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History and Physical of infants and young children

History and Physical of infants and young children. Ayman Aljazaeri , MBBS, FRCSC, MSc , MHA. History The impact of age . Less than 3-4 year Difficult to communicate History sources Mother is the best source Social barrier is improving Father is not very reliable Nurses are reliable

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History and Physical of infants and young children

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  1. History and Physical of infants and young children AymanAljazaeri, MBBS, FRCSC, MSc, MHA

  2. HistoryThe impact of age • Less than 3-4 year • Difficult to communicate • History sources • Mother is the best source • Social barrier is improving • Father is not very reliable • Nurses are reliable • Not always possible • Important in ICU • Other doctors

  3. Relayed symptoms • Feeding • Feeding well  healthy baby • Poor feeding • Sick baby • GI obstructed • Pain • Vomiting  sick baby • Frequency • Color • Force • Projectile  proximal obstruction • Small amount after each feeds  regurgitation  normal

  4. Relayed symptoms • Bowel movement (BM) • Frequency • What is the normal for infant? • Constipated, obstructed • Failure to pass meconium • Consistency • Loose / watery  diarrhea • Firm & dry  constipation • Color • Very pale  ? • Black  Melena • Bright red

  5. Relayed Symptoms • Crying baby • Baby communicate their need by crying • Hungry • Wet • At >6 month  they learn to cry for other reasons • Want to be carried • Want to play • Bay who continue to cry, refuse feeding and dry  pain • Abdominal pain • Ear ache • Development • Growth (height and weight) • Chronic problems ( Metabloic, Nutrition => gut health) • Psychological • Mental problem, chromosomal abnormalities • Motor • Syndrome • Metabolic

  6. Relayed symptoms • External abnormality • Anything that is not normal • Swelling • Abscess • Mass (lymph node, Tumor, Cyst, Hernia) • Color changes • Inflammation • Rash • Vascular malformation • Mental changes • Responsiveness • Sleepy • Not interested in feeding • Indicates; sepsis, shock, CNS trauma, metabolic (O2, Glu, urea)

  7. Abdominal problems • Vomiting • Constipated / diarrhea • Poor feeding • Abdominal distension • Palpable mass • Very dark or very pale colored stool

  8. Physical Exam • Vital sings • Fever • RR, BP, HR, O2 Sat • Consciousness (crying) • Crying baby not very sick (not critical) • Calm baby who doesn’t respond well  sick

  9. Physical Exam • Exam while crying • Can’t hear the chest well • Focus on inhalation • Can’t examine abdomen well • Examine while taking breath • Keep hand on abdomen • Can’t concentrate • Parent are stressed  less time

  10. Physical exam • Otherwise similar to adult • A good history = a good logical story Major Predisposing factors   Describe the current problem   Other risk factors  Symptoms of other possible complications History (general skills)

  11. Due to the relative difficulties in taking a reliable history and performing an accurate physical exam we depend more on investigations in diagnosing the underlying problems in infants

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