CFB PAE01 Paediatric History Taking
Paediatric history taking is the systematic process of gathering a child's clinical information—including presenting complaint, history of present illness, birth history, developmental milestones, immunisation status, feeding/nutrition, and family/social history—from the parent or caregiver to guide diagnosis and management.
Paediatric History Taking
This lecture (CFB PAE01) provides the foundational framework for paediatric clinical encounters. Its central message is simple: paediatric history taking is not adult history taking applied to a smaller person. The consultation includes the child or young person and usually one or more caregivers; who supplies each fact, and how reliable it is, matters. Depending on age and the clinical problem, the history also expands to antenatal/perinatal events, development, immunisation, feeding, growth, school and family context.
Why does this matter for exams? Paediatric history taking is tested both directly (OSCE stations, minicase questions asking "list 5 specific questions you would ask") and indirectly (every SAQ that begins "a child presents with…" expects you to know which history components to elicit). The 2023 Fourth Summative Minicase explicitly asked candidates to "list five specific questions" for a vomiting toddler [1]. The 2024 SAQ asked about history relevant to a febrile infant with hip pain [2]. Understanding why each component matters lets you generate the right questions for any paediatric presentation.
Learning Objectives (from the lecture slides)
"Recognize the importance of communication skills when interacting with children and their parents" [3]
"Describe and demonstrate how to conduct paediatric history taking" [3]
"Describe and demonstrate how to perform physical examination in children" [3]
"Recognize, discuss on, and differentiate the causes of common paediatric presentations" [3]
"Read any referral letter ± hospital notes before consultation" [4]
Why this matters: Reviewing available information avoids unnecessary repetition and lets you focus the encounter on the child's story and the family's concerns. It also helps you plan the least distressing, highest-yield parts of the examination while the child is settled.
Practical tips:
- Note the child's age (this changes your entire differential diagnosis framework)
- Note previous admissions and chronic diagnoses
- Check growth charts if available in the file
- Review any antenatal/birth records already documented
2. Introduction and Communication Skills
Communication is THE Key Differentiator in Paediatric History Taking
The lecture emphasises that communication skills are not just a "soft skill" — they directly affect the quality of information you obtain. A frightened child who is crying cannot be examined properly, and an anxious parent may not give you the most important details if they do not trust you.
| Channel | What good performance looks like | What the examiner can observe |
|---|---|---|
| Verbal | Greet and introduce yourself; gather sensitive information tactfully; speak coherently at an appropriate pace and tone; avoid jargon or explain it; adapt language to the informant | The child and caregiver understand what is being asked and why |
| Non-verbal | Put the family at ease; maintain culturally appropriate eye contact; respond to cues; use open body language; appear calm and confident | You notice distress, hesitation and the parent-child interaction rather than only recording words |
| Listening | Listen actively; acknowledge verbal and non-verbal cues; avoid unnecessary interruption | The family's narrative and concerns emerge before you narrow the history [3] |
| Action | Why it matters |
|---|---|
| Introduce yourself and confirm the child's name, age, sex and ethnicity | Age and background alter both communication and the differential |
| Identify every accompanying adult and their relationship to the child | A parent, grandparent, domestic helper or social worker may know different parts of the history; record the source and any limits to reliability |
| Address and involve the child at their developmental level | The child is the patient, even when a caregiver supplies most of the history |
| Build rapport through play or age-appropriate conversation | Cooperation is earned; it improves both history and examination |
| Observe the child-caregiver interaction | It may reveal attachment, distress, inconsistency or a safeguarding concern |
| Ask for a photo or video when appropriate | A resolved rash, paroxysmal movement or seizure may otherwise be impossible to characterise [4] |
Adolescents: privacy is part of good paediatric care
Explain confidentiality and its safety limits in language the young person understands, then routinely offer developmentally appropriate private time without caregivers. Do not make the young person wait until a parent has been interviewed separately, and do not promise absolute secrecy: information may need to be shared to protect the young person or someone else from serious harm. Continue to involve family with the young person's agreement whenever appropriate [23][24].
