Paediatric Assessment

Name:
Age:
Sex:
Family H/o:
Consanguinity:
Epilepsy:
Disability:
Maternal H/o:
Number of children:
Abortion if any:
Causes
Prenatal:
Maternal age:
Trauma/accident:
Hypertension:
Diabetes:
Viral infection:
Convulsion:
Asthma / lung disease:
Natal
Induced /prolonged /caesarean:
Birth cry- Delayed / Immediate:
APGAR score:
Post natal
Meningitis:
Jaundice:
Trauma/ Accident:

Previous Therapy H/o:

Physical Examination:
Chest examination:
Height:
Weight:
Head circumference:

Reflex assessment:

Neonatal:
Moro:
Gallant:
Crossed ext.:
Flex withdrawal:
Ext thrust:
Palmar grasp:
Plantar grasp:
Postural reactions:
Tonic labyrinth:
ATNR:
STNR:
Positive supporting:
Righting /protective:
Neck:
Body on body:
Body on neck:
Protective extension:
Landu reaction:
Equilibrium:
(A=Absent, P =Present, E= Exaggerated, C= clonus)

Respiratory status:
Pattern of breathing:
Rib cage/symmetry:
Nature of motor involvement:
Tone:
Contracture:
Orthopaedic Changes:
Any anomalies:
Scoliosis, Kyphosis etc.:
Motor Activity:
Development Milestone:
Gross motor, Fine Motor, Oro motor
Lift head, rolling, sitting, quadruped, kneeling, half kneeling standing, and single leg
standing.
Cognitive:
Vision:
Hearing:
Speech:

Problem List:
Treatment: