Why Pediatric History Taking is Different?
An accurate history is the essential first step in medical diagnosis. Make no mistake, if you have gotten it wrong, you are less likely to make a correct diagnosis.
Pediatric history and examination is a very complex ecosystem of children, parents and the pediatrician.
Why it is difficult to take Pediatric history?
There are several reasons which make Pediatric history taking a challenging job.
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- Your patient cannot give information directly due to a lack of language skills.
- Even when the language skills are developed, the information may or may not be relevant.
- You will have to depend largely on parents/caregivers for the sequence of events. This again may or may not be reliable on all occasions.
- Pediatric diagnosis is not just based on history and examination, but birth events, development, nutrition can completely change the diagnostic pathway.
- There will be tons of information coming through, you need to learn to put filters where necessary.
- Your job is not alone to establish a medical diagnosis but create an overall picture of developmental, social, and psychological issues to help the child get better.
Is it just a problem with small patients?
Even in adolescents, getting a full account of how the symptopms evolved is difficult due to autonomy, privacy, other social and psychological issues.
Overall it's a tough task and you need to keep the patience and learn the art of it. This includes focusing your attention on the relevant events and scrapping out irrelevant information.
What are the focused objectives of Pediatric history taking?
- To get appropriate direction for examination and investigation.
- Develop a differential diagnosis and the best possible diagnosis.
- Establish the overall picture of a child's illness not only inlcuding medical issues but psychological, family, and social context. The treatment will not alone depend on therapies and medicine but all these factors.
- Establish a good rapport with the child and his/her parents. This is necessary to convince the parents about the advice you are giving to give after your history taking and examination. The cases where parents may have conflicts due to their expectations or beliefs are not uncommon in pediatrics.
- You also need to deal with your parent's anxiety and worries during your history-taking process itself.
If you have not listened to Dr Janani's previous episode on How to survive the first year of pediatric residency, here is the link.
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Dr Janani Shankar | DNB (Pediatrics) PhD MNAMS
Dr Janani Shankar is a senior consultant in Pediatrics and Pediatric Infectitious diseases at Kanchi Kamakoti Child Trust Hospital, Chennai, India. She is involved in teaching activities conducted by NBE across the country for many years and also an examiner for the DNB Pediatrics exam conducted by NBE