Important slide-reading correction: the lecture's warning that an approach "can be counterproductive" refers to an indiscriminate, exhaustive systems enquiry—not to direct questions in general. Begin with an open invitation, let the family describe the problem with minimal interruption, then use focused closed questions to test hypotheses and screen relevant systems [3].
Mental model: this is usually a clinician-child-caregiver interaction, but it is not automatically a parent-owned history. Invite the child's account, compare it with caregiver observations where appropriate, and document who supplied important facts.
3. Structure of the Paediatric History
Name, age, sex, relationship with carer [4][5]
Why age is critical:
- Age determines differential diagnoses (neonatal jaundice ≠ childhood jaundice)
- Age determines normal vital signs (a heart rate of 150 bpm is normal in a neonate but tachycardic in a 10-year-old)
- Age determines developmental expectations (not walking at 10 months is normal; not walking at 24 months is concerning)
| Age Category | Definition |
|---|---|
| Neonate | < 28 days |
| Infant | < 1 year |
| Toddler | 1–3 years |
| Pre-schooler | 3–6 years |
| Older child | 6–12 years |
| Teenager/Adolescent | 12–19 years |
- State the chief concern in the patient's (or parent's) own words
- Keep it concise: "3 days of fever and cough" rather than a paragraph
Start broadly: "Tell me what has been happening" or "What has worried you most?" Allow the initial account to unfold without unnecessary interruption. Then clarify chronology, severity, associated symptoms, previous consultations or treatment, the parent's and child's concerns, and both medical and psychosocial impact. Every later question should have a purpose: to characterise the problem, assess severity, or move a diagnosis up or down the differential [3].
One useful symptom scaffold is:
For any current symptoms, follow: Onset → Precipitation → Quality → Region/Radiation → Severity → Time course → Alleviating/Exacerbating factors [6]
| Element | Questions | Why |
|---|---|---|
| Onset | When did it start? Sudden or gradual? Any prodrome? | Sudden onset suggests acute pathology (e.g., intussusception, anaphylaxis); gradual onset suggests infection or chronic disease |
| Precipitation/Context | What was the child doing? Any preceding illness, trauma, exposure? | Foreign body aspiration occurs during eating/playing; post-infectious complications follow viral URTIs |
| Quality | Describe the symptom (e.g., barking cough vs. productive cough; projectile vs. non-bilious vomiting) | Quality narrows differentials enormously — bilious vomiting = surgical emergency until proven otherwise |
| Region/Radiation | Where exactly? Does it spread? | Periumbilical pain migrating to RIF = appendicitis |
| Severity | How bad? Functional impact? | Important for grading — can the child still play/eat/sleep? |
| Time course | Duration, frequency, progression, pattern | Chronic cough > 4 weeks needs different workup than acute cough |
| Alleviating/Exacerbating | What makes it better/worse? Response to medications? | Relief with bronchodilator → asthma; worsening at night → asthma/croup |
High Yield: The Paediatric ADL Assessment
Always compare baseline vs current! [4] This is the paediatric equivalent of asking an adult about activities of daily living. It tells you the severity and impact of the illness.
| Domain | What to Ask | Clinical Significance |
|---|---|---|
| Diet (食) | Type, amount, frequency of feeds; % of usual intake | Decreased oral intake → risk of dehydration; tells you about severity |
| Urine output (尿) | Number of wet nappies/day; are nappies lighter than usual? | Decreased urine output = dehydration marker |
| Bowel habit (屙) | Frequency, consistency, colour, blood, mucus | Bloody mucoid stool → bacterial GE or intussusception [7] |
| Activity/Play (玩) | Is the child as playful as usual? Going to school? | Decreased playfulness = significant illness; a playful febrile child is reassuring |
| Sleep (瞓) | Bedtime, duration, quality, waking episodes | Nocturnal cough → asthma; sleep disturbance → severity marker |
"ADL: child (PAC ME: playfulness, alertness, consolability, motor activity, eating)" [5]
Safety interpretation: Change from the child's normal feeding, urine output, activity and interaction is often more informative than a single symptom adjective. Preserved play and feeding are reassuring features, but do not exclude sepsis or other serious illness; interpret function with appearance, observations, age, risk factors and trajectory. A limp, poorly responsive child or one unable to feed needs urgent assessment.
