0/4First contact
- Take a full, focused or interval history as the setting demands; from the parent and, as they mature, the child.
- Strike up a conversation with child and caregiver about common interests; talk to the child to show you are interested in them.
- Watch the parent-child interaction: is this a happy, strained, tense or anxious family? The family's concern may differ from the chief complaint.“Is there a specific illness you are worried about?”
- Discuss the limits of confidentiality, with or without the parents in the room: immediate risk of suicide or harm, abuse of a child under 16, and some STIs are reportable.
0/2History of present illness
- Onset“When were you first concerned about your child's health? When were they perfectly well in the past?”
- Management so far: what physicians have said, investigations, treatments; contacts and exposures if infectious.
0/3Neonatal history
- Review the maternal perinatal record if available: birth weight, gestational age.
- Newborn problems: prematurity, respiratory distress, jaundice, infection, Apgar, resuscitation, hospitalization, NICU stay.
- Pregnancy: GTPAL; maternal illness (hypertension, diabetes); labour duration, delivery type, prenatal care, infections, drugs, alcohol, medications.
0/6Growth, diet, development
- Diet: amount, type and method of infant feeding, variety of foods, mealtime behaviour, when solids started, intolerances, preferences and restrictions, prior growth concerns.
- Development: depth depends on age and complaint“How is your child doing at school? Have the teachers been worried?”
- Immunizations: everything received, anything missed.
- Family history: consanguinity, genetic disorders, early childhood deaths, illness relevant to the presentation; names, ages and health of siblings and parents.
- Social history: home environment, school and peer relationships (IHELLP, HEEADSSS).
- Review of systems tailored to age: neonate, infant, toddler, school age, adolescent.
15 steps left in this station.