--- module: 070-02 language: en chapter: 70 title: "Child Growth, Development, Paediatric Assessment, and Longitudinal Care" module_title: "History, examination, diagnostic strategy, differential diagnosis, and common disease" source_sha256: 3b52024f230cc7adf657318316a08bfea648de44818fe95b290fee1859d69f12 --- # Paediatric history, examination, and diagnosis ## Observation-first strategy ### Observe before contact #### Interaction, colour, breathing, posture, cry #### Reveals severity, minimises distress ### Age-specific probability, serial examination ### Low escalation threshold with limited reserve ## Layered history ### Symptom, onset, intake, urine, stool, sleep ### Birth, growth, development, vaccination ### Confidential adolescent psychosocial assessment ### Caregiver concern is diagnostic #### Sleepy, inconsolable, not interacting #### Ask concrete comparison with baseline ### Feeding history #### Supply, technique, oral-motor, cardiac, pain #### Blame impairs accuracy and care ## Severity by age-appropriate physiology ### Full-interval respiratory rate, correct cuff ### Normal ranges shift with age, sleep, fever ### Trends and work of breathing over thresholds ### Respiratory distress signs #### Recession, flaring, grunting, head bobbing #### Quieter child, falling rate: may be worse #### Normal saturation does not assess ventilation ### Hydration integrates many signs #### Turgor unreliable in malnutrition, obesity #### Sunken fontanelle nonspecific ## Fever by age, source, appearance ### Very young infants: invasive bacterial risk #### Urine, blood, sometimes CSF, empirical treatment ### Older children: seek a focal source #### Urinary infection may be fever alone #### Bag urine contamination-prone ### Infant meningitis may lack neck stiffness #### Do not delay antibiotics for lumbar puncture #### Defer puncture if unstable or high pressure ### Kawasaki disease: prolonged fever, coronary risk #### Features evolve, not simultaneous ### Post-infectious multisystem inflammation ## Respiratory disease and failure ### Bronchiolitis: clinical, supportive care #### Routine radiography, antibiotics cause harm ### Croup: barking cough, inspiratory stridor #### Steroids reduce severity #### Adrenaline temporary, observe recurrence #### Drooling, tripod posture: other diagnoses ### Asthma: variable expiratory limitation #### Silent chest signals critical obstruction ### Pneumonia: radiograph cannot identify pathogen #### Effusion, persistent fever widen imaging ## Gastrointestinal and surgical ### Gastroenteritis red flags: bile, blood, peritonism #### Small frequent oral rehydration, keep feeding ### Intussusception: classic triad uncommon #### Ultrasound diagnoses, enema can treat ### Malrotation with volvulus: rapid ischaemia ### Appendicitis presents late in young children #### Torsion, ketoacidosis, pneumonia mimic ### Constipation usually functional #### Red flags: delayed meconium, poor growth #### Incontinence may be overflow, not misbehaviour ## Growth, anaemia, chronic symptoms ### Growth faltering: verify measurements #### Intake, losses, absorption, demand, use #### Targeted tests, systemic clues justify ### Iron deficiency impairs development early #### Ferritin rises with inflammation ### Coeliac: varied or no gut symptoms #### Serology needs adequate gluten exposure ### Neonatal jaundice by age in hours #### First-day or rapid rise needs urgent review #### Unconjugated bilirubin crosses immature barrier #### Conjugated jaundice never physiological ## Neurological and musculoskeletal danger ### First seizure: exclude mimics, check glucose ### Status epilepticus needs timed treatment ### Febrile seizures usually benign ### Headache red flags #### Abrupt onset, focal deficit, papilloedema #### Morning vomiting, positional change ### Limp: trauma, infection, malignancy, abuse #### Fever, restricted passive movement: infection ## Safe discharge and reassessment ### Adequate hydration and breathing ### Reliable caregivers, access to return ### Concrete warning signs ### Uncertainty lowers reassessment threshold