hx taking of peadiatrics

8/17/2019 Hx Taking of Peadiatrics

1/5

Name of the child: Nickname:

Date of birth: Age:Gender: Boy / Girl

Hospital ID: Race: Date

of clerking: Date of admission: Date of

discharge: Address:

Schooling Age:

!" #hief complain :

History of presenting Illness:

GIT$ / % Appetite&omittingloose stools /constipation'Ho( many stools aday'colo)r ? 'fo)l smell

abdominal pain *a)ndiceabdominal distensionpostprandial h)rry+erianal rednessAbdominal pain(eight loss / gain'Ho( m)ch,ail)re to thri-e

Genitourinary system+assing )rine' ho( many times' .)antity same/dierent' colo)r'smell'Appearance of )rine clear / clo)dy+ainf)l )rination / cries

(hile passing )rineBed(etting / toilettrained

Hematologicalsystem+allor

Neurological systemHeadache+hotophobiasei1)resAbnormal mo-ements2nsteadiness3

4remorsDro(siness

loss of conscio)sness /syncope limp 56oppy"&is)al problemsSti DiplopiaS7)int8o-ement of lips toone side (hile cryinghearing

Nasal reg)rgitation3 4orticollis

MSSK +ain / s(elling of

*oints9 spine or bones2nable to mo-ing alimbGait dist)rbance

#rying on mo-ingthe limbs / onhandling

SkinRashesS(elling/s

" Re-ie(s of symptomsCVSHeart 8)rm)r#HD#yanosis of lips/tong)e/nails/ skins/e;teremities$s(eatingpalpitation3e;ercise tolerance3

s)ck'pa)se's)ckcycle / feeding less /takes longer to feed3breathlessness d)ringfeed or play#o)gh / (hee1e/ stridorchest recessions

ENT


2/5

Known to hae!ronchial asthma"#sthma since the age of

>>>>>>>>

>>>> (eeks

8edications:

>>>>>>>>>>>>>>>>>

$ast e%iso&e ofasthma on: >>>>> Home/ Hospital

treatment

Current condition (ell

,e-er

?hee1ing

#o)gh R)nny nose

Shortness ofbreath

Getting better /(orse thanbefore

History o' Noct)rnal co)gh

,re7)ency >>>>>>>>>

Allergiccon*)ncti-itis

Allergic rhinitis >>>>>>> days / year

Home an& liingenironment Smoker in the

ho)se B)rn r)bbish near

ho)se +ets / neighbo)rs

pet

Birds / chickenfarm

Ho)se nearroadside /7)arry/factories

#onstr)ctionnearby

Reno-ating ho)se

8os7)ito coil /electric mat

Insecticide sprays

Bakh)r / incensef)mes

Generators

,an cleaningonce in ''days

Air conditionerClter cleaning

#arpets

,)rry toys

,a-o)rite pillo( Garden

Grass ,lo(ering plants 4ype of mattress #hanging bed

sheet once indays

#lean the ho)se)sing mop/broom/ -ac))m

Schoolen-ironment:

Nearroadside/7)arry/factories


3/5

'" (ast Me&ical H*If yesS@#

RA 4<

S

(ast Surgical H*'?hat'?hen'?hy

'Any diEc)lty

F" Me&ication#)rrent: +ast:

" #llergy H*Dr)gs:,ood:@thers:

" H* s%eci+c to(ea&iatrics+renatal H;'+arents age:

'Accidental/ +lannedpregnancy

'4erm/+reterm/+ost term ?eeks ofgestation' #heck )p (hen:' 4akes medication:folic acid/Iron/ other:' Imm)nisationtetan)s to;oid /'H; of fe-er (ith rash : /N

Vomitting'onset'colo)r:' has fo)l smelling/ Not'fre7)ency:

)eer' J#5Ko( grade/ High gradefe-er"'onset'+attern Intermittent /contin)o)s / Relie-ed byantipyretic'Intensity'Associated symptomsR)nny nose/ #o)gh / Soretro)t / headache/ chills/Rigor/,it

others:'D)rationDs/ (k

Date:'Di)rnal Day / Night'Any ,amily members hadfe-er recently'Dist)rbed Sleep'


4/5

'complete/ IncompletecycleIf not yet3?hen ne;t appointment:

?here?ith',ollo( sched)le/ ; 'Any H; of fe-er/ rashes/itchy after immn)nisation

,eelo%mental history- )se de-0 #hart

MM" )amily H*'predigree chart'Name3 age3

gender3occ)pation3 illness

Neonatal H* .+rst /weeks o' li'e0

a)ndiceSei1)res+hototherapy


5/5

(eri%hery to centre:E*tremities:Han&s 1 'eet:'skin is (arm / cold' colo)r 5pale3 cyanosed3 *a)ndiced "' cl)bbingrashes

s(ellingfeat)res of infecti-e endocarditiscapillary reCll timepedal oedema in a (alking childsacral oedema in infants / bed'ridden children

Hea&:Dysmorphic feat)res3B)lgesanterior / posteriorfontenelles)t)rescraniotabes /transill)minations)bc)taneo)s nod)lesEyes:pallorin*ection ofcon*)ncti-a

*a)ndice3redness

eyelid s(ellingStyechala1ion3discharge

ENT an& mouth nasal / ear dischargehypertrophied terbinatesredness of throat3m)cosa of mo)th

4onsilitis)-)la3+etichiae)lcers / bleeding inside themo)th or g)mkoplik spots in s)spectedmeaslescyanosisstate of g)m / teethn)mber of teeth

Any otoscopic CndingsSkin(u!ertal assessment in a&olescents(rimitie re2e*es in neonates an& in'antsNeurocutaneous markers

Socioeconomic history'

hx taking of peadiatrics

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