Children who present with neurological problems or developmental abnormalities on general physical examination should undergo a complete neurological assessment.1,2
Initially, as much information as possible from the parents or caregivers should be obtained during the first visit. During the initial clinical encounter, the examiner should formulate an opinion regarding possible causes (Table 1-1). A diagnostic hypothesis can then be confirmed, supported, or rejected by the neurological and physical examinations, laboratory tests, and other tests. A clear chief complaint is probably one of the most important first steps, and is best elicited from the child, parents, or caretakers. It is common that school-age children may often provide their own chief complaint. The chief complaint should represent the exact words or expression of the child or parent and not a reinterpretation of the symptoms by the physician. Ideally, the child or parent should be allowed to freely tell the story without interruption or distractions. However, brief directed questions can help focus the interview, especially if the history begins to wander. It is important to note that one should be certain that interrupting will not result in suppression or skewing of important information and the parent's concerns.
Table 1–1. Tips for Examining Poorly Cooperative Children3 |Favorite Table|Download (.pdf)
Table 1–1. Tips for Examining Poorly Cooperative Children3
|During history taking||Keep the child next to the parent. Observe the child carefully. Smile, be friendly, and maintain eye contact. Avoid wearing the white laboratory coat. Start interacting with the child|
|Beginning of interaction||Present a toy or a lollipop. Keep hands off; use observation. Keep the younger child in the mother's lap. Let the parents do the undressing. Try not to show all your tools|
|During examination||Start with the most relevant system. Be focused. Use your observational skills, starting with gait. Demonstrate some testing on the parents. Leave threatening or painful tests to the end|
|During procedures||Invite parents to attend. Prepare child and parent for their roles. Use the treatment room, with adequate pain control. Position the child in a comfortable manner. Maintain a calm and positive atmosphere.|
Information related to the timing of the onset of symptoms (acute, progressive, and chronic) should be obtained. It is also important to develop optimal rapport with both the parents and child. An environment that is both child friendly, free of distractions, and age appropriate will help to facilitate an ambience of ease for both child and parent. Parents are quick to pick up on a hurried care-provider, so allowing at least 1 hour or more for a new consultation and at least 30 minutes for follow-up visits is important to keep in mind. Additional questions such as precipitating factors or triggers, past or concurrent illnesses, toxic exposures, sick contacts, travel history, and changes in mood ...