What questions should be asked when evaluating a pediatric patient?

Key Questions in Pediatric Patient Evaluation

A comprehensive pediatric evaluation should include age-appropriate questions about physical symptoms, developmental milestones, psychosocial factors, and trauma history to identify potential health concerns that affect morbidity and mortality.

General Health Assessment

Medical History

• Current symptoms and concerns
  • Duration, frequency, and severity of symptoms
  • Aggravating and alleviating factors
  • Associated symptoms
• Past medical history
  • Previous illnesses, hospitalizations, and surgeries
  • Birth and perinatal history
  • Immunization status
• Family history
  • Hereditary conditions
  • Family members with similar symptoms

Physical Symptoms Assessment

• Specific system-related questions based on presenting concerns:
  • Respiratory: Coughing, wheezing, shortness of breath, snoring, sleep apnea 1
  • Gastrointestinal: Vomiting, diarrhea, constipation, abdominal pain, changes in appetite
  • Neurological: Headaches, dizziness, seizures, changes in consciousness
  • Musculoskeletal: Pain, limited movement, swelling (note that back pain in children warrants thorough evaluation as it's less likely to be non-organic) 2

Growth and Development

• Height, weight, and head circumference measurements
• Developmental milestones appropriate for age
• School performance and learning difficulties
• For infants: Feeding patterns, sleep patterns, developmental progress

Age-Specific Assessments

Infants and Young Children

• Feeding history (breast/bottle, introduction of solids)
• Sleep patterns
• Developmental milestones
• Elimination patterns (urination and bowel movements)
• For children with enuresis: Frequency of bed wetting, presence of daytime symptoms, voiding patterns, and bowel habits 1

School-Age Children

• School performance and attendance
• Peer relationships
• Physical activities and exercise
• Screen time and media use
• Sleep patterns and quality

Adolescents

• Use the HEADSSS framework for psychosocial assessment 1:
  • Home environment
  • Education and employment
  • Eating habits
  • Activities with peers
  • Drugs (substance use)
  • Sexuality
  • Suicide/depression risk
  • Safety concerns

Mental Health Screening

Depression and Suicide Risk Assessment

• Direct questions about mood changes, loss of interest in activities
• For suicide risk assessment, ask: "Have you ever thought about killing yourself or wished you were dead?" followed by "Have you ever done anything on purpose to hurt or kill yourself?" 1
• If positive responses, obtain more details about:
  • Nature of thoughts and behaviors
  • Time frame and intent
  • Suicide plans ("If you were to kill yourself, how would you do it?")
  • Access to lethal means (especially firearms)

Trauma Assessment

• Ask "Has anything scary or concerning happened to you or your child since the last visit?" 1
• Look for trauma-related symptoms:
  • Sleep disturbances
  • Hyperactivity, inattention, difficulty completing tasks
  • Emotional lability
  • Aggressive behaviors
  • Somatic complaints (headaches, stomachaches)
  • Changes in school performance 1

Special Circumstances

Brief Resolved Unexplained Events (BRUE)

For infants with possible BRUE, ask about:

• Duration of the event (< 1 minute for BRUE classification)
• Color changes (cyanosis, pallor)
• Breathing changes (apnea, choking)
• Tone changes (limpness, stiffness)
• Level of responsiveness during the event
• Need for resuscitation 1

Liver Disease Concerns

When liver disease is suspected, inquire about:

• Poor weight gain or growth failure
• Jaundice
• Abdominal distension or pain
• Easy bruising or bleeding
• Changes in stool or urine color
• Pruritus
• Changes in mental status 3

Infection Control Screening

During infectious disease outbreaks or seasonal illness periods:

• Recent travel history
• Exposure to individuals with specific infections
• Presence of rash or respiratory symptoms 1

Practical Approach

1. Begin with open-ended questions: "What brings you in today?" or "How has your child been doing?"
2. Follow with targeted questions based on presenting concerns
3. Include age-appropriate developmental and psychosocial screening
4. Always assess for red flags that might indicate serious illness
5. For adolescents, ensure confidentiality when appropriate while explaining its limits

Common Pitfalls to Avoid

• Failing to speak directly to the child when age-appropriate
• Missing trauma history by not asking specifically about adverse experiences
• Dismissing parental concerns, as parents often detect subtle changes in their children
• Overlooking psychosocial factors that may impact physical health
• Not recognizing that back pain in children, unlike adults, often has an organic cause 2
• Failing to recognize that children may not complain of symptoms when there is no organic cause 2

Remember that pediatric patients span from birth through young adulthood, and the approach should be tailored to the patient's developmental stage while considering both physical and psychosocial health 4.