pediatric

• Medical history


  An accurate and complete medical history should be taken directly from the patient or a member of the patient's family, as it is main for correct diagnosis
• Systematic approach to medical history

  1. Mandatory

  2. Clinician must be alert to significant clues that may prove essential to the diagnostic process

  3. Process of identifying a differential diagnosis should begin at the outset of questioning
• Fundamental pathologic processes


  • Infectious
  • Traumatic
  • Metabolic
  • Endocrinologic
  • Toxic (exogenous and endogenous)
  • Congenital
  • Structural malformations
  • Vascular
  • Neoplastic
  • Degenerative
  • Idiopathic
• Infectious


  The important clue is the fever
• Metabolic


  Clues can be metabolic acidosis, hypogycemia and also the relationship history between mother and father
• Endocrinologic


  Encephalopathy caused by hypothyroidism
• Toxic


  Poisoning caused by the stove
• Congenital


  Atipic facies, microcephaly are important findings
• Structural malformations


  Rezistant seizures, microcephaly or macrocephaly
• Vascular


  • Sudden loss of consciousness, headache may indicate brain hemorrhage
  • Suddenly develop fokal weakness may suggest cerebral infarction
• Neoplastic


  Weight loss, headache, vomiting
• Degenerative


  • Usually of unknown or obscure cause
  • Regression of the patient's motor development steps
• Idiopathic


  Unknown cause
• Review of past medical and developmental histories is an essential component of a good history-taking session
• Prenatal period history


  1. Information should be sought from records and from questioning the mother about health problems, including infertility, and diseases that occurred during pregnancy

  2. It is important to ask whether conception was achieved naturally and, if not, what method of assisted reproductive technology was employed

  3. Gestational information about infection, radiation, acute trauma, chronic illnesses such as diabetes mellitus, and toxins, including illicit drugs, smoking and alcohol, should be acquired

  4. Further information about medications that the mother received, including over-the-counter preparations, should be probed

  5. Review of birth records, including prenatal and delivery records of the mother, may reveal information concerning difficulties with pregnancy and problems in the perinatal period

  6. Details of the intrapartum period, including associated hypertension, drugs administered, length of stages of delivery, occurrence of chorioamnionitis, and if possible, information concerning placental pathology may contribute to diagnosis

  7. It is important to determine the status of the newborn infant

  
• Natal period history


  1. It is essential that an adequate family history be recorded

  2. Ages of siblings (including those who have died and those aborted), parents, grandparents, uncles, and aunts should be available

  3. It is particularly helpful to gain health history details of siblings and relatives
• Family members suffering or who have suffered from

  • Ataxia
  • Blindness
  • Cerebral palsy
  • Deafness
  • Dementia
  • Mental retardation
  • Movement disorders
  • Seizures
  • Weakness
• Chief complaint


  • The primary problem of the child
  • A combination of chief complaints may prove more specific and narrows the diagnostic spectrum
• Determining onset and course of symptoms

  1. Is the process acute or insidious?

  2. Is it focal or generalized?

  3. Is it progressive or static?

  4. At what age did the problem begin?

  5. The presence of repeated episodes or associated phenomena should be determined
• Patterns of onset and courses of neurologic conditions

  • Sequelae of traumatic events develop over a period of minutes to a day
  • Cerebrovascular events normally develop over minutes to hours, the underlying process may be long-standing
  • Degenerative diseases and neoplastic conditions usually progress over weeks or months
  • Infectious processes, electrolyte imbalances, and toxic processes (endogenous or exogenous) usually reach their zenith within a day to several days
  • Inborn metabolic disorders usually progress insidiously over weeks or months or years
• Focal vs generalized conditions

  • Focal neurologic lesion in the brainstem may cause ipsilateral cranial nerve and contralateral corticospinal tract involvement
  • Neoplastic and vascular diseases frequently result in focal processes, sometimes trauma results in such abnormalities
  • Generalized or multifocal conditions are usually associated with degenerative, congenital, metabolic, or toxic abnormalities
• The clinician should not substitute medical terminology in place of the terms used by parents or patient when recording the chief complaint
• Developmental history


  1. The history should include steps of motor milestones and should contain specific information regarding motor, language, and adaptive-social behavior

  2. In progressive conditions, documentation of increasing loss of normal function or an increase in any symptoms is essential

  3. The clinician should ask specific questions regarding the age of attainment of developmental landmarks

  4. The clinician should make every attempt to discern whether the child is delayed in many areas of development or has developed normally in some areas but not in others
• Developmental delays


  • Children who have normal motor development but also have hearing impairment may have delayed speech
  • The presence of neuromuscular disease may cause obvious retardation of motor development but may allow normal development of social and language skills
• One of the best ways you can help people stay healthy and strong is by understanding their medical histories
• When you understand and document an individual's medical history, you help to assure that you provide the most proper and effective treatment
• History taking is especially important for making a correct diagnosis
• Normal neurological development in children

  • Rapid changes in the gaining of development skills and responses based on maturation of physiologic processes and anatomic structures of the developing central and peripheral nervous systems
  • Visual, sensory, and motor pathways are the most rapidly evolving in the first year of life
  • Bases of social communication and language are also becoming more organized and sophisticated with each passing month
• Neurologic assessment


  Comparing the results of the infant's examination with established norms
• Developmental reflexes


  • Patterned responses that are ontogenetically determined at certain ages
  • Represent maturational stages of the developing nervous system
  • Can be helpful in assessing neurologic development
• Abnormal findings include the absence or poor manifestation of the expected response, persistence of a reflex that should have disappeared, or an asymmetric response
• Palmar grip


  • Age at disappearance: 6 months
• Plantar grip


  • Age at disappearance: 12-15 months
• Moro reflex


  • Age at disappearance: 6 months
• Asymmetric tonic neck reflex

  • Age at disappearance: 3 months
• Babinski reflex


  • Sign of a problem in the central nervous system (most likely the pyramidal tract)
  • Normal in children up to 1-2 years old
  • Unilateral babinski sign is always pathological
• Child development


  1. Eye contact at 1 month

  2. Lifts head up at 3 months

  3. Rolls from prone to supine at 3 months

  4. Sits without support at 5-6 months

  5. Crawling at 6-8 months

  6. Walks by self, falls easily at 13-15 months (upper limit:18 months)

  7. Transfers object from hand to hand at 6 months

  8. Uses pincer grasp at 9-10 months

  9. Climbs stairs with assistance at 18 months

  10. Climbs up on chair

  11. Builds 4-6 block tower at 24 months

  12. Holds crayon at 24 months
• Child development milestones


  1. Simple game (''clap'', '' bye bye'') at 8 months

  2. Drinking water with a glass at 10-11 months

  3. Spoon use at 18 months

  4. Hand washing at 2-2.5 years

  5. Button click at 4-6 years
• Child's speech pattern


  • 2-3 words (least) at 12 –13 months
  • Speaking few words (up to 20 word) at 18-24 months
  • Simple sentence formation at 24-30 months
• By 15 months of age, the child should have consistent vocabulary of 2 to 6 words