Paediatric history

Clarify symptoms, feeding/hydration, urine/stools, baseline function, immunisation, birth history, medicines, allergy, development and parental concern.

• Clarify the presenting complaint, onset, course, previous attendances, treatments tried, and effect on school and activities.
• Ask about feeding and hydration, wet and dirty nappies, work of breathing, rash, vomiting, fever and weight change.
• Ask about milestones, regression, communication, sleep, nutrition, screen time and toileting; formal tools such as PEDS or Brigance may be used^1,2.
• Check immunisation status against the Australian Immunisation Register or the child health record rather than parent recall alone.
• Adolescents: use a HEEADSSS interview in private⁶.
• Opening well: ask what they think is wrong, why they came today, and what they fear it might be; a hidden worry (for example a friend's child recently diagnosed with leukaemia) often explains the visit. Use open questions, let them finish the story, and ask when the child was last completely well. The order in which symptoms evolved is often diagnostic⁹.
• Check shared meaning: parents may say diarrhoea for loose but infrequent stools, or bile for yellow rather than truly green vomit; words like wheeze or croupy may mean something different to them. Avoid jargon (say blue, not cyanosed)⁹.
• Birth and early history: gestation, labour problems, mode of delivery, condition at birth and any resuscitation, birth measurements, and the first weeks. Simple probes such as whether the mother could hold the baby straight away and how soon they went home can uncover problems. This stays relevant in older children with neurological or developmental concerns⁹.
• Growth: plot birth and earlier measurements on centile charts to see both size and whether the child is tracking along a centile; take a typical day's food intake⁹.
• Development screen: ask about gross motor, fine motor and adaptive, language and hearing, and personal-social skills. In older children ask how they compare with siblings and peers at school, and what they enjoy and are good at⁹.
• Medicines: include over-the-counter and complementary remedies, which parents often forget or are reluctant to mention⁹.
• Family and social context: who lives at home and who does most of the caring, whether the child moves between households, childcare or school, parents' work and finances, smoking at home, and distance from hospital or transport. A quick family tree is very informative⁹.
• Closing: ask whether anything else is worrying them, or anything you have not asked about⁹.
• Practical tips: observe the child playing and interacting before the formal history; stranger anxiety is common from about 8 months to 5 years; young children tire after about 30 minutes, so complex problems may need more than one visit; use an interpreter when needed⁹.
• Full history template (PC, HPC, PMHx, medications, allergies, birth history, immunisations, nutrition, nappies, development, family history with genogram, psychosocial, HEEADSSS, systems review) and symptom-based differential lists:
  PC

  • “So, what’s brought your child in today?”
  • “What’s brought you in today?”
  HPC

  • 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 so far and what treatments have been tried?
  • Have there been similar episodes in the past?
  • Does anything seem to make the problem better or worse?
  • Do you have any photographic or video evidence (e.g. seizure)?
  • SOCRATES
    • seasonal variation
    • effect on normal activities (school, sport)
  PMHx

  Medical conditions

  Ask if the child has any medical conditions:

  • “Does your child have any medical conditions?”
  • “Are they currently seeing a doctor or specialist regularly?”

  If the child does have a medical condition, you should gather more details to assess how well controlled the disease is and what treatment(s) the child is receiving. It is also important to ask about any complications associated with the condition including hospital admissions.

  • Injuries
  • Childhood infectious diseases

  Surgical history

  Ask if the child has previously undergone any surgery or **procedures **(e.g. heart valve replacement, appendectomy):

  • “Has your child ever previously undergone any operations or procedures?”
  • “When was the operation/procedure and why was it performed?”
  Medications

  Ask if the child is currently taking any prescribed medications or over-the-counter remedies:

  • “Is your child currently prescribed medications or are you giving any over-the-counter treatments?”
  • Compliance /resistance to medication

  If the child is taking prescribed or over the counter medications, document the medication name, dose, frequency, form and route.

  Allergies

  Ask if the child has any **allergies **and if so, clarify **what kind of reaction **they had to the substance (e.g. mild rash vs anaphylaxis).

