HOW TO EXAMINE CHILDREN AND ADOLESCENT
Pediatrics examination is an important procedure done among children starting from newborn to the other growth stage. Pediatrics recommend that parents schedule at least an annual wellness check or a check-up at any time when important healthcare concerns arise
HISTORY
The approach to the examination will be determined by the age, level of development and level of understanding of the child.
In very young children who have limited speech or no speech, the history should be taken through the parents or parent and the doctor learns to interpret it
In the adolescent, it may be necessary to invite the parent to leave so that further history can be taken. This time should be used to ask questions about alcohol, drugs and sexual activity which such person may be uncomfortable discussing in front of the parents.
In case of any current sickness, the doctor may ask questions about the sickness .The aim is to investigate, reach a correct diagnosis and establish the context of a child’s illness whether psychological, family and social context.
Questions may include:
- Any prior episodes of similar sickness
- How it developed
- What aggravates or relieves the symptom(s)
- If there is any contact with the same sickness in siblings or infectious outbreaks
- Any recent overseas travel
- If the symptoms have kept the child from attending school
- Whether there has been weight loss or gain
Structure of history taking in children
Previous history during and after birth
- The doctor should establish any maternal sickness or problems during pregnancy.
- If the child was conceived naturally or by assisted reproduction
- If there was any exposure to prescribed, recreational drugs or over-the-counter (OTC) medication during pregnancy
- Gestation, duration of labor, mode of delivery and the birth weight
- If there was any problem in the neonatal (newborn) period such as jaundice, fits, feeding problems, bleeding disorder
- Immunization record and travel details
- Any subsequent illnesses, surgery, accidents or trauma
- Have there been any concerns from screening tests at the child health clinics or schools, if yes, such result should be presented?
It is also important to note developmental history or progress such as when the child first sat up, crawled, walked, and talked. Others may include toilet training, reading.
FAMILY HISTORY
Relevant history such as
- Previous miscarriages, stillbirths or other childhood deaths in the family
- The age of the parent
- This occurs more commonly in some cultures
- The number of children in the family including their ages and sex
- Previous illness in the sibling, parents or any close relatives
- Any condition with a genetic component
SOCIAL HISTORY
When enquiring about the structure of the family unit, the doctor should be diplomatic and take care not to offend.
The doctor should ask about:
- Who lives at home and if they have any role in the child care. Does the child-parent live together? And if they are facing any problem in their relationship
- The childcare (if a parent works or both parents work)
- Parental occupation (s)
- Smoking in the home
- If there are pets at home
EDUCATIONAL HISTORY
Specific question about a child’s experience and attainment at school be explored. This may include the level of concentration and progression with writing, spelling, and mathematics.
If there is any report of bullying. Reports from teachers can be enlightening and may help.
Specific questions about mood, eating and sleeping habits, hobbies, interests, and other activities may be asked. Emotionally disturbing events may have a major effect on well-being and general development.
The history-taking session helps the doctor and the parents to understand problems and any psychological factors.