PEDIATRIC HISTORY AND
Professor of Pediatrics
Jordan University of Science &
Differences between Adult and
History is given by second person.
The parents may place their own interpretation on
events(any fever may be called tonsillitis).
The cooperation of the child cannot be guarantied
The expression of the disease may be influenced
by the child’s developmental status(apnea may
indicates convulsion in newborn)
Differences between Adult and
The predominant impact of the disease may
be on growth and development (UTI,
Physiological norms are more constant in
adults, variable with age in infants and
children( HR, RR)
Clinical signs of the disease may differ from
those of adults (Liver is palpable in
Age Groups In pediatrics
Neonatal period 1st month
Infancy 1st year
Childhood 1-15 years
-Toddler 2 years
Pre-school child 2-5 years
school child 5-15 years
Introduce yourself to the parents and child.
A worm greeting and friendly smile to allay
anxiety and promote confidence.
Encourage the parents to tell the story with
minimum of interruption and listen carefully.
You should not swallow the diagnosis given by
It is essential to find out what the concern of the
History of present illness and important
related positive & negative symptoms.
Maternal history (Pre-natal).
Birth history (Natal).
Growth and development
– Multiparity, any miscarriages, stillbirth or
– Maternal health during pregnancy, regular
antenatal care, Rh iso-immunization.
– History of drugs ingestion during pregnancy,
oligohydroamnios or polyhydroamnios
– Mode of delivery.
– Crying immediately or not.
– Apgar score
– History of asphyxia
– Meconium stained amniotic fluid.
– NICU admission
– How much did the baby stay in the nursery.
– Did the baby required mechanical ventilation ?
– Oxygen was given ? Duration of oxygen.
– Baby had history of jaundice? Exchange
– Any illness during first month of life:
meningitis, convulsion, fever ..etc.
– Breast or bottle feeding
– Type of formula
– How much milk is given , number of feeds/day
– How is the milk prepared
– When the solid food or cereals is introduced,
content of food, any allergy to the food.
– Vaccination program in details( National,
– Any special vaccination was given.
– When the last vaccine was given
– Any complication of given vaccine
– Any contraindications for certain vaccine?
Growth and development history:
– Details of development milestones, smiling ,
sitting, standing, walking, speech,
– Bladder and bowel control
– School performance, behavioral and emotional
– Father and mother age, consanguinity, level of
education and they are healthy or not.
– History of smoking in either parent
– Siblings: number, sex, and their ages.
– History of similar disease, unexplained death
and genetic diseases.
– Draw family pedigree
Social & Environmental history;
– It is necessary to build up a picture of the
child’s social and cultural environment
– Appreciate fears and stresses at home( parental
attitudes, separation, divorce, absence of
– Jealously at the arrival of a new baby
– Unexplained injuries may raise the possibility
of child abuse.
Important points to remember:
– The examination of infants and children is an
art, demanding qualities of understanding,
sympathy and patience.
– Heart rate, Respiratory rate, BP, liver size, heart
size varies with age.
– Keep disturbing or painful procedures to the
– It is not necessary to be systemic in your
examination , but should be complete.
– The first step is ascertain quickly if the baby is
well, mild or severely ill.
– Assess state of consciousness, breathing
pattern, position, reaction to environment.
– State of nutrition, speech, cry, size relative to
– The child should be as completely undressed as
possible, but not necessarily all at once.
– If the child is seriously ill ABC and vital signs
must be taken without delay and necessary
immediate intervention is undertaken.
– Describe any dysmorphism, abnormal
movements, unusual position he assumes, his
mental status and activity.
Measurements: should include
– Height (length)
– Head circumference
– All given with percentile for age.
– Temperature (rectal, oral ,axillary)
– Blood pressure
– Include color
– The presence of cyanosis
– Discolored patches
– Skin turgor
– Amount of subcutaneous tissue
– Examine the head for shape
– Bone defects
– Size and tension of fontanelles
– The hair and scalp should be examined
Eyes: make a gross test of vision.
– Visual fields should be tested in all children old enough
– Evaluate for strabismus by position of the light reflex
and the cover test
– Look for nystagmus
– Examine the conjunctivae for anemia and sclerae for
jaundice and the cornea for haziness and opacities
– Pupils size and shape
– Fundoscopic examination
– Check for position(low set ) and shape of both
– Examine the tympanic membrane for injection,
bulging or perforation
– Evaluate hearing
– The mastoid also need to be checked
Mouth and throat:
– The color of lips and mucosa
– The condition of teeth, gums and buccal
– Look for tongue, palate, tonsils and pharynx
– Listen to the voice and the quality of cry and
the presence of stridor
– Examine for neck rigidity
– Lymph node
– Thyroid gland
– The position of trachea
Nose and sinuses:
– The nasal examination is performed to detect
– Deviation of the septum
– Color and state of the mucosa and turbinates
– Presence of foreign body
– Examine the sinuses for tenderness and
– The general shape of the chest (pectus excavatum or
– Abnormal signs to look for are beading (rosary),
asymmetry of expansion
– In infants respiration is diaphragmatic and abdominal
– Auscultation: breath sounds in children are usually
– Palpation: the apex beat is normally felt in the 4th
intercostals space just to the left of the midclavicular
line in children under 7 years of age. After that it is felt
in the 5th intercostals space in the midclavicular line.
– Auscultation: Note the effect of changing of position
and exercise on the murmur. Splitting of the 2nd heart
sound is common in normal children
– Inspection –Distension, Scaphoid abdomen,
– Palpation – The lower border of the liver is
normally 1 cm below the costal margin in
infants and children. Liver span 8 ± 1.8 cm
An enlarged spleen is extending into the left iliac
fossa in infancy and the right in older children
– By employing both observation and palpation,
the spinal shape and posture9lordosis, kyphosis,
– Limitation of motion
– Spina bifida
– Undesent of testes
– Ambiguous genitalia
– Patency(imperforated anus)
– Presence of fissure, fisulae or hemorrhoids
– Rectal examination if indicated
– Anomalies of extremities
– Pain and tenderness of the joint or limbs
– Always s examine for congenital dislocation of
the hip in infants
– Mental status
– Cranial nerves
– Cerebellar function
– Motor system
– Sensory system
– Reflexes-primitive (neonatal reflexes, deep and
– Gross motor
– Vision and fine motor
– Hearing and language
– Social and adaptive
– Head and neck control in prone position(6-8
– Able raise head and chest (3months)
– Pull from lying or no head lag (4 months)
– Sit without support back straight (8-9 months)
– Stand without support (10-12 months)
Vision and fine motor
– Follows moving person with eyes (6-8 weeks)
– Follows small ball at 10 feet distance(9months)
– Pincer grasp (between index finger and thumb
using small object (11-12 months)
– Copies a circle (with pencil, build a bridge of 3
cubes when shown (3years)
Hearing and language:
– Turns eyes to sound-rattle 12 inches(2-4
– Says Mama, Baba (7-9 months)
– Says simple sentences 3-4 words(2-2.5 years)
– Says first name, knows own sex (3 years)
Social and adaptive
– Smiles when spoken, vocalizes (6-8 weeks)
– Reaches for and shakes rattle, puts objects to
– Drinks from cup without spilling (18 months)
– Wash hands, pull pants up and down (3 years)