Childhood illness – assessment and management of primary survey negative children

Chapter 6 Childhood illness – assessment and management of primary survey negative children






Secondary survey


A secondary survey will be required for all children who have not required transfer to hospital following the primary survey (see Chapter 5). Its aim is to fully assess the child so that decisions about their future management and disposal can be safely made. The SOAPC system (Box 6.2) can be used to undertake this survey but is modified to take account of the particular needs of children (see Chapter 5).




Subjective assessment


Most parents and carers will be very sensitive to changes in their children’s health. Consequently, if they express concern about their child’s wellbeing they are often right. It is important to ask parents or carers what they think the matter is and, if appropriate, what treatment they might be expecting. They may relate treatments that have helped the child during similar illnesses, and this will help to identify the parent’s expectations about what they believe is required.


It may be necessary to ask parents what constitutes normal behaviour and appearance for their child, but the patient should always be involved in the discussion. Even toddlers and younger school-age children should be spoken to directly, using language appropriate to their ability to understand. It may be helpful to assess teenagers without parents or guardians present, to encourage them to discuss their illness and any concerns they may have openly.


As well as a detailed history of the presenting complaint, details of past illnesses or operations, medications, and allergies should be sought and recorded, as should the family history. Birth history may also be important, particularly in infants and younger children. On occasion a brief developmental history may also shed light on the problem.


The parents of children with chronic illnesses (such as renal disease) or congenital problems are likely to have considerable expertise about assessment and management of the condition – as indeed may the children themselves. Practitioners should not be dismissive of information provided and suggestions made by ‘expert’ parents and children. It is important to remember, however, that although they be very knowledgeable about their field of expertise, they are likely to know no more than other people about other medical problems.



Objective examination


Before approaching a child directly, it is a good idea to observe their general behaviour (Fig. 6.1). Are they passive or active? Are they playing normally? Do they pay attention to their surroundings?



When approaching a child, their behaviour should be noted. Is this normal for their age group? Have they reacted to your presence (perhaps by hiding behind the furniture)? Consider the child’s general condition – do they appear well cared for, or are they grubby and thin?


The content of the physical examination should be similar to that for an adult, although the order in which each system is assessed may be modified depending on the age and behaviour of the child (see Chapter 5). A cardiovascular, respiratory and abdominal examination should be undertaken as appropriate and opportunistically. There are some aspects, however, that are particularly important to the examination of the child.










Analysis (differential diagnosis) and treatment and disposal (plan)



Common presentations




Abdominal pain


Abdominal pain can also cause diagnostic conundrums. If a child is seriously ill (primary survey positive) he or she should be managed with immediate transfer to hospital and appropriate resuscitative measures. If the child is not seriously ill, the diagnosis can be divided into acute and chronic presentations.


Acute abdominal pain is common. Potential surgical pathology must be excluded and if this is not possible, the child referred for more detailed assessment. Appendicitis may be very difficult to diagnose in small children and must be actively considered. Other serious causes such as intussusception or volvulus may occasionally underlie the acute abdomen. Urinary tract infection must be sought as it often presents non-specifically with abdominal pain with or without urinary symptoms. One of the commoner causes of acute abdominal pain is mesenteric adenitis (acute lymphadenopathy in the abdominal lymph nodes) and a concurrent upper respiratory infection is characteristic. Infective gastroenteritis, Henoch–Schonlein purpura (HSP) and many other disorders all have their own spectrum of associated features and symptoms. If in doubt, refer.


Chronic abdominal pain

Stay updated, free articles. Join our Telegram channel

Jun 14, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Childhood illness – assessment and management of primary survey negative children

Full access? Get Clinical Tree

Get Clinical Tree app for offline access