The lecture explicitly warns that a blind, exhaustive systems review can be counterproductive. Ask about systems that test your working hypotheses or screen for important mimics and complications. For example [3][8]:
| System | Symptoms to Ask About | Why |
|---|---|---|
| GI | Abdominal pain, vomiting, diarrhoea | Most common cause of acute presentations in children |
| Urogenital | Foul-smelling/cloudy urine, haematuria, dysuria (in older children) | UTI is a common occult cause of fever, especially in infants |
| Upper respiratory | Runny nose, sore throat, hoarseness, red eyes, ear pain, stridor | URTI is the most common paediatric illness |
| Lower respiratory | SOB, cyanosis, pleuritic chest pain, wheeze | Pneumonia, bronchiolitis, asthma |
| CNS | Seizure, neck stiffness, photophobia, irritability, weakness | Meningitis/encephalitis must not be missed |
| MSK/Rheumatology | Joint pain, limb swelling, inability to weight-bear | Septic arthritis, osteomyelitis, HSP |
- Previous illnesses: Chronic diseases, recurrent infections
- Hospitalisations: Number, reason, duration
- Surgeries: Any previous operations
Why recurrent infections matter: Recurrent pneumonia may indicate aspiration, congenital airway abnormality, or immunodeficiency [9]. Recurrent UTIs may indicate vesicoureteral reflux [10].
- Current medications (prescribed and OTC)
- True drug allergies — culprit drug, timing, phenotype, severity and re-exposure
- Food allergies — distinguish certain vs. suspected, and the presentation [4]
- G6PD status — document separately from allergy; it is an inherited red-cell enzyme deficiency that creates susceptibility to oxidant-triggered haemolysis [25]
- Previous antibiotic use (affects likelihood of resistant organisms) [9]
G6PD Deficiency
G6PD deficiency is not a drug allergy. Ask and record it because infection, fava beans and particular oxidant medicines can precipitate haemolysis. Check a current local formulary or specialist list before prescribing rather than assuming every drug in a broad class is unsafe [25].
This is a distinctive paediatric domain and one students often under-explore. Its depth should match the child's age and the clinical question: detailed antenatal, birth and neonatal information is central in a neonate, infant, developmental problem or suspected congenital disease, but a remote uncomplicated birth may add little to an unrelated problem in an older child.
"Maternal obstetric Hx (e.g. GBS carrier, prolonged delivery): 產檢，生產有無特別事" [5] "Birthweight and gestation: 足月，足磅，順產" [5]
| Component | Details to Elicit | Clinical Relevance |
|---|---|---|
| Antenatal | Maternal illness during pregnancy (GDM, pre-eclampsia, infections — rubella, CMV, toxoplasmosis, HIV, HBV, GBS) | Congenital infections, macrosomia, prematurity |
| Antenatal screening | Ultrasound findings, Down syndrome screening results | Structural anomalies detected antenatally |
| Mode of delivery | Vaginal (spontaneous/instrumental) or Caesarean section | Instrumental delivery → birth trauma (cephalhaematoma → jaundice) [11] |
| Gestational age | Term ( ≥ 37 weeks) or preterm ( < 37 weeks) | Prematurity → increased risk of RDS, NEC, IVH, ROP, developmental delay |
| Birth weight | Actual weight; whether appropriate for gestational age | SGA → risk of hypoglycaemia, polycythaemia; LGA → maternal GDM |
| Perinatal events | Apgar scores, need for resuscitation, NICU admission, meconium aspiration | Intrapartum asphyxia → HIE → developmental delay [12] |
| Neonatal problems | Jaundice, sepsis, feeding difficulties, prolonged hospital stay | Prolonged jaundice → biliary atresia (if conjugated); G6PD deficiency |
"Birth crucial → premature infants have to think of necrotizing enterocolitis requiring surgery and a resultant short gut; any infective gastroenteritis in later life will be more severe" [13]
General rule of thumb for birth weight: BW doubles by 4–5 months; triples by 1 year [5]
"Developmental history + birth history" [5]
Assess the four core domains of development and ask specifically about vision and hearing, because impaired sensory input may mimic or contribute to delay:
| Domain | Key Milestones to Screen | Red Flags |
|---|---|---|
| Gross Motor | Head control (3–4 mo), sitting unsupported (6–8 mo), walking (12–18 mo) | Not walking by 18 months; loss of previously acquired skills |
| Fine Motor / Vision | Reaching/grasping (4–5 mo), pincer grip (9–10 mo), scribbling (15 mo) | No reaching by 6 months |
| Speech / Hearing / Language | Babbling (6–9 mo), first words (12 mo), 2-word phrases (24 mo) | No words by 18 months; no phrases by 24 months |
| Social / Self-care | Social smile (6 wk), stranger anxiety (8 mo), parallel play (2 yr), toilet training (2–3 yr) | No social smile by 8 weeks; loss of social engagement |
Why this matters: Developmental delay may be the presenting feature of a genetic, metabolic or neurological condition. In an acute encounter, establish the child's developmental baseline when it affects communication, function, aspiration risk, examination or management; do not turn every unrelated consultation into a full milestone inventory [12].
