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Pediatric rehabilitation encompasses a wide variety of conditions, from neurologic disorders to musculoskeletal abnormalities that affect growth and development. Developmental delay, specifically in gross and fine motor activity, is a common concern of parents and caregivers; thus an understanding of normal growth and developmental patterns is essential (Table 20–1). Causes of developmental dysfunction in motor and cognitive skills range from congenital and genetic abnormalities to acquired illnesses and injuries of the neurologic and musculoskeletal systems. A thorough history and examination is key to diagnosis and management. Goals for habilitation or rehabilitation will depend on the child’s age and development.
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GENERAL CONSIDERATIONS IN PEDIATRIC EVALUATION
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In the evaluation of pediatric patients, the importance of the chief complaint and reason for the visit cannot be overemphasized. Traditionally part of the basic history, this component is sometimes omitted or inferred by time-pressed providers. Of similar importance are the parents’, caregiver’s, or patient’s goals and expectations, which will shape the direction of later care and management.
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In addition to obtaining past medical and surgical histories, the examiner should explore the patient’s birth history. Information about prenatal care, maternal illness or conditions, medications, mode of delivery, age of gestation at delivery, and any perinatal and postnatal complications (including treatment course in the neonatal intensive care unit [NICU]) can provide important clues that may help in the differential diagnosis. Queries should be made regarding developmental milestones and functional abilities, including the age at which milestones were achieved, delays, and any skills that were lost or have regressed (see Table 20–1). Relevant information from the family, personal, and social history, including concerns relating to school performance and social interactions, medications and allergies, and immunizations, should be noted.
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