The history and examination is very important and guides further management including investigations and their interpretation. Open probing questions are needed about what has been noticed and what are the concerns. Be aware of non-verbal clues or indicators of discomfort.
Ask about any injury? Remember that minor trauma is common and may be a ‘red herring’. Consider non-accidental injury.
Be aware of normal major motor milestones and normal development. Enquire about change – has there been any regression or is there delay?
Difficulties at school, within the family or in peer groups may be relevant especially in the child with pain with no apparent pathology or disproportionate functional change or pain.
The findings of pGALS and pREMS need to be interpreted in the clinical context. Examination of other systems is often indicated e.g. neurological, development, abdominal.
For children with chronic conditions it is important to assess growth and pubertal development.
Hypermobility is common and is not always symptomatic.
Normal variants are common but do not usually cause pain, swelling or functional limitations.
Growing pains do exist but need careful consideration so as not to miss pathology.
Children are different to adults and it is important to be aware of differences.
Please note: a pdf document of these Top Tips is also available here.
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