High Yield: Global Developmental Delay History
For GDD, specifically ask about: prenatal + perinatal + postnatal history, 3-generation pedigree, history of parental consanguinity, family members with GDD, and auditory/ophthalmological assessment [12]. Consanguinity increases the risk of autosomal recessive conditions — this appeared in the 2023 SAQ (parents were first cousins → SCID) [14].
| Age Group | Key Questions | Clinical Relevance |
|---|---|---|
| Neonates/Infants | Breastfed or formula? Volume/frequency? Any supplements? | Breast milk jaundice; iron deficiency if prolonged exclusive breastfeeding without weaning |
| Weaning (4–6 months) | When was weaning started? Types of foods introduced? | Coeliac disease symptoms appear after gluten introduction |
| Toddlers/Older children | Balanced diet? Picky eating? Cow's milk intake? | Excessive cow's milk → iron deficiency anaemia |
"Feeding: method, amount, urine output, recent change" [5]
"Immunisation: follow HKCIP, extra vaccination, influenza vaccine" [5]
Why this is critical:
- Incomplete immunisation changes your differential — an unvaccinated child with fever and rash could have measles, which would be very unlikely in a fully vaccinated child
- Rotavirus immunisation decreases likelihood of rotavirus GE [7]
- Incomplete pneumococcal or Hib immunisation increases risk of invasive bacterial infections [7]
- Complications from live vaccines (e.g., disseminated BCG in SCID) are important clues to immunodeficiency [15]
Check the written immunisation record where possible rather than relying only on recall. Chronic heart disease is not, by itself, a reason to omit routine vaccines; some high-risk children need additional influenza or pneumococcal vaccination. Recommendations change, so apply the current Hong Kong schedule and condition-specific guidance rather than treating the lecture-era examples as a fixed list.
BCG and Immunodeficiency
A BCG scar that is not completely healed with serous discharge in an infant with recurrent infections and failure to thrive is a classic clue for SCID or other severe T-cell immunodeficiency. This was directly tested in the 2023 SAQ [14].
"ALWAYS draw a 3-generation family tree!" [4]
| What to Ask | Why |
|---|---|
| Similar illness in siblings/parents | Genetic conditions (e.g., cystic fibrosis, sickle cell disease) |
| Consanguinity | Autosomal recessive conditions (SCID, metabolic diseases) |
| Recurrent miscarriages/premature deaths | Chromosomal abnormalities, severe genetic disease |
| "Late bloomers" in the family | Constitutional delay of growth and puberty [16] |
| Family history of seizures | Genetic predisposition to febrile seizures [17] |
| Family history of bleeding disorders | Haemophilia (especially maternal uncles — X-linked) [18] |
| Family history of atopy | Asthma, eczema, allergic rhinitis — strong hereditary component |
| Component | Details | Clinical Relevance |
|---|---|---|
| Home environment | Who lives at home? Housing conditions? | Overcrowding → increased infectious disease risk |
| School/nursery | Performance, attendance, behaviour | May reveal developmental delay, bullying, school refusal |
| Childcare arrangements | Who looks after the child? | Important for child abuse assessment |
| Parental smoking | Active/passive exposure | Exacerbates asthma, increases respiratory infections |
| Psychological stressors | Recent changes (divorce, bereavement, new sibling) | Secondary enuresis, behavioural changes [19] |
"TOCC: whenever infection is included as DDx" [5]
| Letter | Component | Example |
|---|---|---|
| T | Travel | Traveller's diarrhoea, malaria, dengue |
| O | Occupation (of parents) | Healthcare workers (TB exposure), farming (zoonoses) |
| C | Contact | Poultry, animals, insects, household contacts with illness |
| C | Clustering | Similar illness in household, school or people sharing a meal; record who became ill, shared exposures and timing rather than relying on a single memorised outbreak definition [7] |
The history is not complete when the checklist ends. The lecture's outcome slide expects you to [3]:
- Summarise the important medical and psychosocial problems.
