KEY QUESTIONS FROM THE HISTORY

Breathlessness

• Consider the severity of breathing problems with activities
  
• Poor weight gain in infancy (a sign of respiratory distress)

Cough

• Chronology—any link to time of day/activity/environment
  
• Nature of cough: dry (viral), loose (productive), barking (croup), paradoxical (forced repetitive cough with difficult inspiration, seen in whooping cough)

Feeding in Infancy

• Choking (gastro-oesophageal reflux)
  
• Symptoms with introduction of formula milk (cow’s milk protein allergy)

Fever

Noisy Breathing

• Noise in expiration (wheeze = lower airway obstruction)
  
• Noise in inspiration (stridor = upper airway obstruction)

Cough, Wheeze or Stridor in a Young Child

• If sudden onset, is there a history of inhaled foreign body or choking?

Ear, Nose and Throat

• Child pulling at their ears (middle ear infection)
  
• Difficulty in swallowing (tonsillitis or epiglottitis)
  
• Offensive odour breath (bacterial infection)
  
• Nasal secretions, bleeding

Family History

• Family history of respiratory problems (asthma, cystic fibrosis)
  
• Asthma, eczema, hay fever in close relative (atopy)
  
• Any smokers or pet animals in household?
  
• Travel to area of high tuberculosis prevalence, or contact with infected relative?

KEY QUESTIONS FROM THE HISTORY

Medical Condition Associated with Cardiovascular Problems

• Genetic syndromes involving structural heart defects (e.g. Down’s, Turner’s, Marfan’s syndromes)
  
• Renal problems (hypertension)
  
• Chemotherapy (some drugs cardiotoxic)

Breathlessness

• Breathing difficulties without signs of acute infection (consider cardiac disease)

Exercise

• Exercise limited by shortness of breath, palpitations or chest pain
  
• Competitive sports—rarely these may need to be limited with some cardiac defects

Colour Change

• Cyanosis—central (tongue) or peripheral (hands and feet)
  
• Pale and sweaty, poor perfusion (sign of cardiac failure or an arrhythmia)

Growth

• Feeding problems in babies (breathlessness impairs feeding)
  
• Poor weight gain on growth chart

Syncope

• Unexplained collapse or fainting
  
• Collapse linked with exercise
  
• Palpitations
  
• Ask the parents to demonstrate rate/rhythm by tapping with their hand

Murmurs

• Previously noted heart murmur (physiological flow murmurs sometimes audible only at times of illness or after exercise)

Family History

• Family history of congenital heart disease
  
• Sudden death in early adulthood (congenital cardiomyopathy)