Paediatric Consult Guide

Paediatric Consult Guide

Nov 10, 2017 0
onthephones

Editor: Grace Leo

Contributors: Andrew Tagg, Tessa Davis

Reviewed:  Chris Elliot

  • Whether the child appears toxic (see box), if there were any fevers >38
  • Whether there was premature birth or any complications
  • What the parent’s key concerns and reasons for presenting were

Toxicity

One or more of:

Alertness arousal or activity decreased

Breathing difficulties (tachypnoea, increased work of breathing)

Colour (pale or mottled), circulation (cool peripheries) , or cry (weak, high pitched)

Decreased fluid intake or decreased urine output

  • History of complaint – length of illness, any periods of improvement/deterioration
  • The presence and pattern of any fevers
  • Whether there are any sick contacts
  • How the child has been feeding and how much compared to usual – breast or formula milk, solids
  • How many wet nappies have been changed compared to usual
  • Any fluid losses – vomit / diarrhoea / polyuria
  • Immunisation status
  • Birth history including antenatal complications such as pre-eclampsia or gestational diabetes, delivery complications such as emergency c-section for failure to progress and post natal issues such as time in special care nursery
  • Find out if there are any concerns about developmental history and milestones
  • Brief history of previous hospitalisation
  • The primary carer and whether the child attends day care or school
  • Vitals and full physical examination
  • If any respiratory issues – what work of breathing the child has (mild/moderate/severe and signs eg. Tracheal tug, intercostal recession)
  • Whether the child looks well or toxic (see box).
  • Weight and if concerns regarding growth/size, height and HC – plot on chart
  • Usually investigations, particularly invasive investigations should be discussed with registrar and/or admitting officer.
  • Good understanding of social history
  • Knowledge about other sick family members and travel
  • How the child arrived in the department and who was accompanying.

Helpful resources

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