- State the child or family's main concerns and expectations.
- Generate and prioritise likely and must-not-miss differential diagnoses.
- Judge severity and impact on the child and family.
- Use that synthesis to choose a targeted examination, investigations and management plan.
One-sentence synthesis
Practise ending with: "This is a [baseline/age/risk factors] child with [time course and syndrome], currently [severity and functional impact], with [key positives/negatives and family concern], making [leading diagnosis] most likely while [must-not-miss alternative] still needs exclusion."
"Depends on history; prioritised and targeted examination; always begin with inspection; sequence of other parts of examination may need to be altered" [3]
Why the sequence changes: The history tells you what to prioritise, and the child's state determines the order. Always begin with inspection, then do high-value, low-distress components while the child is calm. There is no universal paediatric sequence after inspection:
- Inspection first — observe from a distance (breathing pattern, activity level, colour, rash)
- Auscultation next — heart and lung sounds while the child is quiet (before they start crying)
- Palpation and percussion when appropriate — adapt to the organ system and the child's tolerance
- Most distressing components last — commonly the ears and throat; perform intimate or invasive examination only when clinically indicated, with consent/assent, a chaperone and safeguarding principles
High Yield Exam Point
"Always begin with inspection, sequence of other parts of examination may need to be altered" [3] — This is a classic OSCE/viva point. Examiners expect you to demonstrate that you know to auscultate before the child cries.
Outcomes of Physical Examination
"Identify important physical signs → Interpret the signs in the appropriate context → Formulate diagnosis and differential diagnosis → Guide further investigations and management" [3]
5. Special Paediatric History Components by Presentation
The lecture slides list multiple paediatric presentations that the GC covers. Here is a synthesis of how the history-taking framework adapts to specific presentations:
| History Component | Specific Questions | Why |
|---|---|---|
| Fever pattern | Onset, highest temperature, method of measurement, trend, response to antipyretics, chills/rigors [8] | Height of fever (not rate of rise) is the main risk determinant for febrile seizures [17] |
| Localising symptoms | Run through ALL systems systematically [8] | UTI may present with fever alone in infants — no localising symptoms |
| Rash characteristics | Timing relative to fever, morphology, distribution, progression [8] | Rash on day 4 of fever → think measles; rash after fever defervesces → roseola |
| Immunisation status | Which vaccines received? | Changes differential significantly |
| TOCC | Contacts, travel, clustering | Outbreak identification |
| History Component | Specific Questions | Why |
|---|---|---|
| Duration | Acute ( < 2 weeks) vs. chronic ( > 4 weeks) | Chronic cough → asthma, foreign body, TB, protracted bacterial bronchitis [9] |
| Character | Barking (croup), whooping (pertussis), productive vs. dry | Directs differential |
| Choking episodes | Any history of choking while eating or playing? | Foreign body aspiration — must not be missed [9] |
| Previous episodes | Recurrent pneumonia? | Aspiration, immunodeficiency, congenital airway anomaly [9] |
| Night symptoms | Worse at night? | Asthma characteristically worsens at night [20] |
| Response to treatment | Relieved by bronchodilator? | If yes → likely asthma [20] |
"History Taking" — GC 142 slide [21]
| History Component | Specific Questions | Why |
|---|---|---|
| Duration | > 7 days → think GI, metabolic, systemic disease, IBD, immunodeficiency [7] | Acute vs. chronic diarrhoea have completely different differentials |
| Stool character | Frequency, volume, blood, mucus [7] | Large volume watery stool without blood → viral; small volume bloody mucoid stool → bacterial [7] |
| Vomiting character | Bilious? Projectile? Haematemesis? | Bilious vomiting = intestinal obstruction until proven otherwise [7] |
