Paediatrics: Symptom review

Symptom review

If you haven’t done so already, you need to find out about the child’s general condition. Do they feel unwell, tired, or fatigued? The following list of questions can be used for further review, although it is not exhaus-tive. Some of these questions will have been covered in your assessment of the presenting problem, so there is no point repeating them. However, it is important that you tailor this part of the history to issues you think relevant to the child’s condition—particularly when you suspect multisys-tem disease.

Head

Is there a history of injury, headaches, or infection?

Eyes

·  How good is visual acuity—are glasses needed?

·  Is there a history of infection, injury, or surgery?

Ear, nose, and throat

·  Is there a problem with hearing or balance?

·  Is there a history of ear infection or discharge?

·  Is there any difficulty with breathing?

·  Is there a history of nasal discharge, snoring, or bleeding?

·  Are there any enlarged lumps or glands?

·  Is there a history of sore throat, dental problems, or mouth ulcers?

Chest

·  Is there any limitation to exercise?

·  Is there a history of cough, wheeze, chest pain, or haemoptysis?

·  Has there been any exposure to tuberculosis?

·  Has the child ever had a chest X-ray (CXR)?

·  Are there any smokers in the family?

·  Are there any smoke-free zones in the family accommodation?

Heart

·  Is there a history of heart murmur or rheumatic fever in the patient or family?

·  Is there a history of dyspnoea, orthopnoea, chest pain, or cyanosis?

Gastrointestinal

·  How good is the child’s appetite?

·  Have there been any recent changes in weight, food tolerance, or bowel movements?

·  Has there been any rectal bleeding?

Genitourinary

·Is there a history of infection?

·How frequent is urination?

·Is there any dysuria, or haematuria, or discharge?

·Is there a history of bedwetting?

·What was the age of menarche?

Joints, limbs, and tissue

·Is there any pain?

·Is there swelling or limitation in movement?

·Is there muscle weakness?

·Is there any difficulty walking or a limp?

Nervous system

·  Is there a history of fits, faints, or funny turns?

·Is there a history of febrile seizures?

·Are there any abnormal involuntary movements or tremors?

·How has the child being doing at school—has there been a recent change that has concerned the teachers or the family?

·Is there a history of hyperactivity?

Skin

·  Is there a rash?

·  Are there any birthmarks or unusual marks on the skin?