PAEDIATRICS: INTRODUCTION

Dr Simon Attard Montalto

History Presenting complaint

History of presenting complaint

Past history

Family history

Social history

Medication

Immunisations

Review of systems

Examination LOOK before touch

Newborn dysmorphism (3Hs) & palate

general & clavicles

respiratory

cadiovascular & femorals

abdomen & umbilicus

genitalia & anus

neurology, eyes & spine

limbs

Children as per adults!

non threatening

patience

Nutrition, growth & development

Nutrition

breast milk

formulae

weaning

deficiency states

Growth

normal growth

centiles

sexual maturation

Development

normal milestones

gross motor

fine motor

special senses

psychosocial

educational

Neonatology

Examination

Prematurity, low birth weight

Congenital anomalies

Respiratory diseases

Infections

Jaundice

Asphyxia, convulsions

Surgical problems

Respiratory disease

Infections - upper

- lower

Asthma

Cystic fibrosis

Congenital anomalies

Surgical problems

Cardiovascular disease

Examination - murmurs

- femorals

- BP

Congenital heart disease

Acyanotic - VSD

- ASD

- PDA

- Pul & aortic stenosis

- Coarctation of the aorta

Cyanotic - transposition of the great arteries

- Fallot tetralogy

Acquired heart disease

Heart failure

Arrhythmias

Digestive system

Abdominal pain

Vomiting & diarrhoea

Constipation

Diseases - Coeliac

- malabsorption

- Crohn’s

- ulcerative colitis

Liver - jaundice

- hepatitis

Neurological system

Congenital anomalies

Handicap & disability

Infection

Seizures

Headaches

Neuromuscular diseases

Urological system

Congenital anomalies

Infection

Proteinuria - nephrotic syndrome

- nephritis

Haematuria - calculi

Endocrine system

Stature - short

- excess

Puberty - normal

- abnormal

Thyroid disease - hypo

- hyper

Adrenal disease - hypo

- hyper

IDDM - hypo

- DKA

DI

Hereditary disease

Inheritance - recessive

- dominant

- X-linked

- multifactorial

Chromosomes: Down Edwards Patau Turner Klinefelter Fragile X

Inborn errors

Immunodeficiencies

Infectious disease

Immunisation

Bacterial - URTI & LRTI

- UTI

- meningitis

- septicaemia

Viral infection - URTI & LRTI

- measles, mumps, rubella

- varicella, herpes

- EBV, hepatitis

- HIV

Other infection - chlamydia

- mycoplasma

- Kawasaki disease

Haematology & Oncology

Anaemia - blood loss

- iron deficiency

- red cell defects

- abnormal haemoglobin

Coagulopathy - thrombocytopenia

- factor deficiencies

- DIC

Neoplasia leukaemia & lymphomas

brain tumours

sarcomas

neuroblastoma

nephroblastoma

Behavioural problems

minor - habits & tics

- breath holding & tantrums

- sleep disorders

- enuresis & encopresis

major - anorexia & bulimia

- ADHD

- autism

psychiatric - anxiety states & depression

- suicide & parasuicide

- psychoses

Social problems

- substance abuse

- accidental injury & ingestion

- non accidental injury & sexual abuse

Surgical problems

congenital anomalies - atresia

- malrotation (volvulus)

- Hirschsprung’s

- hernias

- neural tube defects

- urological anomalies

- genitals & gonads

acquired anomalies - meconium ileus

- pyloric stenosis

- appendicitis

- intussusception

Orthopaedic

congenital anomalies - CDH

- talipes

- dysplasias

- scoliosis

acquired anomalies - osteomyelitis & arthritis

- irritable hip

- Perthes & SUFE

- Juvenile chronic arthritis

- trauma & fractures

ENT

congenital anomalies - cleft lip & palate

- laryngo-tracheomalacia

acquired anomalies - foreign bodies