Illness questionnaire

Pre-consultation Questionnaire for Parents regarding the Child’s Condition

Physician's Objective Examination of the Child. Diagnosis, day of illness, circumstances. Examination results—general condition, skin, hydration, throat/tonsils, otoscopy, nasal breathing, breath sounds in the bronchi and lungs and their character, bowel movements. If there is a dry cough and a temperature above 38°C lasting longer than 5 days, laboratory tests and/or a chest X-ray must be performed by your family doctor to clarify the diagnosis

Signs observed by parents – (signs present only during the illness)

1. Screaming, demanding, crying, whining, expressing fear, biting, constantly walking around, being overly talkative, calling people over.

2. Skin color and condition - pale, flushed, bluish, mottled (patchy), presenting with a rash (what kind, where?), sweating.

3. Characteristics of fever - sudden or gradual onset; during the fever, does the child uncover themselves or ask for a blanket? Do they want someone by their side? Are they sweating (where, and does the sweat have a specific odor)? At what time did the temperature rise?

4. Thirst - does not ask for a drink / drinks rarely, or drinks frequently? Prefers ice-cold or warm drinks? Gulps it down all at once or takes small sips? Prefers sour or sweet flavors? Drinks more at night or during the day?

5. Bowel Movements - loose/watery or hard; what does it smell like? Contains undigested food particles? Quantity and color?

6. Pain and Secretions - Which side did the pain start on, and did it move to another side or body part? Does the child hold the painful area, or do they refuse to be touched? Is there pain when coughing, or pain in the ear? Any discharge (purulent/pus-like, clear, white, green)? Did it start after an injury (where, what kind, due to what)? What improves the pain, and when does it worsen?

7. Cough - Dry, wet/productive, accompanied by nausea or vomiting? At what time is it better or worse? What brings relief (e.g., a warm drink)? Which posture is best (sitting, lying down, walking)? What color is the phlegm/mucus? Any blood present? Is it better indoors or in the fresh air? Does the child cry during coughing? Do the nostrils flare or does the abdomen move intensely while coughing? Face color during coughing? Any other actions while coughing (rubbing the face, sneezing, accidental wetting/urination)? Is there hoarseness, watery eyes, sleepiness, or frowning?

8. Sleep - In what position do they fall asleep? How do they wake up? Nightmares, hallucinations, screaming, moaning, bedwetting, talking in sleep, teeth grinding, or sudden twitching/startling?

9. Cause of Illness ( triggers ) - injury, following a fright/scare, after being scolded, after exposure to cold wind, after overheating in the sun, lack of sleep, or after swimming in cold water.

Dear Parents - go through this checklist the first couple of times, and after that, it will become second nature to share these observations even before asking - what should I do?