INTRODUCTION TO PEDIATRICS - National University to paediatrics .pdf · 19 Review of Systems:...

INTRODUCTION TO PEDIATRICS

By Assoc. Prof. Elamin Osman Sidahmed

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THE HEALTH PROBLEMS OF CHILDREN ARE DIFFERENT

FROM THOSE OF ADULTS.

HEALTH PROBLEMS ARE CHANGING WITH TIME

INFORMATION RELATED TO CHILD HEALTH DOUBLE

EVERY 8 YEARS

SUPER SPECIALIZATION WITHIN PEDIATRICS

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The health problems are different in different

regions because of:

_ Prevalence and ecology of infectious agents and

their hosts

_ Climate

_ Educational, economic and cultural consideration

_ Gene frequencies

Gen. Objective of Pediatrics Course

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To develop responsible and compassionate

behavior

To develop communication skills

To appreciate the role of perfect understanding of

basic sciences

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To be aquainted with epidemiological profile

To attain knowledge and skills necessary to maintain

the health and identify problems of child health

(esp emergencies)

To interact with the health team

Specific Objectives6

1. To practice communications with pts,

parents and team members

2. To develop clinical skills

3. To IDENTIFY Emergency ped. Conditions

4. To be aware of Neonatal problems

5. To know Post neonatal, infancy and

preschool child problems

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Also to know:

7. Puberty and adolescence problems

8. Non-age related disease

9. Chronic and malignant disease

10. Essential drugs used in pediatrics practice (WHO list)

Log Book Requirements8

1. Communication skills

2. History taking

3. Physical examination

4. Specific skills

Educational Strategies and Methods

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11 weeks course (1/1/2017 -17/3/2016)

Evaluation and Assessment methods:

-10% for continuous evaluation: (Attendance, case

presentation and contribution in seminars, night duties )

- IMCI

- Log book record of skills

- 10% for mid term exam.

- 80% for final exam.:

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The 80% is divided as follows:

30% Theoretical exam. (Single correct answer,

Problems, OSPE)

50% Clinical exam. – (OSCE)

Clerkship:

Student and Staff discussions

Questionnaire (evaluation)

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Children are at higher risk for different health

problems in different age groups (neonates, young

infants, infants, children and adolescents)

Children are more prone to accidents, zoonosis and

complications of congenital problems

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PEDIATRIC HISTORY & PHYSICAL EXAM

(CHILDREN ARE NOT JUST LITTLE ADULTS)

-HISTORY-

Learning Objectives:

1. To understand the content differences in obtaining a medical history on a pediatric patient compared to an adult.

To understand how the age of the child has an impact on obtaining an appropriate medical history.

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2. To understand the appropriate wording of

open-ended and directed questions, and

appropriate use of each type of question.

3. To develop an awareness of which clinical

settings it is appropriate to obtain a complete

medical history compared to a more limited,

focused history.

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ASSESSMENT AND INTERVIEWING OF SICK

CHILD

HISTORY TAKING

SETTINGS:

relaxation

privacy

Communication:

non-verbal

verbal

GENTLENESS, RESPECT, UNDERSTANDING,SYMPATHY and KINDNESS

•IDENTIFICATION17

INFORMANT

NAME of pt.

AGE of pt.

RESIDENCE

TRIBE

PRESENTING PROBLEMS18

CHIEF COMPLAINTS

SEQUENCE

DURATION

HISTORY OF PRESENT ILLNESS

SYSTEMIC REVEW:

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Review of Systems: (usually very brief for infants and

younger children)

A. Weight - recent changes, weight at birth

B. Skin and Lymph - rashes, adenopathy, lumps,

bruising and bleeding, pigmentation changes

C. ( Head, Eye, ENT)- headaches, concussions, unusual

head shape, strabismus, conjunctivitis, visual problems,

hearing, ear infections, draining ears, cold and sore

throats, tonsillitis, mouth breathing, snoring, apnea,

oral thrush, epistaxis, caries

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D. Cardiac - cyanosis and dyspnea, heart murmurs, exercise

tolerance, squatting, chest pain, palpitations

E. Respiratory - pneumonia, bronchiolitis, wheezing, chronic

cough, sputum, hemoptysis, TB

F. GI - stool color and character, diarrhea, constipation,

vomiting, hematemesis, jaundice, abdominal pain, colic,

appetite

G. Renal - frequency, dysuria, hematuria, discharge,

abdominal pains, quality of urinary stream, polyuria, previous

infections, facial edema

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H. Musculoskeletal - joint pains or swelling, fevers,

scoliosis, myalgia or weakness, injuries, gait

changes

I. Pubertal - secondary sexual characteristics,

menses and menstrual problems

J. Allergy - urticaria, hay fever, allergic rhinitis,

asthma, eczema, drug reactions

DEVELOPMENTAL HISTORY22

PREGNANCY (MOTHER)

DELIVERY

PERINATAL PERIOD

DEVELOPMENTAL mile stones

PAST HISTORY23

SIGNIFICANT DISEASE

NUTRITIONAL HISTORY24

BREAST FEEDING

SUPPLEMENTARY AND COMPLEMENTARY FEEDING

CURRENT FEEDING

DRUG HISTORY25

VACCINATION HISTORY26

FAMILY HISTORY AND SOCIAL HISTORY

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FAMILY HISTORY OF RELEVANT DISEASES

SOCIAL HISTORY

-PHYSICAL EXAMINATION-

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Objectives

1. To understand how the general approach to the

physical examination of the child will be different

compared to that of an adult patient, and will vary

according to the age of the patient.

2. To observe and demonstrate physical findings

unique to the pediatric population, and to

understand how these findings may change

depending upon the age of the child.

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Competencies :

1. To obtain accurate vital signs (Temperature, HR, RR, BP) in

a pediatric patient in different age groups and to be able to

evaluate these vital signs compared to age-adjusted

normals. To understand the normal variation in temperature

depending on the route of measurement.

2. To complete a thorough physical examination on

apediatric patient in different age groups.

Physical EXAMINATION30

APPROACH:

Gentle, reassuring and unhurried .

Follow the art of not missing an opportunity during exam but presentation should be systematic

Start with inspection ( least annoying)

Palpation

Percussion

Auscultation

Other instrumentation ( e.g. TONGUE DEPRESSER Otoscopy,Opthalmoscopy)

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INSPECTION32

General condition: posture, jaundice cyanosis,

palour, bruising, haematoma, malformation, hernia

Skull: hair, skull shape, size, fontanels, sutures other

signs

Face: dysmorphic features, hare lip, eyes, ears etc..

Hands, Feet, Spine

NUTRITION AND DEHYDRATION

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SIGNS: in eyes, mouth, fontanel, skin

Wasting

Oedema

General condition ( eg apathy)

CARDIORESPIRATORY SYSTEM

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Inspect for cyanosis, active alae nasi, precordium,

apex

Respiratory movement (symmetrical), signs of resp

distress

CNS35

Posture

Motor activity

Gait

Interaction, hearing, vision etc

ANTHROPOMETRIC MEASUREMENTS

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WEI

GHT WEIGHT

HEIGHT ( LENGTH)

HEAD CICUMFERENCE

MIDARM upper CIRCUMFERENCE (MUAC)

Resume examination37

Palpation (superficial, deep)

Percussion (not very usefull in neonates and young

infants)

Auscultation and using other instruments

Percussion

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Other physical examination manovers needed for

especial co

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Stethoscope for auscultation

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References42

Nelson Text book of pediatrics

Essentials of pediatrics

Diseases of children (Jolly)

Hutchison clinical methods

Cameron Pediatrics

Harriet Lane handbook

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THANKS