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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