| Urine output | Increased or decreased? | Decreased → dehydration; increased → consider DKA [7] |
| Recent food intake | What, when, where? | Food poisoning, food allergy, overfeeding [7] |
| Birth history | Prematurity? Previous NEC? | Short gut syndrome → worse GE [13] |
| Component | Key Questions | Why |
|---|---|---|
| Pre-ictal | Aura? Precipitating factors? What was child doing? | Differentiates epileptic seizure from non-epileptic event (breath-holding spell, syncope) [22] |
| Ictal | Duration, focal vs. generalised, eye deviation, limb movements, continence | Simple vs. complex febrile seizure; focal features → structural lesion |
| Post-ictal | Drowsiness, Todd's paralysis, return to baseline | Todd's paralysis → focal seizure |
| Witnesses | Who saw it? Video? | Parents' description is your only data — ask for smartphone video [4] |
| Fever history | How high? What infection? | Febrile seizure diagnosis requires fever AND seizure [17] |
| Developmental history | Any regression? | Regression = alarm bell for neurodegenerative disease |
| Trap | Correct Approach |
|---|---|
| Treating birth history as either mandatory or irrelevant | Ask it in depth when age, development, congenital disease or the presenting problem makes it informative; keep it proportionate in an older child with an unrelated acute problem |
| Asking about dysuria in a 6-month-old | Young children cannot report dysuria — ask about crying during nappy changes, foul-smelling urine, fever without source |
| Not asking about immunisation status | Changes your differential — unvaccinated child with cough and rash = possible measles |
| Using the same history template as adults | Must add: birth, development, feeding, immunisation, growth, family pedigree |
| Forgetting to identify the informant | The person giving the history affects its reliability — grandparent may not know medication details |
| Not asking about urine output in diarrhoea | Change in wet nappies/voiding is an important hydration clue, but assess it with intake, losses, appearance, perfusion, weight and observations [7] |
The lecture emphasises that history drives examination: "Depends on history; prioritised and targeted examination" [3]. After taking the history, you should have a mental differential diagnosis list and perform a focused examination to confirm or refute your top differentials.
For example:
- Fever + decreased urine output + irritability → examine for dehydration signs (dry mucous membranes, sunken fontanelle, poor skin turgor, prolonged capillary refill time)
- Recurrent infections + failure to thrive + oral thrush → examine for lymphoid tissue (tonsils, lymph nodes, spleen) — absence suggests XLA or CVID [15]
- Vomiting toddler → abdominal examination for masses (intussusception), tenderness (appendicitis), distension (obstruction)
The opening slides are an orientation to the lecture-era undergraduate pathway. Cohort schedules and assessment formats may change; use these slides to understand the intended progression, not as a current timetable [3].
| Stage | What Happens |
|---|---|
| Clinical Foundation Block (CFB) | Face-to-face foundations: history and physical examination; antenatal/perinatal/pre-pregnancy and newborn medicine; lactation/feeding; growth; immunisation |
| General Clerkship (GC) | In the deck: a 2-week rotation using four E-Paed cases, flipped-classroom discussion, six examination videos, bedside demonstrations, community/genetics exposure and formative assessment |
| Assistant Internship (AI) | 7-week rotation |
The GC learning objectives in the slides are to communicate with children and parents, demonstrate history and examination, reason through common presentations, understand Hong Kong community paediatric services, and recognise the relevance of genetics. The whole-class topic map spans cardiology, genetics, endocrinology, gastroenterology, general paediatrics/safeguarding/infection/nutrition, oncology, allergy/immunology, intensive care, hepatology, nephrology, neurology/development and respiratory medicine [3].
