Patient History
- Depending on the child’s age and approachability, the history-taking may be supplemented with information from a third party.
- Even if an older child can talk for themselves, third party history can yield relevant supplemental information.
- Ask about changes in behaviour, and how the parent/carer assesses the condition.
- Phrase the questions in a manner appropriate for the child – not too difficult, but also not too childlike.
- The history-taking should be quite broad. Cause of the pain may be in a location other than that indicated by the child. For example, abdominal pain can be caused by middle-ear infection.
- The past history always deserves attention, including the child’s birth, development, growth, illnesses, and vaccinations.
- Observe the child and their interaction with parents/carers during the history-taking.
Physical Examination
Form a general impression at the beginning of the examination. If the child is sick, how severe is the illness? If the child appears sick, always check vital functions first. Determine which examination has priority, sometimes rapid intervention is necessary, and a more detailed examination can be performed later.
In addition to the pulse, respiration, consciousness, temperature, and blood pressure; also measure the child’s height and weight.
In general, examination of the child is usually broader than that for an adult with the same symptoms. For example, a child with abdominal pain may also undergo ear/nose/throat examination and pulmonary examination.
When examining a child, start at the top and work downward. Children are more likely to perceive the examination as threatening, particularly with the use of instruments. Give children time to adjust. For example, let them examine or even hold the stethoscope, let them try it first on the back of the hand, or demonstrate the examination on a toy.
Inspection of the groin (inguinal or femoral hernia) and scrotum (undescended testes, testicular torsion) are part of the abdominal examination. Inguinal hernias can also occur in girls.
Save unpleasant or painful examinations for last (ear/nose/throat examination, rectal examination). Take advantage of favourable moments during the examination. For example, check the throat while the child is crying and auscultate while the child is calm. Distract a crying child (pacifier, bottle, game) or let the child sit on the lap of the mother/carer. Many examinations can be performed in this position.