Paediatrics
History
1. History + Demographic (name, age, year of school) + Identify relationship of adult
2. PC + “IS THERE ANY FEVER?”
3. HPC
a. Fever How hot? How was it measured? (Ask CARHO as per below)
b. SOB When did it start? Episodes before? Sudden or gradual? Getting worse? Indrawing of chest? Grunting? Feeding? (CARHO)
c. Cough
i. When did it start? Episodes before? Sudden or gradual? Getting worse?
ii. What does it sound like (whoop, bark, etc)? Worse at day or night?
iii. Bronchiolotis (<2yr), Croup (>2yr), Whooping cough (non-immunised), Pneumonia (any age)
d. D+V:
i. D How many times passed stool? Loose + watery or fully formed? Any blood, mucus, tummy pain?
ii. V How many times vomited? Related to meals? Projectile? What colour/any blood?
iii. Weight loss? Abdominal pain? Foreign travel? Fever? Loss of weight/appetite? Yellow eyes?
e. Constipation (NICE Guidelines history) CF, Hirsch, Spinal cord, Obstruction, Drugs, Dehydration/Immobility/Low Fibre
i. Since birth or after birth? (from birth = bad sign not indicative of idiopathic constipation [which is usually benign])
ii. Meconium delay? (delay = probable underlying pathology – CF/Hirsch)
iii. Ribbon stools? (bad sign)
iv. Weakness of legs or problems walking? (?Spinal cord)
v. Abdominal bloating/distension + vomiting? (obstruction, etc)
f. Seizures:
i. Before Ever happened before? How was child prior? Fever? Lights flashing? Head injury?
ii. During Moving/limbs jerking? Tongue biting? Incontinence? LoC? How long for? Blue around lips?
iii. After Sleepy/drowsy? Headache?
4. Paediatric Questions:
a. About illness:
i. Before - Has this happened before?
ii. Siblings – Anyone at home or around child with same/similar thing?
iii. School - Has it kept child from school?
b. Febrile Child Assessment (no fever= ask eating/drinking/sleeping, general wellbeing)
i. C Pale or blue?
ii. A:
1. Playing? Active and alert or floppy?
2. Sleeping well?
3. Abnormal high pitched cry?
iii. R
1. Struggling to breath? In drawing of chest? Any GRUNTING noises?
2. Any coughing, runny nose or noises when breathing?
iv. H
1. Eating and drinking well? Wet nappies + passing stool?
2. Skin look dry?
v. O:
1. Rashes, neck stiffness, photophobia?
2. Seizures/FITS?
3. Vomiting or diarrhea? Weight loss?
c. Child’s history (mainly for young children):
i. Obstetric:
1. Any illness during pregnancy? Scans + tests normal? Any issues?
2. Gestational age at birth? Prolonged labour? Mode of delivery + any tools?
ii. Neonate Any problems after birth?
iii. Child:
1. Growing well (red book) – HEIGHT AND WEIGHT?
, 2. Milestones? (ASK to see child’s red book for growth + development – assess
FTT)
3. Immunisations?
iv. Currently School
d. ICE + Impact on life (really important)
5. PMH
6. PSurgHx
7. FH
8. DH + allergies
9. SH:
a. HOME Who is at home? Pets? Anyone smoke? Who looks after when at work?
b. SCHOOL How is school? Performance? Friends?
