Anamnesa dan PF anak

History

On the basis of the chief complaint, the pediatrician must ask question that help distinguish between common and potentially life threatening entities.

Common complaints

Altered mental status Vomiting Respiratory distress Fever Abdominal pain

Altered mental status

Should inquire about the presence of fever or headache

Screening Q?: Feeding changes Medication in the household Trauma possibility

Lethargic in febrile patients must be differentiated from lethargic child with sepsis or meningitis

Child w/ sepsis or meningitis: May have irritability history And/or inconsolability Not waking up for feeding Poor feeding Grunting respiration Seizures Decreased urine output

Patiens w/ poisoning or inborn error metabolism can also be present with lethargy, poor feeding, seizure and vomiting.

Nonaccidental trauma should always be considered in lethargic infant.

Child w/ meningitis may hv: History of fever Complaints of neck pain Photophobia vomiting

In ingestion can be present: Ataxia Slurred speech Seizures Characteristic constellations of vital sign changes Other physical findings (toxidromes)

vomiting

Vomiting is a very common complaint of intestinal, abdominal (pancreas,liver) or non-GI (hyperammonemia, increased intracranial pressure)

Care should be taken to determine whether the emesis is bilious => suggestive of intestinal obstruction

Other historical data

Presence of abdominal distention Weight changes Presence of diarrhea Obstipation or hematochezia History of trauma Presence of headache

Common causes of vomiting are gastroesophageal reflux and viral gastroenteritis

In infant, bilious emesis and abdominal distention and/or pain are worrisome for obstruction.

Important to consider extra-abdominal causes in neonate e.g: hydrochepalus, incarcerated hernia, inborn errors of metabolism, nonaccidental trauma

In older child, the DD includes: Intussusception (vomiting, colicky abdominal pain

may present) Incarcerated hernia Diabetic ketoacidosis Appendicitis Poisonings Trauma

Patient w/ headache and vomiting, concern for increased intracranial pressure and should be questioned about neurologic changes, meningismus and fever

Respiratory distress

Normal variations in respiratory patterns must be distinguished from true respiratory distress

Ask about associated symptoms such as fever, limitation of neck movement, drooling, choking, stridor ,or wheezing

History of apnea or cyanosis warrants further investigation

Infants with congenital heart defects may be tachypneic but may lack any signs of resp.distress.

In older children with wheezing after coughing or choking episode must be evaluated for a foreign body aspiration.

Stridor is most commonly due to croup

Toxic appearing child w/ resp distress

Check possibilities of: Epiglotitis Bacterial tracheitis Rapidly expanding retropharyngeal abscess (may

present with drooling, limitation of neck movement (esp. hyerextension)

Fever

Most fevers are the result of self limited viral infections

In first 3 months, pathogens that can cause sepsis: Group B streptococcus E. coli Listeria monocytogenes Herpes simplex virus

In neonates, history mus include obstetric information and patient's birth history

Septic infant can present w/: Lethargy Poor feeding Grunting respirations Impaired perfusion fever

Bacterial pathogens in infants above 3months: Streptococcus penumoniae H.influenzae type B Neisseria meningitidis

Other ailments with fever manifestation

Septic arthritis (only one joint, painful and often w/ pseudoparalysis of that joint)

Osteomyelitis Juvenile rheumatiod arthritis (pain, stiffness,

swelling, warmth in several joints) Kawasaki disease

Abdominal pain

Often this symptom is due to a minor illness such as: Constipation Functional abdominal pain Urinary tract infection Gastroenteritis

Ask about: stooling patterns, abdominal distention, fever, urinary symptoms, vomiting.

In neonates,appear ill and tender abdomen is concerning for presence of small bowel obstruction. There may be history of vomiting and decreased or no stooling

Bloody stools can also present in milk protein intolerance but these infants are well appearing and no abdominal tenderness

Diagnosis of appendicitis in the child younger than 3 years is difficult because they do not localize their pain well. Diagnosis is often made after the appendix has ruptured.