  Birth Hx

  • Prenatal (antenatal)
    • Planned pregnancy?
    • antenatal care
    • Illnesses or medical problems during pregnancy?
    • Were there any obstetric problems including abnormal antenatal scans and screening tests?
    • exposure to smoking, alcohol, drugs
    • Were any medications taken during the pregnancy?
  • Birth
    • Were there any concerns during delivery or interventions required? APGAR? resus needed?
    • breathing problems, feeding problems, jaundice?
    • What was the child’s gestation and birthweight? duration of labour?
  • Neonatal
    • Mother’s health post natal (PND)
    • Did the child require admission to a special care baby unit and if so, for what reason?
  Immunisations

  • Is the child up to take with their immunisations?

  Ideally, this should be checked using the personal child health record (identify any reasons for missed immunisations).

  Nutrition

  • current feeding - breast-fed, fomula, solids?
  • growth normal?
  • feeding issues - typical day’s intake?
  Nappy

  • Wet nappies - quantity, amount
  • Dirty nappies - colour, amount, f, meconium passed?
  Development

  • Is the child currently growing along an appropriate weight and height centile?
  • Is the child meeting their developmental milestones?
  • Are there any concerns about the child’s development?
  FHx

  Ask if any family members or friends have recently experienced **similar symptoms **to those the child is presenting with:

  • “Has anyone else in the household had a fever recently?”

  Ask about conditions which appear to run in the family and clarify who has been affected:

  • “Are there any conditions which appear to run in the family?”
  • “Who has been affected by these conditions?”

  If one of the child’s close relatives are deceased, sensitively determine the age at which they died and the cause of death:

  Stillbirths, miscarriages, deaths of siblings

  • “I’m really sorry to hear that, do you mind me asking how old his brother was when he died?”
  • Genogram

  

  Psychosocial Hx

  Explore the child’s general social context to gain a more complete picture of their wellbeing including:

  • who lives with the child, safety at home, parental employment
  • the relationship status of the parents/carers
  • what** type of accommodation** the child is living in
  • the child’s preferred play or leisure activities
  • the child’s happiness at home
  • the child’s happiness at school/**nursery, academic progress **
  • the smoking status of the parents and anyone else living with the child
  • the impact of the child’s illness on the family
  • Family support

  -

  Social services involvement

  Ask if the child is currently under the care of social services, subject to a **child protection plan **or has previously had social services involvement:

  • “Are social services currently involved with the care of your child?”
  • “Is a child protection plan currently in place?”
  • “Have you ever had input from social services?”
  HEEADSSS

  Home and relationships

  Key questions include:

  • Who lives at home with you?
  • Do you have your own room?
  • Who do you get on with best and/or fight with most?
  • Who do you turn to when you’re feeling down?

  Education and employment

  Key questions include:

  • Are you in school/college at the moment?
  • Which year are you in?
  • What do you like the best/least at school/college?
  • How are you doing at school?
  • What do you want to do when you finish school/college?
  • Do you have friends at school?
  • How do you get along with others at school?
  • Do you work? How much?

  Eating

  Key questions include:

  • Are you worried about your weight or body shape?
  • Have you noticed any change in your weight recently?
  • Have you been on a diet?

  Activities and hobbies

  Key questions include:

  • How do you spend your spare time?
  • What do you do to relax?
  • What kind of physical activities do you do?

  Drugs, alcohol and tobacco

  Key questions include:

  • Does anyone smoke at home?
  • Lots of people your age smoke, have you been offered cigarettes? How many do you smoke each day?
  • Many people start drinking alcohol around your age, have you tried or been offered alcohol? How much/how often?
  • Some young people use cannabis, have you tried it? How much/how often?
  • What about other drugs, such as ecstasy and cocaine?

  Sex and relationships

  Key questions include:

  • Are you seeing anyone at the moment?
  • Are they a boy or a girl?
  • Young people are often starting to develop intimate relationships, how have you handled that part of your relationship?
  • Have you ever had sex?
  • What contraception do you use?