10. Request
a. Full Examination of relevant system including ENT, Resp, Cardio, GI
b. Obs + NICE traffic light assessment, Red book
c. Urine dip (occult UTI – must rule out)
Common paeds complaints: Headache, fits, respiratory, GI, bedwetting, rash
NB: Any Fever in <18mo = Meningitis, Pneumonia, UTI (don’t forget these)... consider foreign body with wheeze
CARHO Green Yellow Red
Low Risk Medium Risk High Risk
Colour Normal Pale Pale/Blue
Activity Responds normally Not responding normally Unresponsive
Playing Smiling + Playing ↓activity Barely rousable
Sleeping Strong cry Weak, high-pitched cry
Floppy
Respiratory Normal Nasal flaring Grunting
↑RR Severe distress (High RR or
↓Sats recessions)
Lung sounds
Hydration Normal Dry membranes Reduced skin turgor
(Drinking/urine) Poor feeding
(Feeding) Poor urine production
Cap refill >3sec
Other Normal Fever >5d Meningism (rash, neck stiff,
bulge font, photophob, fever)
(Meningism) Bile-stained vomit
Seizures/focal neurology
Management Manage at home Hospitalise
Give Calpol Ix: Blood, urine, CXR, ?LP (if Hx/Px dictate)
Check on child often Rx: Immediate Abx, consider paracetamol (if child distressed w/ fever)
Offer regular feeds (inc breast)
New symptoms/not better, seek help
NB: ↑Heart rate is earliest sign of pathology!
Any child <3mo with a fever >38 = ADMIT TO HOSPITAL irrespective of other signs (even if otherwise well)
Any child 3-6mo with a fever >39 = ADMIT TO HOSPITAL irrespective of other signs (even if otherwise well)
,Fever with no other localising symptoms Meningitis, UTI, LRTI (less common)
Child with a Cough
1. Introduce + Name/Age/Occupation + Child name/age
2. PC
3. When did it start? Anything like this before? Suddenly or gradually? Getting worse? Any fever?
4. Cough:
a. What does it sound like? Barking?
b. Bring up anything?
5. SOB:
a. Difficulty with breathing?
b. In drawing of chest?
6. Wheeze?
7. Other:
a. Runny nose?
b. Grunting?
8. Paeds Hx (Anyone at home with similar, affected school, CA(r)HO, Preg, Neonate Now,
Growth/Milestones/Immunisations, ICE, PMH/FH/DH/SH
, Enuresis UTI, DM, Constipation, Primary enuresis (stress, abuse, behaviour problems)
1. Introduce + Name of adult + Relationship to child + Name/Age/Year in school of child
a. >5 GIRLS, >6 BOYS.... 5+ any age (new guidelines)
2. PC
3. HPC
a. How long been going on for?
b. Has child ever been continent for >6mo? (Primary vs Secondary)
c. Does it occur at day or night?
d. Where does it occur? (school, home, friends, or anywhere)?
e. How many times in a week does it happen, and how many times in an average night?
f. How much volume does he lose?
g. UTI Any frequency, urgency, burning, dysuria, haematuria? Abdo pain? Any fever? Vomiting?
h. DM Recurrent infections? Excessive urination during day? Excessively thirsty? Wt loss? Tired?
i. Constipation Any constipation?
j. Primary enuresis Any stresses with child or at home? Any behaviour or emotional problems?
Does child drink caffeinated drinks?
11. Paediatric Questions:
a. About illness:
i. Before - Has this happened before?
ii. Siblings - Any siblings at home with same/similar thing?
iii. School - Has it kept child from school?
b. General wellbeing (if no fever, ask about eating, drinking, sleeping, playing, general
wellbeing)
i. C Pale or blue?
ii. A:
1. Playing? Active and alert or floppy?
2. Sleeping well?
3. Abnormal cry?
iii. R
1. Struggling to breath?
2. Any coughing, runny nose or noises when breathing?
iv. H
1. Eating and drinking well? Wet nappies + passing stool?
v. O:
1. Rashes, neck stiffness, photophobia?
2. Vomiting or diarrhea? Weight loss?
c. Child’s history (mainly for young children):
i. Obstetric:
1. Any illness during pregnancy? Scans + tests normal? Any issues?
2. Gestational age at birth? Prolonged labour? Mode of delivery + any tools?
ii. Baby:
1. Neonatal Any problems after birth? – spina bifida
2. Child:
a. Developmental milestones? (ASK to see child’s red book for growth +
development – assess FTT)
b. Immunisations?
