The Pediatric Pulmonary History

Christopher Harris, MD, FAAP

History of Present Illness

The medical history for pulmonary concerns may differ from a routine history because there is often a waxing and waning or a recurrent aspect to respiratory diseases in children. Elements of particular importance include

•Attention to the timeline of events

•Occurrence, timing, and relative severity of symptoms

•Past therapies and previous responses to them

Primary Concern

•Ask parents and care providers about the reason for the visit.

•If the patient is an older child or adolescent, make sure to ask him or her about the primary concern.

•The history may include the duration of the symptom or problem.

Presenting Problem or Symptom

•Onset (gradual vs sudden)

•Duration (acute vs chronic)

•Recurrence or persistence (Are there symptom-free intervals?)

—Is there a specific time of day when symptoms appear or worsen?

—Is there a seasonal appearance or recurrence of symptoms?

•Are there obvious physical findings when the symptom is present?

—Retractions or accessory muscle use

—Nasal flaring

—Shortness of breath or impaired ability to speak, eat, or cry

•Factors that worsen or improve the symptom

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