  Self-harm, depression and self-image

  Key questions include:

  • How is life going in general?
  • Are you worried about your weight?
  • What do you do when you feel stressed?
  • Do you ever feel sad and tearful?
  • Have you ever felt so sad that life isn’t worth living?
  • Do you think about hurting or killing yourself?
  • Have you ever tried to harm yourself?

  Safety and abuse

  Key questions include:

  • Do you feel safe at school/at home?
  • Is anyone harming you?
  • Is anyone making you do things that you don’t want to?
  • Have you ever felt unsafe when you’re online or using your phone?
  Systems Review

  • Behaviour: ask if the child appears to be their usual self, including their level of activity, mood and social interaction.
  • Fever: ask if the child has had a fever recently and if this was confirmed with a thermometer.
  • Eyes
  • Coryzal symptoms: ask if the child has recently had a runny nose, or sounded ‘sniffly’.
  • Cough: ask if the child has a cough and if they are bringing up any sputum with it. Gain further details about the frequency of the cough, including associations with particular triggers or times of the day (e.g. nocturnal cough).
  • **Throat **
  • Dietary intake: clarify what the child’s baseline dietary intake is and, if relevant, how this has changed recently.
  • Fluid intake: calculate the child’s fluid intake over the last 24 hours.
  • Vomiting: if the child has been vomiting, determine the frequency, volume and consistency of the vomit (e.g. bilious, haematemesis). Ask specifically about projectile vomiting if considering pyloric stenosis as an underlying diagnosis.
  • Work of breathing: ask if the child’s breathing has appeared more laboured recently.
    • Grunting, flaring, retractions
  • Rash: ask if the child currently has a rash, including its location, whether it appears to be spreading and if it appears to be itchy.
  • Urine output: ask if there has been any change in the child’s urine output (in younger children, ask if there has been a change in the number of wet nappies).
  • Stool: ask about the recent frequency and form of the child’s stools.
  • Weight change: ask if the child appears to be gaining weight at an appropriate rate and review growth charts if available.
  Developmental delay

  • Global developmental delay (DS)
  • Non-specific developmental delay
  • ASD/ADHD
  • Isolated speech and language delay
  • Cerebral Palsy (hypertonia) - brain injury/malformation prenatal, birth or postnatal complication
  • Muscular dystrophy (progressively worse, muscles cannot produce protein for healthy muscle mass , genetic)
  • Undiagnosed syndrome
  • Delayed motor maturation (familial)
  GI upset

  • Intussusception
  • Strangulated inguinal hernia
  • Gastroenteritis
  • Appendicitis
  • Pyloric stenosis
  Jaundice

  • Breast feeding jaundice
  • Breast milk jaundice
  • Biliary atresia
  • Bruises
  • Hypothyroidism
  • Cholecystitis (CF)
  • Blood cell disease - sickle cell, G6PD-def
  • Infection - HSV, sepsis
  Seizure (jerky/unusual movements, stiff/tight muscles)

  • febrile convulsions
  • non-epileptic seizures
  • childhood epilepsy
  • meningitis - bacterial
  • viral encephalitis
  • rubella
  • blood sugar/electrolyte abnormalities
  Rash (cough, flue sympyoms, HEENT)

  • Measles
  • Chickenpox
  • Rubella
  • Scarlet fever
  SOB + (wheeze, breathlessness and chest tightness)

  • asthma (bronchiolitis)
  • Viral induced wheeze
  • LRTI (pneumonia)
  • viral illness
  • allergic rhinitis
  • CF
  Tired + GI symptoms

  • coeliac disease
  • Drugs (IV Abx)
  • IBS
  • IBD
  • T1DM (DKA)
  • Chronic pancreatitis
  • Liver disease
  URT symptoms

  • croup (larynx, trachea)
  • asthma
  • recurrent viral bronchitis
  • inhaled foreign body
  • tracheo-oesophageal fistula
  • catarrhal child syndrome (postnasal drip following an acute resp infection and allergic rhinitis)