o u g h t w i t h y o u t o d a y ?”
.
Explain that you’d like to take a history.
Gain consent to proceed with history taking.
Rapport
Make sure you maintain a comfortable distance from the child at the beginning of the consultation, whilst
trying to build rapport with the family as a whole. Young children generally feel more comfortable and secure in their
parent or carer’s arms or lap and may require some time to feel at ease with a stranger in an unfamiliar environment.
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Presenting complaint

Use open questioning to explore the child or young person’s presenting complaint, allowing them (and/or their parents or
carers) to recount the presenting symptoms in their own words and at their own pace\:
“ S o , w h a t’ s b r o u g h t y o u r c h i l d i n t o d a y ?”
“ W h a t’ s b r o u g h t y o u i n t o d a y ?”
“ T e l l m e a b o u t t h e i s s u e s y o u r c h i l d h a s b e e n e x p e r i e n c i n g .
”

History of presenting complaint

Exploring the presenting complaint

Try to gather as much information as possible about the presenting complaint.
Facilitate the child or young person (and/or their parents or carers) to expand on their presenting complaint using open
questions
“ O k a y , c a n y o u t e l l m e m o r e a b o u t t h a t ?”
“ T e l l m e m o r e a b o u t t h e c o u g h .
”
The closed questions you ask will depend on the presentation, but the following questions may help\:
When did the current problem start? What was it like?
Has the problem changed at all? If so, when and in what way?
Has medical attention been sought before now? If so, what investigations have been performed and what treatments have
been tried?
Have there been similar episodes in the past?
Does anything seem to make the problem better or worse?
How is the problem a
Do you have any photographic or video evidence (e.g. seizure)?

SOCRATES

The SOCRATES acronym can be used to explore pain further and can be adapted for other presenting complaints.
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbating and relieving factors
Severity

Ideas, concerns and expectations

A key component of history taking involves exploring the parent's or carer’s and the child or young person’s ideas, concerns
and expectations (ICE). This allows you to gain insight into how a child or young person and their parents or carers currently
perceive the situation, what they are worried about, and what they expect from the consultation.
It can be challenging to use the ICE structure in a way that sounds natural in your consultation, but the Geeky Medics ideas,
concerns and expectations article provides some example phrases to use.

Summarising

Summarise what the child or young person and/or their parents or carers have told you about the presenting complaint. This
allows you to check your understanding of the history and correct inaccurate information.
Once you have summarised, ask if there’s anything else you’ve overlooked. Continue to periodically summarise as you move
through the rest of the history.
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Signposting

Signposting, in a history taking context, involves explicitly stating what you have discussed so far and what you plan to
discuss next. It can be a useful tool when transitioning between di
child/parents with time to prepare for what is coming next.
Signposting examples
Explain what you have covered so far\:
h o p i n g w e a c h i e v e t o d a y .
"
What you plan to cover next\:
" N e x t , " O k , w e’ v e t a l k e d a b o u t y o u r c h i l d' s s y m p t o m s , y o u r c o n c e r n s a n d w h a t y o u' r e
I’ d l i k e t o d i s c u s s y o u r c h i l d' s p a s t m e d i c a l h i s t o r y .
"

Systems review

A systems review (or systematic enquiry) involves performing a brief screen for symptoms in other body systems that may or
may not be relevant to the primary presenting complaint. A systems review may also identify symptoms that the child or young
person and their parents or carers have forgotten to mention or did not think were relevant.
Feeding and toileting are signi

Feeding

What does the child or young person usually eat and drink?
Has there been a change in their normal eating and drinking habits?
For infants, are they breastfeeding or bottle feeding (or both)? How often and how much do they feed? If bottle feeding,
what formula do they use?

Toileting

Has there been any changes in the child or young person’s urine output?
In younger children, how many wet nappies do they have per day and has this changed from their normal?
How often do they open their bowels?
What do their stools (“poo”) look like?

Other areas to cover

Other areas to cover in a systems review include\:
Systemic symptoms\: fevers, night sweats, weight change
Cardiovascular\: pallor, cyanosis, syncope
Respiratory\: cough, noisy breathing, laboured breathing
Gastrointestinal\: vomiting (speci
Genitourinary\: dysuria, urinary frequency
Neurological\: seizures, headaches, abnormal movements, behaviour
Ear, nose and throat\: runny nose, earache, sore throat, snoring
Musculoskeletal\: limp, muscle or joint pain or swelling
Dermatological\: rashes

