Paediatric- History taking & physical examination to child abuse

Paediatric- History taking & physical examination to child abuseCreated OnApril 22, 2020Last Updated OnApril 22, 2020byadmin You are here: Main Clinical Examination Paediatric- History taking & physical examination to child abuse < All Topics Table of Contents History taking: Ask about patient’s information Name, home address, contact number, date of birth, gender, ethnicity, nationality, language spoken, school attended and graded level, work sites (adolescents) Ask about chief complaint and relevant history of presenting illness Accurately record in the parent/caregiver’s own words Document the cause(s) or concern(s) that prompted the necessity for an evaluation of abuse Obvious injury Disclosure by the child A witness to the abusing event Suspicions based on behaviour changes If suspected emotional abuse, ask about: Social withdrawal Excessive anger or aggression Eating disorders Failure to thrive Developmental delay Emotional disturbance – depression, anxiety, fearfulness, history of running away from home If suspected sexual abuse: Interview the child out of the presence of the parent if possible Ask for a description of the event Offer the option of writing answers down or drawing the event Ask about genital complaints such as vaginal, rectal, penile pain, staining of underwear, discharge, foul odour Ask about new or changed behavioural problem, including emotional symptoms Ask about recurrent somatic complaints such as abdominal pain and headaches Ask about menstrual history for adolescent girls Ask about sexual history Ask about the child’s concerns or fears Ask about behavioural symptoms: Emotional disturbance Unexpected awareness or acting out of sexualized behaviour beyond what would be expected for age Soiling or secondary enuresis Self-harm, aggressive or sexualized behaviours Regression, poor school performance **When taking history for a suspected sexual abuse, use short simple sentences, simple tenses, active verbs, concrete terms, proper names and direct questions. Every statement made by the child should be verified. If there is a physical injury, ask about: Who witnessed the injury? Where and when did injury occur? The response or act of child after the injury What did the caregiver do after the injury? if the injury involves a fall, ask about: The initial position and location of the child before the fall The fall dynamics – distance and description of the fall The final position and location of the child after fall including how and what they landed on If suspected abusive head trauma in infants, ask the caregiver about the following symptoms: Altered mental status, coma, irritability, fussiness, high pitched cry Vomiting, poor feeding, apnoea Seizures, abnormal movements Enlarged head (chronic) Associated fractures and bruises Ask about systemic review Ask about antenatal and birth histories – gestational age, delivery method, birthweight Ask about past medical/surgical history Previous traumatic events, injury or hospitalizations Other medical problems Ask about drug history Current and past medications Allergies Ask about nutrition history Do a 24-hour dietary recall to assess nutrition (ideally for three days) Ask about birth weight and serial weights (review or plot on growth charts to rule out failure to thrive) Ask about developmental history – assess if the child’s development is up to age Ask about immunization history – ask if the child has completed immunization based on the national immunization schedule Ask about family history Family composition History of bleeding disorders and hearing loss Other inherited illnesses (Osteogenesis imperfecta, collagen vascular disorders, copper deficiency) Siblings who died of sudden infant death syndrome, or who have a serious illness History of growth delay in siblings, parents, or relatives Abuse in other family members Ask about social history Information about the interview List of all persons present Name of the primary interviewer Date, time, and location/site of interview Information about the parents/caregivers All names, including maiden, married, alternates Home address and telephone number(s) Work address and telephone number Country of origin Languages spoken; ability to comprehend; need for an interpreter Name(s) of...

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