History

An infant or young child cannot give a complete history, but if the child is verbal, one should try to get historical information from him or her and then obtain and listen carefully to what the parent or caregiver says. Find out the accurate chronology of events, whether fever has been a part of the illness, the quality and location of pain, feeding and bowel habits, and the quality and quantity of vomiting and bowel losses. Inquire whether bleeding has been present in vomitus or stools. Ask about weight changes. A history of prematurity, necrotizing enterocolitis, congenital anomalies, inborn errors of metabolism, cystic fibrosis, intussusception, or sickle cell anemia are all associated with abdominal complications.

Unfortunately, because some children either are too young or too frightened to speak for themselves or have not been under continuous observation, trauma as a factor in the development of a GI emergency may be missed in battered or abused children. A parent or caregiver may mislead and confuse a physician by evasion and lies. Trauma must always be considered by physicians evaluating pediatric patients presenting with what appears to be an abdominal emergency.

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