a. Currently School
History
1. History + Demographic (name, age, year of school) + Identify relationship of adult
2. PC + “IS THERE ANY FEVER?”
3. HPC
a. Fever How hot? How was it measured? (Ask CARHO as per below)
b. SOB When did it start? Episodes before? Sudden or gradual? Getting worse? Indrawing of chest? Grunting? Feeding? (CARHO)
c. Cough
i. When did it start? Episodes before? Sudden or gradual? Getting worse?
ii. What does it sound like (whoop, bark, etc)? Worse at day or night?
iii. Bronchiolotis (<2yr), Croup (>2yr), Whooping cough (non-immunised), Pneumonia (any age)
d. D+V:
i. D How many times passed stool? Loose + watery or fully formed? Any blood, mucus, tummy pain?
ii. V How many times vomited? Related to meals? Projectile? What colour/any blood?
iii. Weight loss? Abdominal pain? Foreign travel? Fever? Loss of weight/appetite? Yellow eyes?
e. Constipation (NICE Guidelines history) CF, Hirsch, Spinal cord, Obstruction, Drugs, Dehydration/Immobility/Low Fibre
i. Since birth or after birth? (from birth = bad sign not indicative of idiopathic constipation [which is usually benign])
ii. Meconium delay? (delay = probable underlying pathology – CF/Hirsch)
iii. Ribbon stools? (bad sign)
iv. Weakness of legs or problems walking? (?Spinal cord)
v. Abdominal bloating/distension + vomiting? (obstruction, etc)
f. Seizures:
i. Before Ever happened before? How was child prior? Fever? Lights flashing? Head injury?
ii. During Moving/limbs jerking? Tongue biting? Incontinence? LoC? How long for? Blue around lips?
iii. After Sleepy/drowsy? Headache?
4. Paediatric Questions:
a. About illness:
i. Before - Has this happened before?
ii. Siblings – Anyone at home or around child with same/similar thing?
iii. School - Has it kept child from school?
b. Febrile Child Assessment (no fever= ask eating/drinking/sleeping, general wellbeing)
i. C Pale or blue?
ii. A:
1. Playing? Active and alert or floppy?
2. Sleeping well?
3. Abnormal high pitched cry?
iii. R
1. Struggling to breath? In drawing of chest? Any GRUNTING noises?
2. Any coughing, runny nose or noises when breathing?
iv. H
1. Eating and drinking well? Wet nappies + passing stool?
2. Skin look dry?
v. O:
1. Rashes, neck stiffness, photophobia?
2. Seizures/FITS?
3. Vomiting or diarrhea? Weight loss?
c. Child’s history (mainly for young children):
i. Obstetric:
1. Any illness during pregnancy? Scans + tests normal? Any issues?
2. Gestational age at birth? Prolonged labour? Mode of delivery + any tools?
ii. Neonate Any problems after birth?
iii. Child:
1. Growing well (red book) – HEIGHT AND WEIGHT?
, 2. Milestones? (ASK to see child’s red book for growth + development – assess
FTT)
3. Immunisations?
iv. Currently School
d. ICE + Impact on life (really important)
5. PMH
6. PSurgHx
7. FH
8. DH + allergies
9. SH:
a. HOME Who is at home? Pets? Anyone smoke? Who looks after when at work?
b. SCHOOL How is school? Performance? Friends?
