This document provides guidance on taking a history and performing a physical exam in pediatrics. It discusses collecting personal details, chief complaints, history of present and past illnesses, perinatal history, developmental history, immunization history and more. The physical exam section outlines examining various body systems like HEENT, respiratory, cardiovascular, abdominal, neurological and others. It also covers anthropometric measurements like weight, height and mid-upper arm circumference to assess malnutrition in children. The document aims to teach proper history taking and physical exam skills for pediatric patients.

1. HX & PE in pediatrics
For 2nd year anesthesia students
By Dr Ademe B (MD) 1
DEBRE TABOR UNIVERSITY
COLLEGE OF MEDICINE & HEALTH SCIENCE

2.  To teach how to take proper Hx & do
PE in pediatrics
 To understand interpreting anthrop
values
By Dr Ademe B (MD) 2

3.  Hx taking in pedi
 PE in pediatrics
 Anthropometry…..
 References
By Dr Ademe B (MD) 3

4. HX Taking …..
 Components of pediatric History
• Personal details( Identification)
• Chief complaints
• History of present illnesses
• Past medical illnesses
• Perinatal history
• Nutritional history
• Developmental history
• Immunization history
• Family and social history
• Review of systems
By Dr Ademe B (MD) 4

5. PERSONAL
IDENTIFICATION
 Date and time of interview
 Name
 Age
 Sex
 Parents name, age, occupation and level of
education
 Address
 Historian: - E.g. Mother, father or any other
relative or care taker with description of
extent of relation with the patient
By Dr Ademe B (MD) 5

6. By Dr Ademe B (MD) 6

7.  The main complaint that has brought the
patient to seek for medical help
 Put in the patient own words
 Precise duration
 There may be more than one CC.
By Dr Ademe B (MD) 7

8. HISTORY OF PRESENT
ILLNESS (HPI)
 Detailed description of the chief complaint
 Mode of onset and duration
 Order of appearance in chronological order
 Time when the patient was last well
 Positive and Negative symptoms for differential
diagnosis
 Possible risk factors
 Possible complications
 Associated symptoms . By Dr Ademe B (MD) 8

9.  Past childhood illnesses like measles, mumps,
pertussis, chickenpox etc. with clear description
of the time of illness and outcome.
 Major chronic illnesses like tuberculosis, cardiac
diseases, diabetes mellitus
 Hospital admissions with clear description of
time, reason and outcome
 Surgical procedures major or minor like
circumcision, uvulectomy
 accidents - time and sequele By Dr Ademe B (MD) 9

10. PERINATAL Hx
 Antenatal history
• Duration of pregnancy
• Maternal medical illnesses
• HTN,DM,TB
• SYPHILIS,UTI
• Medication hx
• Radiation exposure
• Maternal vaccination against tetanus
• Past obstetric hx.
By Dr Ademe B (MD) 10

11.  Natal hx..
• Place of delivery
• Mode of delivery
• Duration of labor initiation, duration
• Time and duration of ROM
• presentation and complications during
delivery
By Dr Ademe B (MD) 11

12.  POSTNATAL HISTORY;
• whether the child cried immediately after
birth or was cyanosed
• Need for resuscitation at birth
• Difficulty of respiration or sucking
• Medical Hx e.g. Hx. of convulsion, jaundice,
fever, sucking---
By Dr Ademe B (MD) 12

13. NUTRITIONAL HX
Duration of exclusive breast feeding and
breast feeding
Time of initiation of complementary feeding
Type and composition of supplementary
feeds
Sunshine exposure
vitamin or mineral supplement
Time of introduction of solid diet
By Dr Ademe B (MD) 13

14.  Grosse motor - we ask the time at which the
child support his/her head and seat
independently
 Fine motor -we ask the time at which the child
transfer material from one hand to other.
 Language - we ask at which time the child start
to say mama, Baba
By Dr Ademe B (MD) 14

15. age Milestones
1 moth Raises head slightly when prone; alerts to sound; regards face; moves extremities
equally
2-3 mths Smiles, holds head up, reaches for familiar objects, recognizes parents
4-5 mths Rolls front to back & back to front; sits well when propped; laughs, orients to voice;
enjoys looking around
6 mths Sits unsupported; passes cube hand to hand; babbles
8-9 mths Crawls; pulls to stand; pincer grasp; feeds self with bottle
12 mths Walking, talking a few words, understands NO; says mama/dada
15-18 mths Comes when called; walks backward; uses 4 -20 words, builds tower of 2 blocks.
24-30 mths Removes shoes; follows 2 step command; jumps with both feet; points to body parts;
runs; spoon feeds self
3 years Dresses & undresses; walks up & down steps; draws a circle; knows more than 250
words; takes turns; shares group play.
4 years Hops; skips; catches ball; memorizes songs; knows colors; use pleural
By Dr Ademe B (MD) 15