Past medical history

The scope and detail of this part of the history are determined by the nature and severity of the presenting complaint and the
child or young person’s age. For example, a detailed birth, neonatal, and developmental history would be required if a young
child presents with delayed speech. However, this might not be necessary for an older child with a simple ear infection.
Medical conditions
Ask if the child has any medical conditions\:
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“ D o e s y o u r c h i l d h a v e a n y m e d i c a l c o n d i t i o n s ?”
“ A r e t h e y c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e gu l a r l y ?”
" H o w w e l l c o n t r o l l e d i s t h e i r m e d i c a l c o n d i t i o n ?"
" H a v e t h e y e v e r b e e n a d m i t t e d t o h o s p i t a l a n d , i f s o , w h y ?"
Surgical history
Ask if the child has previously undergone any surgery or procedures (e.g. appendicectomy, tonsillectomy)\:
“ H a s y o u r c h i l d e v e r p r e v i o u s l y u n d e r go n e a n y o p e r a t i o n s o r p r o c e d u r e s ?”
“ W h e n w a s t h e o p e r a t i o n / p r o c e d u r e , a n d w h y w a s i t p e r f o r m e d ?”
Prenatal history
Key questions\:
Were there any obstetric problems, including abnormal antenatal scans or screening tests?
Did the mother take any medications during the pregnancy?
Birth history
Key questions\:
Were there any concerns during delivery or interventions required?
Was the child or young person born premature?
What was the child or young person's gestation and birthweight?
Neonatal history
Key questions\:
Did the child or young person require admission to a special care baby unit? If so, why and for how long?
Child development
Key questions\:
Is the child or young person meeting their developmental milestones?
Are there any concerns about their development?
Growth history
Key questions\:
Is the child or young person growing along an appropriate weight and height centile?
Immunisation history
Key questions\:
Is the child or young person up to date with their immunisations? If not, why were they missed?
Ideally, growth and immunisation history should be checked against the personal child health record (the 'red book').

Drug history

Ask if the child or young person is currently taking any prescribed medications or over-the-counter remedies\:
“ I s y o u r c h i l d c u r r e n t l y p r e s c r i b e d m e d i c a t i o n s , o r a r e y o u g i v i n g a n y o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
If the child or young person takes prescribed or over-the-counter medications, document the medication name, dose,
frequency, formulation, and route.
Check if there are any problems with taking the medicine (concordance) – some children do not like the taste of certain
medications or struggle with speci

Allergies

Ask if the child or young person has any allergies and, if so, clarify their reaction (e.g. mild rash vs anaphylaxis).
“ I s y o u r c h i l d a l l e r g i c t o a n y t h i n g ?”
“ W h a t h a p p e n e d w h e n t h e y w e r e e x p o s e d t o …?”
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Family history

Ask if any family members or friends have recently experienced similar symptoms to the child or young person\:
“ H a s a n y o n e e l s e i n t h e h o u s e h o l d h a d a f e v e r r e c e n t l y ?”
Ask about conditions which appear to run in the family and clarify who has been a
“ A r e t h e r e a n y c o n d i t i o n s w h i c h a p p e a r t o r u n i n t h e f a m i l y ?”
“ W h o h a s b e e n a
If one of the child or young person's close relatives is deceased, sensitively determine the age at which they died and the
cause of death\:
“ I’ m r e a l l y s o r r y t o h e a r t h a t . D o y o u m i n d m e a s k i n g h o w o l d h i s b r o t h e r w a s w h e n h e d i e d ?”
It can be helpful to draw a family tree (genogram) that you can annotate with key details about the child or young person’s
family members (e.g. age, health conditions, consanguinity).
Family tree symbols

Explore the child or young person’s general social context to gain a more complete picture of their wellbeing, including\:
Who lives with the child or young person
The relationship status of the parents or carers
What type of accommodation the child or young person is living in
The child or young person’s preferred play or leisure activities
The child or young person's happiness at home
The child or young person’s happiness at school or nursery
The smoking status of the parents and anyone else living with the child or young person
Social services involvement
Ask if the child or young person is currently under the care of social services or has previously had social services involvement\:
" D o y o u h a v e a s o c i a l w o r k e r ?"
" H a v e y o u e v e r h a d i n p u t f r o m s o c i a l s e r v i c e s ?"

HEEADSSS

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When taking a history from young people (adolescents), it is important to address the speci
prevalent in this population. The HEEADSSS framework is useful for performing a psychosocial assessment in young people.
HEEADSSS stands for\:
Home
Education and employment
Eating
Activities
Drugs and alcohol
Sexual activity, sexuality, and gender identity
Suicide and self-harm
Safety
It is important to reassure the young person that the content of the conversation will remain con
discuss any aspect of it with their parents or carers without their express permission. However, it is also important that the
young person understands that con
“ A n y t h i n g w e t a l k a b o u t t o d a y i s c o n
p e r m i s s i o n . T h e o n l y e x c e p t i o n w o u l d b e i f I t h o u g h t y o u o r s o m e o n e e l s e w a s a t r i s k o f s e r i o u s h a r m . I n t h a t c a s e , I w o u l d n e e d
t o t e l l s o m e o n e e l s e .
”

Closing the consultation

Summarise the key points back to the child or young person and parents or carers.
Ask the child/parents/carers if they have any questions or concerns that have not been addressed.
Thank the child or young person and parents or carers for their time.
Dispose of PPE appropriately and wash your hands.

References

Lissauer T, Clayden G, and Craft A. (2012). I l l u s t r a t e d t e x t b o o k o f p a e d i a t r i c s . Edinburgh\: Mosby.
Tasker RC, McClure RJ, and Acerini CL. (2013). O x f o r d H a n d b o o k o f P a e d i a t r i c s . Oxford\: Oxford University Press.
Fozi and Wood (2016). H E E A D S S S A s s e s s m e n t . Nottingham Children’s Hospital. Nottingham University Hospitals NHS Trust.
[LINK]
Source\: geekymedics.com
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