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1. INJIBARA HEALTH SCIENCE AND
BUSINESS COLLEGE
Pediatrics History & Physical
Examination
LECTARIO PRESENTS= GEDAMU. D
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2. History
Identification:
• -Name -Age –Gender/sex/ -Address
• -Parents name, age, and occupation.
Historian: E.g. Mother, father or any other
relative or care taker with description of
extent of relation with the patient.
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3. History…
CHIEF COMPLAINTS:
• the main reason for parents or other caretakers
to seek medical advice.
• one or more chief complaints; HWs should
extract the most pertinent ones and present it
along with the duration of illnesses
chronologically.
• E.g. Cough of 2 days duration; Cough of 2
months, dyspnea of 2 weeks, leg swelling of 3
days duration.
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4. History…
HISTORY OF PRESENT ILLNESS (HPI):
• This section elaborates the chief complaints
with emphasis on the genesis of the illness
and on other associated symptoms
• HWs’ critical thinking & fund of knowledge
are vital for searching detailed information &
arrive at w/c organ specifically affected.
• systematic approach is mandatory in order to
identify the problem of the patient; since the
historian will tell only the illness.
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5. History…HPI..
• Differential diagnoses need to be clear out
based on positive & negative statements.
• For tangible fact, HWs may be obliged to
include other histories like immunization,
nutrition, growth and development, family
and social history in the HPI.
• interpret information and formulate ideas as
the historian speaks.
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6. History… HPI…
Estimates of probability of specific underlying
illnesses are based on the 8 characteristics of
symptoms and combinations of nonspecific
symptoms and signs.
1. Anatomic location
2. Quantity and quality of symptoms
3. Aggravating and relieving factors
4. Variations over time
5. Chronological evolution
6. Associated symptoms
7. absent symptoms
8. Responses to intervention if any.
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7. History…HPI…
• Besides past medical events related to present
complaints and review of symptoms involved by
major complaints should be included.
PAST MEDICAL HISTORY (PMH):
 Past childhood illnesses like measles, mumps,
pertusis, chickenpox etc… with clear description
of the time of illness and outcome.
 Major chronic illnesses like TB, DM, cardiac
diseases, etc.
 Hospital admissions with clear description of
time, reason and outcome.
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8. History… PMH…
• Surgical procedures (major or minor) like
circumcision, uvulectomy
• accidents - time and sequele
• perinatal history (ANC, INC & PNC)
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9. History…Nutrition
Nutritional history: from time of birth till
present age:
• Time breast feeding initiated (immediately
after birth, later or not at all)
• Total duration of breast feeding
• History of bottle feeding
• Time formula feeding started, type of
formula, amount, concentration and
frequency
• Reasons for change of breast feeding to
formula
• Weaning age, type of weaning diet
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10. History… Dev’t
DEVELOPMENTAL HISTORY:
• Development is dynamic and not static thus should
be assessed from birth to present age of the child.
• Ask for certain milestones except in cases where a
detailed developmental assessment is needed.
– raise and support head?
– show social smile?
– roll over?
– sit alone or unsupported?
– crawl and creep?
– stand and walk supported and alone?
– use words?
– talk in sentences?
• Schooling, dentition, peer interaction, growth spurt,
sexual maturation
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11. History…
IMMUNIZATION HISTORY:
• Type of vaccine
• Age administered
• Frequency
• Side-effects/complications
• Status:
Not started?
Defaulted ?
Not up to date?
Up to date?
Completed ?
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12. History …
FAMILY HISTORY:
– Family size, number of siblings, age and health
status
– If any death in the family, ask for time of death,
cause of death.
– Familial diseases like hypertension, diabetes
mellitus, epilepsy and genetic disorders.
– Communicable disease in the family like,
Tuberculosis, pertussis, chickenpox, etc.
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13. History…
PERSONAL AND SOCIAL HISTORY:
– School adjustments, habits of sleeping, eating,
swimming and playing.
– Accidents
– Parental occupation, marital status, monthly
income, educational background.
– Housing condition
– Waste disposal and water source for the family.
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14. History…
REVIEW OF SYSTEMS (ROS): searching unaddressed or
overlooked problems in the HPI:
• General constitutional symptoms- fever, chills, malaise,
fatigability, night sweat, weight loss or gain.
• HEENT:
– H: Headache, dizziness, syncope, head injuries,
– E: Visual acuity, blurring, diplopia, photophobia, trauma
– E: Hearing loss, pain, discharge, tinnitus, vertigo
– N: Sense of smell, colds, obstruction, epistaxis
– T: Hoarseness of voice, sore throat, gum bleeding or
swelling, taste disturbance.
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15. History…ROS…
• Respiratory system:- cough, sputum production
with amount, character and aggravating factors,
chest pain, dyspnea, difficult of breathing,
wheezing, cyanosis.
• CVS:- chest pain, dyspnea, orthopnea, paroxysmal
nocturnal dyspnea, cough, leg swelling, palpitation,
exercise tolerance, sore throat, joint swelling.
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16. History…ROS…
• Gastrointestinal: appetite, food intolerance,
dysphagia, nausea, vomiting, haematemesis,
constipation, diarrhea, abdominal pain, color
change of stool, abdominal distension, visible
peristalsis, jaundice.
• Genitourinary: dysuria, frequency, urgency,
color change, polyuria, flank pain,
incontinence, history of skin lesions, edema.
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17. History…ROS…
• Lymphoglandular: neck, axillary or inguinal
swelling, heat or cold intolerance, weight
change, polydipsia, polyuria, polyphagia,
body hair change distribution, voice
changes, history of menses, breast pain
• Musculoskeletal: leg pain, joint stiffness,
restriction of movement, swelling, redness,
heat bone deformity
• Neuropsychiatric: syncope, seizure,
paralysis, abnormality of sensation or
coordination, tremor, loss of memory,
headaches, mood changes, sleep
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18. History
• At the end of all activities of the history, the
interviewer will do:
Subjective summary…?
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19. PHYSICAL EXAMINATION (P/E)
• Examination of a child is a very difficult task requiring great
patience and is time consuming especially for the
untrained person.
• Interviewer should make familiar to the child while history
taking
• Smiling faces and colorful objects soothe the child
• Careful inspection of the child; all possible areas
• the attendant undress the patient; prevent refusal
• For infants and young children the lap of the mother is the
preferred site for examination.
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20. P/E…
1. GENERAL APPEARANCE:
– Level of consciousness- conscious, lethargy,
comatose.
– Signs of cardio-respiratory distress- not in
distress, in mild, moderate, or severe distress
– Nutritional status-well nourished, malnourished,
extremely emaciated
– Status of health- whether acutely sick looking,
chronically sick looking or not sick looking.
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21. P/E…
2. VITAL SIGNS:
 Pulse:
• In all children all peripheral pulses should be
checked for their presence, rate, rhythm and
character.
• Normal pulse rate differ from age to age.
Pulse rate being higher in younger children.
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22. P/E…
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Age of the
child
Pulse rate
(normal
range)
0-1 years 100-160
1-3 years 90-150
3-6 years 80-140

23. P/E…
 Respiration
– Count full minute the number of respiratory cycle,
and check regularity and pattern.
– Normal respiratory rate differs by age.
• Cut offs for fast breathing at different age
groups
• Age (years) rate per minute
• 0-2 months 60
• 2 –12 months 50
• 12mo –5 yr 40
• 5-8 yr 30
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24. P/E…
 Blood pressure
– Appropriate cuff width should be used in
children.
Age Cuff width (cms)
• New born 2.5 - 3
• Infants 4 - 5
• 1-4 years 6 - 7
• 5-10 years 8 - 10
• > 10 years 10 - 12
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25. P/E…
Age of the child Systolic blood
pressure (normal)
0-1 year Above 60
1-3 years Above 70
3-6 years Above 75
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26. P/E…BP…
– too wide cuff will underestimate BP; while too
narrow cuff will give an artificial high
measurement.
– Values should be computed since normal values
vary in children with age.
– B/P should be measured on both right and left
side and a difference of > 15mmHg should be
taken as abnormal.
– A difference of > 20 mmHg between the lower
and the upper is abnormal.
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27. P/E…
 Temperature
• In neonates, infants and young children
temperature measurement is best done
rectally rather than orally or axillary.
• In neonates low reading thermometers may
be necessary since low temperature is an
important sign.
 Oxygen saturation
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28. P/E…
3. ANTHROPOMETRIC MEASUREMENTS
This includes the measurements of :
– height or length,
– weight,
– head circumference,
– mid upper arm circumference &
– chest circumference.
• The height, weight, and head circumference
should always be checked for age using a
reference data.
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29. Anthropometry…
Composite variables of height, weight and age
are:
• Height for age (Ht or Lt/age)
• Weight for age (Wt/age)
• Weight for height (Wt/Ht or Lt)
• Weight for squared height: Wt/(H)2
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30. P/E…
4. HEAD, EYES, EARS, NOSE AND THROAT
• Head- appearance or shape, size (head
circumference), areas of swelling, scars,
tenderness, hair distribution, texture, bluk
ability, color, fontanel- depression, size,
closure.
• Eyes- congenital abnormalities,conjunctival
appearance, follicles on the conjunctivae,
corneal opacity, pupillary size, and reaction
to light, sclera color, xerosis, bitot spot,
vision, eye lid-retraction or dropping.
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31. P/E…
• Ears- Pinna abnormalities, external ears -
signs of inflammation,
• Otoscopic examination- light reflex,
tympanic membrane patency, discharge,
hearing ability, foreign bodies
• Nose- Shape, septum, discharge, mass
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32. P/E…
• Mouth and throat
• Lips - congenital abnormalities, fissure.
• Tongue - hydration status, fissuring, texture
• Teeth - development, shape, number, any carious
process.
• Throat - tonsils, uvula, pharynx for any enlargement
and signs of inflammation.
• Generally, look for dysmorphic features like low set
ears, oblique palpabral fissure, epicanthal folds,
hyperteleorism, flat occiput, high arched palate,
depressed nasal bridge.
• Neck- Mobility, swelling, tenderness, deformity and
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33. PEDI
GRACIAS!!!.
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