16. At birth OPV0,BCG
6wks OPV1,DPT1Hep1+Hib1
+PCV1 +Rota1
10wks OPV2,DPT2Hep2+Hib2
+PCV2 +Rota2
14wks OPV3,DPT3Hep3+Hib3
+PCV3
9 months Measels,vitamin A
Rota??
By Dr Ademe B (MD) 16

17. Hx of a chronic illness in the family
 Socio-economic status
Housing and living conditions
By Dr Ademe B (MD) 17

18.  Reviews all systems
 It gives a clear understanding of the present
illness
 It is a double check on the history of present
illness
 It guides the examiner to concentrate on specific
systems during the physical examination when
he/she is in a hurry.
By Dr Ademe B (MD) 18

19.  HEAD:-Headache
 EAR: -discharge; pain
 EYES: discharge; redness
 NOSE:-nose bleeding;
discharge
 MOUTH: ulceration; gum
bleeding; oral thrush
 THROAT:
 RS: Cough; chest pain;
dyspnea
 CVS:-Dyspnea;
orthopnea; PND;
Cyanosis
 GIS: Nausea, vomiting,
diarrhea; constipation
 GUS:-bloody urine;
pain during urination
 IS:-rash….
 MS: Joint pain, Bone
pain, Bone/Joint
swelling
 CNS:- ABM, weakness;
speech problems
By Dr Ademe B (MD) 19

20.  General principles to follow
• Reflect on your approach to the
patient
• Decide on the scope of the
examination
• Choose the examination sequence
• Adjust the lighting and the
environment
• Make the patient comfortable
By Dr Ademe B (MD) 20

21.  G/A
 V/S
 A/M
 HEENT
 LGS
 RESPIRATORY
 CARDIOVASCULAR
 ABDOMINAL
By Dr Ademe B (MD) 21

22.  GENITOUNIRARY
 MUSCULOSKELETAL
 INTEGUMENTARY
 CNS
By Dr Ademe B (MD) 22

23.  Acutely sick looking
• active bleeding
• In CRD
• Severe pain
 chronically sick looking
• Visible wasting
• prominent zygomatic bone
• Bone and skin appearance
 Acute on chronic base
By Dr Ademe B (MD) 23

24.  Nutritional status
 mood ,dressing style
By Dr Ademe B (MD) 24

25. By Dr Ademe B (MD) 25

26.  The rate of respirations per minute ranges
between:
• newborn or <2moth >= 60 B/min
• 2 month up to 1 year >=50 B/min
• 1 -5 year >= 40 B/min
• 5-8 year >=30 B/min
Considered as tachycardia
• 8-10 years >=25 B/min By Dr Ademe B (MD) 26

27. By Dr Ademe B (MD) 27

28.  Blood pleasure pediatrics B/p is depend
on H.t,Age.Sex
Normal B/P for pediatrics is b/n 5th and 90th
centile
Above 90th centile is hypertension and below
five centile is Hypotension
90-95th centile pre hypertension
95-99th +5 stage one By Dr Ademe B (MD) 28

29. By Dr Ademe B (MD) 29

30.  The normal range for malnourish and well
nourish is differ.
 For well nourish normal b/n 36.5.37.5 oc
 For malnourish b/n 35.5-37.5 c
By Dr Ademe B (MD) 30

31.  HEAD-fontanelle size,any abnormality
 Ear: form, shape, recoil, patency, low set ear,
discharge, tender behind the ear,…….
 Nose: patency, flat nasal bridge; polyp, nasal
flaring, runny nose, bleeding,…….
 Throat: tongue size, arched pallet,
clfetlip/pallet, micrognathia, cyanosis,
tonsil,…
 Neck: short neck, skin fold,

