Dr Jayadeep BP BHMS MD(Hom)
General instructions
- Physician should be soft, gentle, friendly & caring with genuine interest & love for children
- Be smiling & polite to children & never get angry with children even if they are at their worst
- Approach the child with a smiling face & treat him as a child & not as a patient & comfort him
- Never start examining the child as soon as he enters the clinic & try to build a rapport with the child before examination
- Should literally come down to the level of child both physically & mentally to elicit cooperation
- Clinic should be well lighted, quiet & decorated with toys & pictures to allay the anxiety of the child & can offer a soft toy to establish a rapport
- Questioning of the children should be avoided at the very beginning of the interview
- Ask the mother about the child’s behavior, but observe the child constantly during the interview. Answers from the mother are less relevant than the observations you make while you are interviewing the mother .
- But do not be tempted to interrupt a mother in full flow to try & ask what you think is a clever question; it will be like trying to impose our diagnosis on them
- Observation of each & every movement of the child should be noted properly & can spend maximum on it
- Intelligent neglect of the child & proper respect to the mother to gain the child’s confidence is essential
- A careful observation during the interview often reveals stresses & concern which are otherwise not apparent
- We should confirm our observations by direct questioning or using leading questions & tricky questions which is essential & safe here
- For school going children asking them their name, name of school, age, hobbies ,their best friend, name of their teacher etc makes them feel at ease
- Avoid staring at the child because they are often scared if you intently look into their eyes
- Anxiety of the parents should be allayed. Over anxious parents will ask many questions about the child. Proper explanation in context to the questions & relevant developmental milestones of a normal child along with its normal variations should be explained to allay the anxieties of parents
- Physicians should also observe the interactions between the child and parents. This reveals the amount of concern of the parents towards the child’s health & interests. It also reveals the notion of do’s & don’ts in the family of child
- To get the desired information, it is necessary to have privacy which is often overlooked in case of children as some adolescent children who are often rather resentful of their parents, will be happy to share their thoughts when alone
- Parents also will be interested to talk in private with doctor & often during such discussion that the real reason for consultation emerges
- Care should be taken not to ridicule, not to laugh at what the child says seriously, not to be always funny or amusing and not to tease unless the child is known well
- If the problem is related to the adjustment of the child or its behavior, parents & child should be given suggestions separately & or both together as deemed necessary
- In younger children the observation of parents & physician himself are utmost important
- In acutely ill child, information obtained rapidly and in brief may suffice to identify the primary problems of concerns
- The essence of art of examining children is that during the most of the examination the child should be contented
CASE TAKING IN DETAIL
There cannot be any standard or regulated patterns of history taking, as the questioning will change depending on the age group of the patient we are dealing with
Physician should be aware about the normal physical, social, emotional & intellectual development
Questions should be asked to understand the moral character, intellectual character, social & domestic relationships
Data can be collected in an order of
1.Chief complaints– with causations like vaccinations,emotional turbulences,physical factors,medicines etc
2.History of present illness
3.Associated complaints
4.Past history-of previous illnesses; their nature, severity, the age at which occurred,like infectious diseases, seizures, bowel disturbances, URTI, discharging ears, cough & history of accidents, physical injuries, burns or poisonous incidents and medical history
5.Prenatal history ie. mother‘s history during pregnancy- -relevant in cases of congenital disorders, tumors, juvenile arthritis, juvenile diabetes
-any illnesses she had? like rubella & any drug history
–maternal stress-emotional stress during pregnancy like anxieties, fear, tensions in relationship with husband & other family members, friends her reactions to that
- Economic status of family
- Attitude of not wanting a baby at all, or at that time
- Birth history
- how was the delivery-normal vaginal or forceps,breach,cesarean etc
- full term?
- birth weight
- enquiry about jaundice,breathing & feeding difficulties,fits etc
- History after birth
- was the mother unconscious after delivery
- How soon were the mother & child brought together after delivery
- Feeding history-how often? how does suck the breast? fast or slow? any preference for side of breast?
- if bottle fed, which milk? Any diarrhea, regurgitation, colic etc?
- when weaning started?
- if child asks for extra feeds & are not content with the quantity of mother’s milk can consider as thirsty & others are thirstless
- Developmental history
- Mile stones like smile, dentition, crawl, walk, talk etc
- Precocity
- assessment of intellect-intelligences of linguistic or verbal, logical or mathematical, bodily or kinesthetic, spatial or visual, musical or rhythmic etc
10.immunization history-when? how many times? which ?
- Family history
- How old are the parents?
- How many children are there in family. their age, sex
- Any still births, miscarriages, or childhood deaths in family
- Any illnesses in siblings, parents or near relatives
- Social history-Living conditions, economic status, mother’s occupation
- Child as a person-physical & mental characteristics, life situation
- Physical Constitution
- distribution of fat
- progress of emaciation
- eating habits
- generals- Thermal state by checking temperature of abdomen, neck, perspiration, usage of covering during sleep
- appetite & thirst
- desires & aversions
- Sleep-How does the child wake from sleep, sleep position,deep or light sleep
- emotional level & expressions of reactions to stimuli
- anger response-impulsive [extrapunitive & intrapunitive} or
- inhibited
- Jealousy & its reactions-direct & indirect
- grief-expressive & non expressive
- fears- in babies [towards loud noises,dark rooms,animals,high places,strange persons,places,objects,being alone} In pres school children-[towards ghosts,monsters,darkness,sleeping alone] InSchool going children-school performance,results,reprimands]
- shyness,embarrassments,worry,anxiety with heir expression d.Behaviour & temperamental patterns
Sociability
- approach or withdrawal
- adaptability
Activity
- activity level-high or low
- threshold of responsiveness{sensitivity}-to sound, taste, touch, temperature change
- intensity of reaction-amount of energy a child uses to express emotions like High intensity denotes-laughing & crying loudly, is easily frustrated, screams so loud,
- rhythmicity-regularity of biological functions like sleep, hunger & eliminations
- distractibility-how much or how little extraneous stimulus is needed to interfere with an ongoing activity
- attention span & persistence-how long a child can stay with any given activity
Destructabilty-destructive or non destructive
- Thoughts on miasms behind
And can conclude the interview with general physical examinations with proper systemic & relevant local examinations.
