Clinical approach
Clearly there is need to approach this as with any other child with an intercurrent illness but specific factors to consider in the recent history:
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VP shunt – Are there any signs of raised intracranial pressure such as headache, vomiting, new or different seizure activity, irritability or drowsiness?
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UTI – Is there a history of fever, recent fluid intake, decreased frequency of clean intermittent catherization and any other difficulties? Any recent history of constipation?
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Fracture – Remember that fractures below the level of the injury will be painless but could there could be abnormal limb positioning or movement.
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Medications – particularly any started recently.