10. Request
a. Full Examination of relevant system including ENT, Resp, Cardio, GI
b. Obs + NICE traffic light assessment, Red book
c. Urine dip (occult UTI – must rule out)
Common paeds complaints: Headache, fits, respiratory, GI, bedwetting, rash
NB: Any Fever in <18mo = Meningitis, Pneumonia, UTI (don’t forget these)... consider foreign body with wheeze
CARHO Green Yellow Red
Low Risk Medium Risk High Risk
Colour Normal Pale Pale/Blue
Activity Responds normally Not responding normally Unresponsive
Playing Smiling + Playing ↓activity Barely rousable
Sleeping Strong cry Weak, high-pitched cry
Floppy
Respiratory Normal Nasal flaring Grunting
↑RR Severe distress (High RR or
↓Sats recessions)
Lung sounds
Hydration Normal Dry membranes Reduced skin turgor
(Drinking/urine) Poor feeding
(Feeding) Poor urine production
Cap refill >3sec
Other Normal Fever >5d Meningism (rash, neck stiff,
bulge font, photophob, fever)
(Meningism) Bile-stained vomit
Seizures/focal neurology
Management Manage at home Hospitalise
Give Calpol Ix: Blood, urine, CXR, ?LP (if Hx/Px dictate)
Check on child often Rx: Immediate Abx, consider paracetamol (if child distressed w/ fever)
Offer regular feeds (inc breast)
New symptoms/not better, seek help
NB: ↑Heart rate is earliest sign of pathology!
Any child <3mo with a fever >38 = ADMIT TO HOSPITAL irrespective of other signs (even if otherwise well)
Any child 3-6mo with a fever >39 = ADMIT TO HOSPITAL irrespective of other signs (even if otherwise well)
,Fever with no other localising symptoms Meningitis, UTI, LRTI (less common)
Child with a Cough
1. Introduce + Name/Age/Occupation + Child name/age
2. PC
3. When did it start? Anything like this before? Suddenly or gradually? Getting worse? Any fever?
4. Cough:
a. What does it sound like? Barking?
b. Bring up anything?
5. SOB:
a. Difficulty with breathing?
b. In drawing of chest?
6. Wheeze?
7. Other:
a. Runny nose?
b. Grunting?
8. Paeds Hx (Anyone at home with similar, affected school, CA(r)HO, Preg, Neonate Now,
Growth/Milestones/Immunisations, ICE, PMH/FH/DH/SH
, Enuresis UTI, DM, Constipation, Primary enuresis (stress, abuse, behaviour problems)
1. Introduce + Name of adult + Relationship to child + Name/Age/Year in school of child
a. >5 GIRLS, >6 BOYS.... 5+ any age (new guidelines)
2. PC
3. HPC
a. How long been going on for?
b. Has child ever been continent for >6mo? (Primary vs Secondary)
c. Does it occur at day or night?
d. Where does it occur? (school, home, friends, or anywhere)?
e. How many times in a week does it happen, and how many times in an average night?
f. How much volume does he lose?
g. UTI Any frequency, urgency, burning, dysuria, haematuria? Abdo pain? Any fever? Vomiting?
h. DM Recurrent infections? Excessive urination during day? Excessively thirsty? Wt loss? Tired?
i. Constipation Any constipation?
j. Primary enuresis Any stresses with child or at home? Any behaviour or emotional problems?
Does child drink caffeinated drinks?
11. Paediatric Questions:
a. About illness:
i. Before - Has this happened before?
ii. Siblings - Any siblings at home with same/similar thing?
iii. School - Has it kept child from school?
b. General wellbeing (if no fever, ask about eating, drinking, sleeping, playing, general
wellbeing)
i. C Pale or blue?
ii. A:
1. Playing? Active and alert or floppy?
2. Sleeping well?
3. Abnormal cry?
iii. R
1. Struggling to breath?
2. Any coughing, runny nose or noises when breathing?
iv. H
1. Eating and drinking well? Wet nappies + passing stool?
v. O:
1. Rashes, neck stiffness, photophobia?
2. Vomiting or diarrhea? Weight loss?
c. Child’s history (mainly for young children):
i. Obstetric:
1. Any illness during pregnancy? Scans + tests normal? Any issues?
2. Gestational age at birth? Prolonged labour? Mode of delivery + any tools?
ii. Baby:
1. Neonatal Any problems after birth? – spina bifida
2. Child:
a. Developmental milestones? (ASK to see child’s red book for growth +
development – assess FTT)
b. Immunisations?
a. Currently School
