Pediatric History Taking

and Physical Exam

Pediatric History Components
A. Informant Data
B. General Data
C. Chief Complaint
D. HPI
◦ 7 Attributes of each symptom
a. Location
b. Quality
c. Quantity/Severity
d. Timing, onset, duration, frequency
e. Setting
f. Aggravating/Relieving factors
g. Associated manifestations
E. Prenatal History
◦ Mother’s age and OB score at pregnancy
◦ PNC visits
◦ Labs taken
◦ Illnesses during pregnancy
◦ Drugs taken during pregnancy
◦ Smoking/alcohol intake
F. Natal History
◦ Age of gestation
◦ Birth rank
◦ Mode of delivery, where delivered, who attended delivery
◦ Condition upon delivery
◦ Birthweight
◦ Perinatal complications
◦ Duration of stay in hospital
G. Post-natal History
a. Feeding History
b. Growth and developmental history
c. Immunization History

H. Past Medical History

I. Family History
J. Personal/Social History
 Physical Examination
Tips on examination:
Perform exam in front of parent
Examine a child’s toy first, then the child
Let the child do some of the exam
Ask the child to “help” with the exam
Let a child hold something in their hands
Let child see and touch tools you are using
Ask permission, or let parent undress child
Normal Ranges
Age HR BP RR
Premature 120 – 170 55 – 75/ 35 - 45 40 – 70
0 – 3 mos 100 – 150 65 – 85/ 45 - 55 30 - 60
3 – 6 mos 90 – 120 70-90/50-65 30 – 45
6 – 12 mos 80 – 120 80-100/55-65 25 – 40
1–3y 70 – 110 90-105/55-70 20 – 30
3–6y 65 – 110 95-110/60-75 20 – 25
6 – 12y 60 – 95 100-120/60-75 24 – 22
> 12y 55 – 85 110-135/65-85 12 - 20
Anthropometric Measurements
Newborn:
 Head circumference: 33 – 38cm
 Chest Circumference: 31 – 33cm
 Abdominal Girth
Length (NB: 45 – 52cm)
Weight
BMI
Growth
Charts
Assessment of somatic growth
Measure of nutrition
Growth charts
◦ include the height, weight, and HC for children up to
36 months
◦ Height and weight for children 2 to 18 years

 Weight-for-age
 Height/Length-for-age
 Weight-for-height
SKIN
Jaundice:
 Physiologic: appears on 2nd or 3rd
day, peaks at 5th day; disappears
within a week
 Progresses from head to toe
 Pathologic: appears within 24
hours of life
 Head
 Sutures and fontanelles
 Sutures: ridges
 Fontanelles: soft concavities

 Anterior
 4 – 6 cm Bulging: increased ICP
 Closes at 2 – 26 months
 Posterior Depressed: dehydration
 1 – 2 cm
 2 months

 Reflects intracranial pressure

 Normally soft and flat
Head circumference: 33 – 38 cm
 Eyes
 Inspect for hemorrhage, icterus, lesions, or
redness
 Assess clearness of corneas, transparency
of lenses
 Observe pupillary light reactions
 Visual reflexes (infancy)
 Pupillary light reflexes
 Optic blink reflex
 Blinking in response to moving object toward eyes
 Childhood
 Visual Acuity
 Conjugate gaze
Ears
 Determine ear position in relation to eyes
 Structure abnormalities
 Patency of the ear canal
 Characteristics of the TM
 Infants: Down and Back
 Young children: Up and Back
 Acoustic Blink reflex in infants
Nose and Sinuses
 Test for patency of nasal passages
 Gently occlude each nostril alternately while holding
mouth closed
 Usually will not cause distress

 Inspect mucous membranes, nasal septum, or

presence of polyps
Thorax and Lungs
Inspection:
 Palpation: assess for tactile fremitus
 Auscultation: breath sounds
 Diminished breath sounds
 Crackles
 Wheezing: small airway obstruction
 Rhonchi: larger airway obstruction
Heart
 Observe for cyanosis
 In addition to skin color, also inspect
mucous membranes
 Oximetry will confirm desaturation

 Palpate for thrills

Pulses
 Palpate for femoral or brachial arteries
 Measure the blood pressure in both arms
and one leg at one time around age 3 to 4
years for coarction of the aorta
 Heart sounds
 assess rate, rhythm, heart sounds
 determine presence of murmurs
 Abdomen
 Infants, toddlers, and children usually have protuberant
abdomens
 Inspection, Auscultation, Percussion, Palpation
 inspect while in supine position
 Infant: inspect umbilical cord for abnormalities, redness, or
swelling

Auscultation
 Bowel sounds

Palpation & Percussion

 Hold and flex legs at the knees
 When palpating liver, start from lower abdomen moving
upwards
 Genitalia
Males
 Inspect for the foreskin, shaft, and scrotal rugae, any congenital
anomalies
 Palpate for the scrotal sacs and contents
 Vasalva maneuver in older children to detect hernias

Females
 High effects of maternal estrogen in infancy
 Hyperpigmented; milky white discharge

 Inspect external structures for symmetry for any any rashes or

lesions, signs of abuse, or precocious puberty
Adolescents:
Tanner stage
Rectal Examination

 Should be done whenever there is a question

of anal patency, or when an intraabdominal,

pelvic, or perirectal disease is suspected