Microsoft PowerPoint - Paediatric history taking Macau Prof Leung use 12 Feb 12

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1 Paediatric History taking, Child health & Immunization 12 February 2012 Leung Ping, Maurice

2 Paediatric History Taking Complete Relevant Built-in analysis (interpretation of signs)

3 Paediatric History Taking Neonatal Infant Preschool School Age Groups 1st 4 weeks 1st year 2-4 years 5-15 years Revelant history Perinatal events Infection, perinatal events, development Infection, development, immunization Infection, behavioural/ learning Adolescent years Puberty 3

4 Paediatric History Taking Onset & related symptoms Precise order of symptoms Changes since the onset Associated symptoms: Fever running nose, cough, diarrhoea Vomiting cough, diarrhoea, intake, urine output 4

5 Paediatric History Taking Associated symptoms Cough breathless, husky voice, stridor Frequency of urine dysuria, bed wetting, volume, character Blocked nose mouth breathing, snooring, skin eczema, recurrent cough 5

6 Paediatric History Taking Onset of present illness Beware of Closely related intercurrent illness ~ febrile illness Over-emphazis on temperature changes over the day Under report chronic illness e.g. wheezy attacks, convulsions Under report multiple symptoms : fever, running nose, cough, vomiting, loose stool 6

7 Paediatric History Taking Need to identity major symptoms Prolonged fever (> 5 days) Convulsions Recurrent cough / wheezy attacks Need to be aware of current endemics 7

8 Paediatric History Taking Different from adult in prsenting symptoms Adult Child Pneumonia fever fever cough vomiting chest pain lethargy UTI frequency fever dysuria vomiting loose stool 8

9 Paediatric History Taking Common confusion by parents Diarrhoea in newborn vs breast feeding stool Chills & rigor vs convulsion Blue discoloration- mottle skin vs cyanosis Vomiting, true vomiting vs cough induced Thick nasal discharge bacterial infection 9

10 Paediatric History Taking Completeness Perinatal (±pre-natal) events Development Immunization Diet Drug history± allergy Family history Social history 10

11 Child Health Physical growth: weight height head circumference 11

30 Nutrition: 110 cal 1kg/day Milk kcal/100ml Vitamins supplement, 6 months 2-3 years Iron supplement Child Health prematurity, dysmaturity Vitamin D??? breast feeding 30

31 Child Health Developmental mile stones: gross motor fine motor social hearing language 31

32 Child Health Development 6 weeks 6 個星期大 Watch and follow your face 看着和注視你的臉孔 Social Smile 社交微笑 Respond to sounds 對聲音有反應

33 Child Health Development 3 months old Make sounds such as gurgling, cooing and babbling 3 個月大發出聲音如咯咯聲咕咕聲和咿呀聲 Support his/her head when you hold him/her in the upright position 在直立姿勢時支撐他 / 她的頭部 Reach out and grasp voluntarily 主動地去拿及抓住物件

34 Child Health Development 6 months old Turns his/her heads to sounds 6 個月大將他 / 她的頭部向聲音方向轉動 Play with his/her hands by touching them together 玩弄他 / 她的雙手, 例如把雙手互雙觸碰 Roll over from supine to prone position 轉身由仰臥轉為俯臥的姿勢

35 Child Health Development 9 months old Sit without support 9 個月大自行坐好 Crawl or creep on his/her hands and knees 爬行 Hold his/her bottle 自行抓緊奶樽飲奶

36 Child Health Development 12 months old Make ma-ma or da-da sounds 12 個月大說出媽媽或爸爸似的聲音 Stand without support and start walking 自行站立及開始學行 Pick up small object with his/her thumb and index finger 用姆指和食指拿起物件

37 Child Health Development 15 months old Waive bye-bye 15 個月大揮手再見 Walk well unaided 自行走路 Hold 3 to 4 cubes with both hands 雙手拿著三至四塊積木

38 Child Health 18 months old Squat to pick object 18 個月大蹲下拾東西 Build tower of 2 to 3 bricks 叠起二至三塊積木 Speak at least five to six single words 說最少 5 至 6 個單字

39 Child Health Development 2 years old 兩歲大 Walk well and seldom fall Walk upstairs, holding onto railing 穩健地行路和很少跌倒抓着扶手行上樓梯 Hold a crayon and scribble freely Used combined words Playing with tea-set, doll and cars meaningfully 握着臘筆塗鴉說出兩個字的組合有意識地玩茶具洋娃娃及玩具車

40 Puberty: changes Tanner staging Girls Menarche 12.8 years Child Health 40

41 Immunization Primary programme local Why immunization given Why at this specific time Complications Concern Differences from overseas 41