The 4 E-Paed cases are:
- A child with acute shortness of breath
- An infant with fever
- A neonate with jaundice
- A toddler with convulsion
The 6 physical examination videos cover: General, Cardiovascular, Respiratory, Abdominal, Neurological, and Newborn examination [3].
The deck also illustrates the expected assessment level: not merely naming a diagnosis, but linking relevant examination findings to a treatment plan and explaining treatment adverse effects and family concerns. Its scarlet-fever sample (fever, sore throat and a sandpaper-like rash) is an example of pattern recognition, not a substitute for full clinical assessment [3].
| Feature | Adult | Paediatric |
|---|---|---|
| Informant | Usually the patient | Child/young person plus caregiver(s); identify the source and reliability of each key fact |
| Birth history | Not routinely asked | Depth varies with age and problem; especially important in neonatal, developmental and congenital presentations |
| Developmental history | Not routinely applicable | Establish relevant developmental baseline; assess four core domains plus hearing and vision when indicated |
| Feeding history | Dietary history | Specific: breast vs. formula, weaning, volume, frequency |
| Immunisation | Usually not asked | Always ask — affects differential |
| Family history | Standard | Draw a 3-generation pedigree when a genetic/developmental problem is possible; ask sensitively about consanguinity |
| Growth | Not routinely charted | Growth charts are a vital investigation |
| ADL assessment | Barthel index, IADL | "食屙玩瞓" — Eat, Poo, Play, Sleep |
| Communication | Direct with patient | Triadic (doctor-child-parent); age-appropriate language |
| Examination sequence | Standard: I→P→P→A | Modified: inspection first, auscultation while calm, distressing parts last |
High Yield Summary
-
Paediatric history taking differs fundamentally from adult history taking.
- Involve the child and caregiver(s); identify who supplied important facts.
- Begin open, then ask hypothesis-directed questions and a targeted systems enquiry.
- Compare feeding, elimination, play/activity and sleep with baseline.
- Add age- and problem-relevant antenatal/birth, development, feeding, growth, immunisation, family, school and social history.
- End with a synthesis of medical and psychosocial problems, concerns, severity, differentials and next steps.
-
*"Always begin with inspection, sequence of other parts of examination may need to be altered"
- — this principle extends to the entire consultation: the least distressing parts first.
Active Recall - Paediatric History Taking
[1] Past papers: 2023 Fourth Summative Minicase.pdf (Case Two, Section 1) [2] Past papers: 2024 Fourth Summative SAQ.pdf (Question 7) [3] Lecture slides: CFB (PAE01) Paediatric history taking.pdf [4] Senior notes: Adrian Lui Pediatrics Notes.pdf (Chapter 1.1: History Taking and Physical Examination) [5] Senior notes: Maksim Paediatric Notes.pdf (Clinical assessment section) [6] Senior notes: Ryan Ho Fundamentals.pdf (Chapter 1: History Taking) [7] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Diarrhoea: History taking, p330) [8] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Fever: History taking, p90) [9] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Pneumonia: History taking, p163) [10] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (UTI: History taking, p394) [11] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Neonatal jaundice: History taking, p315) [12] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (GDD: History taking, p453) [13] Lecture slides: Block C - A child with loose stool.pdf (p11) [14] Past papers: 2023 Fourth Summative SAQ.pdf (Question 11) [15] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Immunodeficiency: History taking, p640) [16] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Puberty: History taking, p682) [17] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Febrile seizures, p488) [18] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Bleeding: History taking, p595) [19] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Enuresis: History taking, p448) [20] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Asthma: History taking, p180) [21] Lecture slides: GC 142. A child with loose stool.pdf (p5) [22] Senior notes: MBBS Final MB (Pediatrics) (Felix PY Lai).pdf (Seizures: History taking, p478) [23] General Medical Council. 0-18 years: Communication (current professional standards) [24] General Medical Council. 0-18 years: Principles of confidentiality (current professional standards) [25] University College London Hospitals NHS Foundation Trust. Glucose-6-phosphate dehydrogenase (G6PD) deficiency (patient guidance, reviewed 2024)
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