Pediatric Co-Morbidities in the ED

When assessing a child in the emergency department, a focused but thorough past history helps you understand baseline risk, likely complications and medication interactions. Use the prompts below to guide your questions about common paediatric co-morbid conditions.

Asthma

• Age of onset and how often they have attacks.
• Known triggers (infections, exercise, allergens, smoke exposure).
• Current controller and reliever medications (inhaled steroids, LABA, montelukast, SABA).
• Correct inhaler / spacer technique and adherence.
• Previous ED visits, admissions or ICU/intubation for asthma.
• Any recent increase in reliever use or night-time symptoms.

Congenital or Structural Heart Disease

• Exact diagnosis (if known) and any surgeries or interventions (e.g. shunt, repair, stent).
• Ongoing symptoms: cyanosis, poor feeding, sweating with feeds, exercise intolerance, syncope.
• Current medications (e.g. diuretics, ACE inhibitors, anticoagulants, anti-arrhythmics).
• Last cardiology follow-up and any restrictions (activity, fluid, medications).
• Baseline saturations if cyanotic heart disease (important for triage interpretation).

Diabetes (Type 1 mainly)

• Age at diagnosis and type of diabetes (Type 1 vs other).
• Insulin regimen (basal-bolus / premix / insulin pump) and typical doses.
• Recent glucose control (frequent hypo/hyperglycaemia, HbA1c if known).
• History of diabetic ketoacidosis (DKA) or severe hypoglycaemic events.
• Ability of child/caregiver to recognise and treat hypo/hyperglycaemia.
• Associated autoimmune conditions (thyroid disease, coeliac, etc.).

Epilepsy

• Seizure type(s) and typical duration/recovery pattern.
• Known triggers (fever, missed doses, sleep deprivation, flashing lights).
• Regular anti-epileptic drugs, doses and adherence.
• Recent change in seizure frequency or pattern.
• History of status epilepticus or ICU admissions.
• Developmental history and school/academic progress.

Developmental and Neurobehavioural Disorders

Includes Autism Spectrum Disorder, ADHD, global developmental delay, learning disorders.

• Developmental milestones (gross motor, fine motor, speech, social).
• Formal diagnoses and current supports (OT, speech, psychology, special schooling).
• Sensory sensitivities or behavioural triggers relevant to ED environment.
• Communication needs (non-verbal, picture boards, parent acting as interpreter).
• Current medications (e.g. stimulants, antipsychotics, mood stabilisers).

Growth and Nutritional Concerns

• Feeding history: breastfeeding, formula, solids introduction, picky eating.
• Any known food allergies or intolerances.
• Documented concerns about poor weight gain or obesity (growth chart if available).
• Chronic conditions affecting nutrition (CF, CHD, chronic diarrhoea, coeliac, HIV).
• Vitamin or micronutrient supplementation.

Genetic and Chronic Conditions

Examples: Down Syndrome, Cystic Fibrosis, Sickle Cell Disease, neuromuscular disorders.

• Specific diagnosis and main systems affected (cardiac, respiratory, neurological, etc.).
• Baseline functional status (mobility, feeding, communication).
• Regular specialist follow-up (cardiology, neurology, pulmonology, genetics).
• History of recurrent infections, hospitalisations or ICU admissions.
• Any advanced care plans or documented treatment limitations.

Previous Surgeries or Hospitalisations

• Major operations (especially cardiac, abdominal, neurosurgical, orthopaedic).
• Any post-operative complications or prolonged ICU stay.
• Hospitalisations for severe infections, respiratory failure, seizures, DKA, trauma.
• History of intubation and mechanical ventilation.

Immunization Status

• Check the Road-to-Health booklet or other records if available.
• Confirm whether the child is up to date with the South African schedule.
• Ask about delayed or missed vaccines and reasons (access, hesitancy, illness).
• Special considerations: immunocompromised status, splenectomy, chronic disease.