1. MD 3-management of diseases.2022.pptx

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1. Introduction to Pediatrics and Child Health, History Taking and Examination Rogatus Kabyemera Pediatrician/Senior Lecturer BMC/CUHAS Octo ber 31 ,2022

2. Learning Objectives By the end of this session, students should be able to; Define common terms in pediatrics Understand the o rganization of Pediatric and Child Health department Understand c ommon childhood illnesses – Globally and in Tanzania Take history of a sick child Examine a sick child

3. Objective 1: Definitions Pediatrics is the specialty of medical science concerned with the physical, mental and social health of children from birth to young adulthood. S ervices range from preventive health care to diagnosis and treatment of acute and chronic diseases .

4. Cont .. Child – individual < 18 years (WHO) Age Name – 28 days Neonate < 1 year Infant 1 – 3 years Toddler 3 – 6 years Pre-scholar 6 – 12 years School age child 10 – 19 years Adolescent 15 – 24 years Young Adult

5. Cont … Preterm baby – born before 37 completed weeks of gestation at birth Full Term baby – born at 37 - 42 completed weeks of gestation at birth Post term baby – born > 42weeks GA

6. Cont … Large-for-gestational-age infant - a preterm, term or post-term infant who is above the 90th percentile for GA in head circumference, weight or length Small-for-gestational-age infant - a preterm, term, or post-term infant who is below the 10th percentile for GA in head circumference, weight or length

7. Objective 2: Organization of Pediatric Department Sub divided to: General pediatrics – C5 & E5 Malnutrition unit – C5 Hematology/Oncology – C5 Emergency pediatrics – C5 & E5 Cardiac and Renal – E5 Neonatal – C2 (Premature unit) ICU – NICU, PICU and adult ICU

8. Objective 3: Global Causes of Morbidity and Mortality in Children

9. M ortality in Tanzanian Children

10. Objective 4: History taking T aking a good history requires good communication skills Always do the following Ask and Listen Praise Advice Check understanding

11. Cont.. Ask relevant questions for clarification of patients’ description of his complaints Older children can provide meaningful history Better ask too many questions rather than few

12. Order of presentation of pt’s complaints History of complaints E xamination Provisional and differential diagnosis Investigations Treatment Prognosis Prevention Counselling and follow up plan

13. Cont.. Introduction of patient should include Patient’s name Age, Gender Residence Referral or not Informant-caregiver/patient Always look and treat emergency signs before taking history

14. Cont.. Chief complaints-list them in chronological order and include duration of complaints History of presenting illness: for each complaint always expand on; Onset, duration, periodicity, associated, relieving and aggravating factors Find relationship between complaints and affected system

15. Cont … Review of Other systems should not include systems which were mentioned in HPI Past Medical History includes; Antenatal hx : duration of pregnancy, maternal conditions, drugs, complications, HIV status Natal: duration of labour, mode of delivery, birth weight, apgar score Post natal: neonatal complications

16. Growth and developmental milestones Include: Gross motor-movement and posture Fine motor- vision and manipulation Speech and hearing Social interaction Conclusion; Normal, regressed or delayed milestones

17. Dietary & immunization hx Dietary hx includes; Feeding after birth-duration and type Weaning and solid foods Current feeds Immunization hx includes: All vaccines given-ask and check the RCH-1 Conclussion; Up to date or Missed opportunity

18. Family Social history Ask for father/Mother-marital status, age, occupation, education Ask for conditions which may run in families eg HTN, DM, SCD Status of other siblings

19. Objective 5: examination of sick child Always observe and feel for emergency and priority signs before doing further exam Assess for level of consciousness-AVPU, GCS (eye, movement and verbal response) Examine from head to toe Check the vital signs-Temp, RR, PR/HR, BP and Oxygen saturation

20. General Exam Check whether the child is well nourished, wasted or obese Mental status-alert, conscious, irritable Look for pallor, cyanosis, dyspnoea , jaundice, oedema and dehydration Assess the skin-rash Examine the lymph nodes

21. Cont.. Head-fontanels, size-macro/microcephaly Examine the eyes, Ears, nose, mouth and neck Examine the extremities-joints, hands, feet and peripheral blood vessels Examine the spine and back

22. Anthropometric measurements Growth assessment; measure weight, length or height, mid upper arm circumference (MUAC) and occipital frontal circumference Interpret the results using appropriate growth chart Conclude based on Weight for Age (underweight), weight for Height (wasting), Height/Length for Age, MUAC and OCF for age

23. Systemic Examination Principle for systemic exam Inspection Palpation Percussion Auscultation Examine RS, CVS, PA and CNS

24. Diagnosis, treatment and Prevention List Diagnosis and differential diagnosis for each diagnosis Investigate your patient based on diagnosis and differentials Treat emergency conditions before definitive treatment Prognosis depends on the diagnosis Prevention should target events which were found on hx and physical exam

25. Cont.. Counselling and follow up plan should target the complaints and diagnosis

26. “ Knowing is not enough; we must apply. Willing is not enough; we must do.” ( Goethe)