42 AGE 年齡 Newborn 初生 1 month 一個月 2 months 兩個月 4 months 四個月 IMMUNIZATION RECOMMENDED 免疫注射建議 BCG vaccine 卡介苗 Hepatitis B vaccine first dose 乙型肝炎疫苗第一針 Hepatitis B vaccine second dose 乙型肝炎疫苗第二針 Pneumococcal vaccine first dose 肺炎鏈球菌疫苗第一針 Infanrix 5in1 first dose 五合一混合疫苗第一針 (Diphtheria, Tetanus, Acellular Pertussis, Inactivated Polio & Hib vaccines) ( 白喉破傷風無細胞百日咳小兒麻痺及乙型流感啫血桿菌混合疫苗 ) Oral Rotavirus vaccine first dose 翰狀病毒 ( 腸胃炎 ) 口服疫苗第一劑 Pneumococcal vaccine second dose 肺炎鏈球菌疫苗第二針 Infanrix 5in1 second dose 五合一混合疫苗第二針 (Diphtheria, Tetanus, Acellular Pertussis, Inactivated Polio & Hib vaccines) ( 白喉破傷風無細胞百日咳小兒麻痺及乙型流感啫血桿菌混合疫苗 ) Oral Rotavirus vaccine second dose 翰狀病毒 ( 腸胃炎 ) 口服疫苗第二劑 6 months 六個月 Pneumococcal vaccine third dose 肺炎鏈球菌疫苗第三針 Infanrix 6in1 third doseinfanrix 六合一混合疫苗第三針 (Diphtheria, Tetanus, Acellular Pertussis, Inactivated Polio, Hib & Hepatits B vaccines) ( 白喉破傷風無細胞百日咳小兒麻痺乙型流感啫血桿菌及乙型肝炎混合疫苗 ) Oral Rotavirus vaccine third dose 翰狀病毒 ( 腸胃炎 ) 口服疫苗第三劑 months 十二至十五個月 18 months 十八個月 2 years 兩歲 2.5 years 兩歲半 6 years 六歲 Pneumococcal vaccine booster dose 肺炎鏈球菌疫苗加強針 MMR vaccine first dose 麻疹流行性腮腺炎及德國麻疹混合疫苗第一針 Chickenpox vaccine first dose 水痘疫苗第一針 Infanrix 5in1 booster dose Infanrix 五合一混合疫苗加強針 (Diphtheria, Tetanus, Acellular Pertussis, Inactivated Polio & Hib vaccines) ( 白喉破傷風無細胞百日咳小兒麻痺及乙型流感啫血桿菌混合疫苗 ) 三型混合小兒麻痺劑加強劑 Hepatitis A vaccine - first dose 甲型肝炎疫苗第一針 Hepatitis A vaccine - second dose 甲型肝炎疫苗第二針 Diphtheria, Tetanus, Acellular Pertussis & Inactivated Polio Booster dose 白喉破傷風無細胞百日咳及小兒麻痺混合疫苗加強針 MMR vaccine second dose 麻疹流行性腮腺炎及德國麻疹混合疫苗第二針 12 years 十二歲 Diphtheria, Tetanus & Acellular Pertussis Booster dose 白喉破傷風及無細胞百日咳加強針

43 Immunization At birth BCG to prevent primary spread of T.B. within body Hepatitis B prevent vertical transmission by mother booster at 1, 6 months? vaccine at 2,4,6, months 43

44 Immunization 2 months, 4 months, 6 months, 18 months Diptheria Tetanus 5 in 1 Pertussis or Polio Inactivated 6 in 1 (+ hepatitis B) Haemophilus Influenza Pneumococcus 13 Roatvirus 44

45 Immunization 1 year Measles Mumps Rubella 45

46 Immunization 1 year 2 years Chicken pox prevent complication of aseptic meningitis pneumonia thrombocytopenic purpura Hepatitis A 46

47 Immunization > 6 months (yearly) Influenza 47

48 Immunization Concerns BCG reaction Autism MMR Guillain Barre Syndrome - influenza 48

49 Immunization Overseas practice Japanese B encephalitis China, Taiwan, Japan Meningococcus C - UK BCG - not done in USA delay in UK Hepatitis B - 2, 4, 6, months in USA 49

50 Thank you

(Microsoft PowerPoint - Paediatric history taking Macau to student 12 Feb 12 Chinese [\260\337\305\252])

$(Microsoft PowerPoint - Paediatric history taking Macau to student 12 Feb 12 Chinese [\260\337\305\252])$ 兒科病史採集兒童健康及疫苗注射 2012 年 2 月 12 日兒科教授梁平醫生 1 兒科病史採集完整相關性內置分式 ( 對記號的理解 ) 2 兒科病史採集新生兒嬰兒幼兒小童青少年年齡群組出生後 4 週內 1 歲 2-4 歲 5-15 歲 13-19 歲相關歷史周產期事件感染, 周產期事件, 發展評估感染, 發展評估, 疫苗注射感染, 行為 / 學習青春期 3 兒科病史採集發病及相關症狀