History

• Introduction
  • Name and DOB of child
  • Confirm relation of person you’re speaking to and how they want to be addressed
• PC + HPC
  • Systems Review
    • General → fever, behaviour, activity, rashes. (FLAWSNV)
    • CardioResp → cough, noisy breathing, dyspnoea, cyanosis.
    • GI → vomiting, abdominal pain, diarrhoea.
    • GU → wet nappies, dysuria, frequency.
    • Neuro → seizures, headaches, abnormal movements. (HNV, LOC, Sensory/Motor Changes).
    • ENT → sore throat, snoring, noisy breathing, earache.
• ICE
• BINDS (Younger) / HEEADSSS (Adolescents)
  • BINDS
    • Birth History
      • Antenatal → how was pregnancy? any complications?
      • Delivery → gestation? mode of delivery? complications at delivery? birth weight? (GMC)
      • Postnatal → well after birth? admission to special baby care unit (how many days were they in hospital after they were born)?
        • Heel-Prick? Passed Meconium?
    • Immunisations → are they up to date with all their vaccinations?
    • Nutrition
      • Eating and Drinking → appetite normal? feeding less than half of what they normally would? bottle-fed or breastfed?
      • Bowels and Bladder → weeing as normal? how many wet nappies per day? pooing as normal, how many per day?
      • General Manner + Sleep → how are they otherwise? more tired than usual? crying more than usual? before this, how were they generally? how was their sleep?
    • Development → how have they been in terms of development? has anyone ever had any concerns about their development? are they following their centiles? do you have red book with you?
    • Social Services → this is a question we ask everyone, but are you or anyone in the family known to social services?
  • HEEADSSS
    • Home and Relationships → who is at home? what are the relationships like? divorce?
    • Education and Employment → going to school? stress? friends? bullying?
    • Eating → stress from eating habits? weight or body shape changes?
    • Activities and Hobbies → any hobbies? meet with friends? time spent on TV/internet?
    • Drugs and Drinking → do you, your friends or family, use tobacco, alcohol or drugs?
    • Sex and Relationships → been in a relationship before? currently in a relationship?
    • Suicide, Self-Harm, and Self-Image → low mood? stressed? previous/current thoughts of self-harm or suicide.
    • Safety and Abuse → violence at home or school?
• PMH
• DH
• FH
• SH

Suspecting NAI

• Suspect → any injury to a child that is not independently mobile, frequent admissions to A&E, multiple fractures/bruises, fractures in unusual places.
• Risk Factors → history of domestic violence? substance abuse or mental health condiitons? unintended pregnancy? excessive crying? developmental problems?
• Work Up → imaging: skeletal survey and neurological imaging. Escalation: early senior involvement and safeguarding lead, admit to ward as place of safety. If abusive trauma refer to opthalmology for retinal haemorrhages.

Investigations

• Bedside → top-to-toe exam (with specific system focus), hydration status, plot weight and height growth chart. Observations (HR, RR, BP, Temp, O2). Urine/Stool Sample. Capillary blood glucose.
• Bloods → septic screen (FBC, CRP, Cultures, VBG for Lactate).
• Imaging → CXR, Abdominal USS, CT Head.