History Taking

Difficulty in breathing
Yani Dewi Suryani
Pediatric Departement
GENERAL OBJECTIVE
After finishing skill practice, the students will able to perform history taking of
difficulty breathing in children in order to make a differential and proper diagnosis.

SPECIFIC OBJECTIVE
At the end of this skill practice, the students will be able to understand the systematic
information gathering from pediatric history taking and physical diagnosis about
difficulty breathing in children.

EXPECTED COMPETENCIES
a) Students will be able to demonstrate procedure of pediatric history taking,
especially about difficulty breathing in children.
Procedure
1. Say Basmalah
2. Greet parents and introduce your self
3. Explain the procedure and its goals to the patient.
4. Ask for informed consent

Preparation
5. Should be taken in an environment with comfort and privacy for patient
6. Record patient identity (name, adress, body weight)
Structure of history taking (auto/ allo-anamnesis)
7. Chief complaint :
Difficulty of breathing
• The onset and duration
• Is it spontaneously or after some specific event?
• Enquires if this is a first episode or a recurrence?
• Progresivity
• Symptoms should be defined by their qualitative and quantitative
characteristics (aggravating and alleviating factors associated
manifestations)
• The relation between respiratory symptom and daily activities, diurnal
variation, food intake
• To know whether other family members also affected
8. Common signs and symptoms of pediatric respiratory disease
Cough
Fever
Noisy breathing - Wheezing - Stridor
Dyspnea on exertion or rest
Cyanosis
History of chocking
Allergies
Medications
9. The Birth history should be reviewed including prenatal, natal and neonatal
10. Feeding history (the amount, type and schedule food intake)
11. Growth and development
12. A detailed report of prior tests and immunizations should be obtained
13. Say Hamdalah
14. Conclusion with Differential Diagnosis
 DD/ Difficult in breathing
• Breathing difficulty with anxiety : • Breathing difficulty with difficulty swallowing:
Panic attack, Hyperventilation, Asthma Allergic reaction, Upper airway infection
• Breathing difficulty when lying flat: • Breathing difficulty with exertion:
Congestive heart failure Congestive heart failure, asthma
• Breathing difficulty while eating: • Breathing difficulty with fever:
Choking, Aspiration pneumonia Bronchitis, Pneumonia
• Breathing difficulty with chest pain: • Breathing difficulty with hives:
Pneumothorax, Pleuritis Allergic reaction,
• Breathing difficulty with cough: • Breathing difficulty with nausea:
Pneumonia, Bronchitis, Bronchiolitis, Asthma Congenital heart disease
• Breathing difficulty with a croupy cough: • Breathing difficulty with wheezing:
Croup, Epiglottitis Bronchitis, Asthma, Bronchiolitis
• Breathing difficulty with difficulty speaking: • Breathing difficulty upon waking:
Allergic reaction, Upper airway infection Congestive heart failure, Asthma