32. By Dr Ademe B (MD) 32

33.  Examining the accessible LN groups & glands
 Report about breast and thyroid glands
By Dr Ademe B (MD) 33

34.  Inspection
• Deformities and shape of chest
• Intercostal & sub costal retractions
• Chest movement
• Concerning chest lesion
 Palpation
• Area tenderness
• Tactile fremitus
• Chest expansion
By Dr Ademe B (MD) 34

35. 
By Dr Ademe B (MD) 35

36.  Percussion is one of the most important
techniques of physical examination
 . Percussion of the chest sets the chest wall and
underlying tissues into motion, producing
audible sound and palpable vibrations.
 Percussion helps you establish whether the
underlying tissues are air-filled, fluid-filled, or
solid.
 It penetrates only about 5 cm to 7 cm into the
chest, however, and therefore will not help you to
detect deep-seated lesions.
 Estimate the extent of diaphragmatic excursion
By Dr Ademe B (MD) 36

37. By Dr Ademe B (MD) 37

38.  Auscultation
• Breath sounds
• added sounds
• transmitted voice sound
By Dr Ademe B (MD) 38

39. 
By Dr Ademe B (MD) 39

40.  Inspection
• JVP raised or not.
• pericordium active or not
• pericordial deformity
• apical impulse
 Palpation
• pulse,heart sound ,PMI ,parasternal heave
&thrill
 Auscultation- heart sounds,murmur
By Dr Ademe B (MD) 40

41.  Inspection-any scar,lesion ,umlicus
(shape,slit),flanks,dileted veins ,hernial sites
 Percussion-TLS,fluid thrill &shifting dullness
 Palpation-tenderness,palpable
organomegally,any mass,aortic pulse
 Auscultation-bruise ,bowel sounds
By Dr Ademe B (MD) 41

42.  Inspect for external
genitalia,phimosis,paraphimosis,epispadiasis,
scrotal shape,creases,foreign bodies
 Appreciate for CVAT,SPT
By Dr Ademe B (MD) 42

43.  Inspect for skin lesion,creases,palmar pallor
 Describe cxr of skin lesion if any
 Any hair or nail abnormality
By Dr Ademe B (MD) 43

44.  Look-deformities,positioning,,symmetry
 Feel- Temp,pulse,wrist widening
 Move- active & passive movement
 Measure-
curcumfirance,length(real,apparent,true
length)
 Report if any joint tendernesss
By Dr Ademe B (MD) 44

45.  Mental status examination –use modified
glasscow coma scale
 Cranial nerve examination
 Motor examination
 Sensory examination
 Meningeal signs
 Neonatal reflexes
By Dr Ademe B (MD) 45

46. By Dr Ademe B (MD) 46

47. By Dr Ademe B (MD) 47

48.  This includes:-
1. W.t :- in neonate should be in Gram
2. H.t :- for less than 2 years called length why?
3. Head circumference
4. MUAC to measure MUAC the age of child should
be >=6 month or >= 65 cm
Why? b/c if we measure below this age we measure
the fat rather than muscle bulk
• If they are combined we called index they are a
very important tolls for assessment of
malnutrition which is very common in our country.
By Dr Ademe B (MD) 48

49. By Dr Ademe B (MD) 49

50. 
By Dr Ademe B (MD) 50

51.  weight-for-age is the simplest method.
 The advantage of this index is that it may reflect
both past (chronic) and/or present (acute) under
nutrition (although it is unable to distinguish
between the two).
 For interpretation we use Harvard curve and NCHS
 But Harvard curve is used only for w.t /age less
than 5 years
By Dr Ademe B (MD) 51

52. Edema 60-80% 60%
Absent Underweight Marasmus
Present Kwashiorkor Marasmic-
Kwashiorkor
By Dr Ademe B (MD) 52

53.  This indicate chronic malnutrition
• > 95% Normal
• 90-95% Mild stunting
• 85-90% Moderate
• < 85% Severe stunting
By Dr Ademe B (MD) 53

54.  It indicates acute malnutrition.
• 90-100% Normal
• 80-90% Mild wasting
• 70-80% Moderate mal nutrition
• < 70 % Severe wasting
By Dr Ademe B (MD) 54

55.  Normal >13 cm
 Moderate acute malnutrition b/n 11-12.5cm
 Severe malnutrition <11cm
By Dr Ademe B (MD) 55

56.  Bate's guide to physical examination
 Nelson text book of pediatrics 20th edition
 SAM national guideline,2016
By Dr Ademe B (MD) 56

57. By Dr Ademe B (MD) 57