How to use Observation, Olfaction, Inquiry\Auscultation, and Palpation in Paediatrics. (part 12)

Hey, so in the last blog, I've written on basic criteria to look for in Olfaction and today I'm touching on INQUIRY with all the important points.  This is How to use Observation, Olfaction,  Inquiry\Auscultation,  and Palpation in Paediatrics(part 12).

INQUIRY

There are 5 main points to check for in carrying out clinical inquiries, namely;

• Patient's condition
• Patient's age
• Patient's medical history
• Patient's vaccination history
• Patient's genetic history

Patient's condition

This category stipulates 2 criteria linking the following:

• Age group: infant to preschooler

• Child's Heat/Cold virus invasion check

Heat invasion 

The common method to check for Heat invasion or body temperature is 

• By mean of a clinical thermometer

• Using the feel of body temperature via physical contact on:

• Forehead  temperature
• Palm and sole temperature in TCM perspective
• Feel the mouth cavity is much hotter than normal during breastfeeding

Cold invasion

As for the 6 months old infant, if invaded by the cold virus, the usual phenomenon is the change in posture such as snuggle up in the mother's arm or curl up to sleep if feeling cold. 

As for toddlers to 12 years old, the direct inquiry is appropriate if the child can transpire the correct complaint of, otherwise the next best inquiry is directed to the parents.

The main reason is the special characteristics of the child's virus invasion in which the condition is subsided in the morning and gradually become more severe as the night approaches.  So the right moment to inquire is important, taking into consideration, which period of the day is a factor.

Perspiration

It is a fact that the infant's skin is much thinner than the adult and therefore perspire more which is considered not pathological.   However, if the sweating is more in the day or perspires more when the body moves, are termed spontaneous sweating.

This condition means Qi deficiency due to Wei Qi unable to build up the strong defence mechanism as yet in this infancy stage in the TCM perspective.

There is a common phenomenon that happens among babies which is night sweats.  These are severe hot flashes occurring in the sleep during normal, not the overheated environment. This kind of night sweat is due to Yin deficient or Qi Yin both deficiency as well in TCM perspective.  Like I mentioned before in the previous blogs, sweating or perspiration is supposed to regulate the body temperature, so if after excessive sweating, the body temperature remains high, then the child or infant needs to see a doctor.

Headache and Body Ache 

As for children from preschooler onwards, they can complain of headaches and giddiness which are common symptoms for anaemia and high fever.  The new term called fever with limb pain is caused by cold, wind, wetness and heat virus invasion in the TCM perspective.

Diet 

This comprises of food consumption and drinks water; the infant must eat daily food on time with a normal appetite not causing vomiting or diarrhoea to be considered as a normal condition.

Otherwise, the following are the pathological conditions:

1. If there is a loss of appetite coupled with consuming less food= weak spleen and stomach digestion
2. If fond to take cold drinks=heat invasion
3. Alternatively, fond to take hot drinks=cold invasion
4. Frequent thirsty coupled with dry lips=stomach Yin deficiency with loss of body fluid
5. Frequent thirsty with no desire to drink= wetness concentrated in Zhong Jiao(abdomen)

Chest and Abdomen

This is commonly applied to all from infant to adolescent:

1. Feeling very stuffy coupled with phlegm wheezing in the upper respiratory tract catching a short breath=asthma
2. Chest pain with fever, cough and breathing difficulty=pneumoniatic cough
3. Abdominal fullness and bloated=indigestion and stagnation
4. Intermittent abdominal pain around the tummy button=ascariasis (roundworm infection)

Defecation and Urine

Normally, inquiries on defecation and urine include the following:

• frequency
• texture and 
• colour of the turbidity

1. Whenever there is an increase in the defecation frequency, the texture turned diluted and thin or sticky would be classified as pathological conditions.
2. When the quantity of urine is more and clear coupled with nocturia(Urinates in the night)=kidney's Yang deficiency.
3. So the urination frequency is more coupled with pain=wetness and heat concentrated in the abdomen.
4. When the urination is getting more painful and dripping endlessly or passing out sandy urine=stone in the urinary system.

Sleep

Under normal conditions, a healthy baby must have a quiet sleep as best;  the younger is baby, the longer is the sleeping time.  

Once somnolence and hypersomnia** occur, the most probable cause is either heat and fire virus invasion has penetrated the pericardium or phlegm has overcrowded to cause this confusion syndrome of the brain in the TCM perspective.
Please turn to my blog on pericardium and browse through quickly.
Restless sleep in children development usually caused by pinworms infection in which there is an itchy area around the anus.

Patient's age

It's a fact that Pediatrics is strongly related to the patient's age:

• fetal yellow, 
• umbilical wind, 
• umbilical cord blood, 
• umbilical sore 

are related to the one-week-old new neonate.

• Oral thrush or candidiasis
• Umbilical cord stump
• Night cry

are related to one to six months old infants. 

However, Enuresis occurs only from 3 years old above.

Measles, chickenpox and rashes are related to children from 6 months old to 12 years old.

Any infectious diseases after 12 years old are related and similar to the adult.

Patient's medical history

This category includes the following:

• Delivery history
• Feeding history
• Physiological development history

Delivery history

It is comprised of the following:

• Parity Assessment
• Full-term pregnancy or not
• Normal delivery
• Dystocia
• Abortion
• Place of birth
• Birth delivery status
• Nutrition status and health care during pregnancy

Feeding history

It comprises of the following:

• Feeding methods
• Supplementary food addition
• Whether weaned or not
• After weaned status

Physiological development history

It comprises of the following:

• Physique 
• Mental development

Patient's vaccination history

It's a historical record of the child's parents registered the various vaccination schedule available in the country.  I'll name you a few now:

• BCG
• Live attenuated measles vaccination
• Tetanus
• Japanese encephalitis

Patient's genetic history

It's a fact that many diseases are closely related to genetic inheritance.  This is a historical record of the health status of all immediate family members and whether are there any genetic inheritance issues.  I'll list a few genetic issues here:

• Bronchial asthma
• Haemophilia
• Close relatives inter-marriage
• Low intelligence

 
Best of all

Xiong

 ***Reference:

( Emperor's Interior Sutra is available on sales better known as the esoteric scripture of the yellow emperor in Amazon, it's just a different way of naming the book cover)