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Inquiry of symptoms in pediatrics

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Updated: Wednesday, Apr 28,2010, 3:28:33 PM
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The infantile viscera are delicate, vigorous and fast in development. Under pathological conditions, they are characterized by quick onset, variability and susceptibility to both asthenia and sthenia. So, apart from the usual aspects included in inquiry, the inquiry of symptoms in pediatrics should be done according to the infantile physiological features.

Since diseases in the newborn (from the date of birth to one month after birth) are usually due to congenital factors or delivery conditions, inquiry should be emphasized on such aspects like the health condition of the mother during pregnancy and delivery periods, the contraction of diseases, the drugs taken, whether there was dystocia and immature delivery.

Because infants (one month to 3 years old) develop fast physically and need much more nutrition than adults, while the functions of the infantile spleen and stomach are weak, improper feeding tends to lead to malnutrition, diarrhea,  five kinds of flaccidity and five kinds of retardation. So the inquiry in pediatrics should emphasize the feeding, sitting, crawling, standing, walking, eruption of tooth and learning to speak so as to understand the postnatal nutrition and development of infants.

At 6 months to 5 years of age, infantile immunity obtained from the mother's body gradually disappears while the postnatal immunity has not fully developed. During this period, infants are susceptible to varicella and measles. Preventive inoculation can help infants reinforce their insistence against diseases and reduce contraction of diseases. The contraction of some epidemic diseases, such  as measles, can develop immunity all life. Close contact with-patients suffering from epidemic diseases, such as varicella, erysipelas and liver disease, may result in infection and contraction of the disease in infants. Therefore, the aspects of inquiry mentioned above can be used as important evidences in making diagnosis.

Since the infantile viscera are delicate and weak in  resisting against diseases and regulating functions, they are very easy to be affected by changes of weather and environment and are likely to be attacked by six exogenous  pathogenic factors, thus developing such symptoms like fever, aversion to cold, cough and sore-throat, etc. The infantile spleen and stomach are weak in digestion and are liable to dyspepsia, leading to such symptoms like vomiting and diarrhea. Since the infantile primordial spirit is not sufficiently developed, infants are very easy to be frighted, causing crying and frightened shouting.

Pediatrics was called dumb department in the ancient times. Direct inquiry of the infants is not only difficult, but also inaccurate. So the inquiry in the pediatrics should be done with the parents, or by inspection, olfaction and listening. The following is a brief introduction to the main points.

Infantile crying: Infantile crying refers to incessant crying in the daytime and night, or sudden crying with fright, even with changes of the facial expression, usually caused by asthenic cold in the spleen meridian, accumulation of heat in the heart meridian, weakness of the heart function and retention of food, etc.

Five kinds of infantile stiffness: Infantile stiffness refers to stiffness of the head and neck, hands, feet, chest and waist as well as muscles, usually due to congenital defects, coagulation of cold and wind as well as predominant liver subjugating the spleen.

Five kinds of infantile retardation: Five kinds of infantile retardation refer to retardation in standing, walking, growth of hair, eruption of teeth and speech, usually caused by congenital defects, asthenia of kidney essence, or postnatal malnutrition and weakness of the spleen and stomach, etc.

Five kinds of infantile flaccidity: Five kinds of infantile flaccidity refers to the flaccidity of head and neck, mouth, hands, feet and muscles, often resulting from congenital defects or postnatal malnutrition, or improper feeding after illness and asthenia of qi and blood.

 Inquiry of ananmesis

Anamnesis, also known as history of past illness, mainly includes the constitution of the patient and previous contraction of diseases.

 Inquiry of past physique
 
The past physique of the patient may be relevant to the present illness. For example, if the physique is usually strong, the disease is often sthenic; if the physique is usually weak, the disease is often asthenic; if yin is often in asthenia, the disease is usually of heat syndrome due to the susceptibility to the invasion of pathogenic febrile and dry factors; if yang is often in asthenia, the disease is usually of cold syndrome due to susceptibility to the invasion of cold and dampness.
 
Inquiry of previous illness

Inquiry of previous illness includes the category, relapse, present treatment, present manifestations and relation with the present illness.

Besides, inquiry of previous illness should also includes contraction of dysentery, malaria, diphtheria and measles, inoculation, allergy and operation.

  Inquiry of family history

Inquiry of family history includes the health of the parents, brothers and sisters, spouse and children who are living together with the patient. If necessary, inquiry of family history should also include the cause of the death of the directly-related family members. Because some hereditary diseases are closely related to ties of blood; some epidemic diseases, such as pulmonary tuberculosis are caused by contact in daily life.
 


Tags: Pediatrics Symptoms

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