This document provides guidance on performing a history and physical examination for pediatric patients. It outlines the key components of the history, including the chief complaint, history of present illness, past medical history, nutrition, development, immunizations, family history, and review of systems. It also describes conducting a thorough physical exam, including vital signs, general appearance, and examination of head, eyes, ears, nose, throat, and other body systems. The goal is to obtain all relevant information from the patient's history and conduct an examination to identify any health problems.

1. University of Gondar
CM & HS
School of Nursing
Department of Pediatrics Nursing
Pediatrics History & Physical Examination
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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
• Present diet - type, amount, frequency
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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
disturbances, nervousness, chorea.
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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

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, blukability,
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
stiffness
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