PEADIATRICS NOTES

PEADIATRIC HISTORY TAKING:

I. Biodata
II. Presenting Complaints
III. History of Presenting Complaints
IV. Past History
V. Birth History
VI. Feeding History
VII. Immunization History
VIII. Developmental History
IX. Family History
X. Socioeconomic History

 BIODATA:
a) Name
b) Father’s Name
c) Gender
d) Religion
e) Address
f) History Given By
g) Date of Admission
h) Mode of Admission

 PRESENTING COMPLAINTS:
a) Always write in chronological order
b) If the day of onset is same for two or more symptoms, it should be written
according to the intensity
c) Always written in patients own words
d) As short as possible

 HISTORY OF PRESENTING COMPLAINTS:

a) Always written in 3 paragraphs
b) 1st paragraph: details about presenting complaints
c) 2nd paragraph: Medication
d) 3rd paragraph: systemic review

 PAST HISTORY:

Made by: Farzeen Khan (Batch 10)

 a) Past Medical History:
 ask about the similar complaints in the past
 any other childhood illnesses e.g. measles, Chicken Pox, mumps etc
 any history of hospitalization & if yes then reason
 any blood Transfusion

b) Past Surgical History:

 History of any surgery
 History of any accident or trauma

 Birth History:
a) Antenatal History: (from conception till the appearance of the true labour pains)

 This was a Booked case. Mother used to attend the antenatal clinic regularly. There is
no history of T.B, Diabetes, HTN, any chronic heart disease, chronic liver disease, chronic
lung disease or chronic renal disease. There is no history of any febrile illness. There is
no history of any trauma. There is no history of any rash appearing on the body. There is
no history of exposure to radiation. There is no history of drugs except multivitamins &
the mother received 2 doses of Tetanus Toxoid in the last trimester.

b) Natal History: (from the time of the appearance of true labour pains till the birth)

 This was a full term pregnancy, spontaneous vertex delivery, delivered at a private
maternity home at 7 a.m. on 1st Feb 2018. Delivery was conducted by a lady doctor.
Labour pains lasted for 16 hours. Membranes ruptured 2 hours prior to the delivery.
Liquor was clear and not miconium stained. There is no history of cord around the neck.
There is no history of cord prolapse. There is no history of purulent vaginal discharge or
bleeding per vagina. There is no history of any anesthesia been given to the mother.

c) Post Natal: (after Birth)

 Baby cried immediately after birth. There is no history of cyanosis, jaundice, apnea or
birth trauma. There is no history of excess resuscitation. APGAR score was 7 at 1min and
9 at 5min.
 APGAR SCORING SYSTEM:

2 1 0
A Appearance Pink Peripheral Blue/Pale
Cyanosis

Made by: Farzeen Khan (Batch 10)

 P Pulse >100 <100 0

G Grimace Sneezing, Grimaces No

Crying, Response
Coughing
A Activity All four SFEJ, Limbs
limbs SFKJ Lethargic
R Respiration Normal Gasping 0

*SFEJ: Slight flexion at elbow joint

*SFKJ: Slight flexion at knee joint

 FEEDING HISTORY:
a) Breast Feeding:
 Did you breasfed your child or not
 If yes then after how many hours of Birth
 Have you given any prelacteal food
 For how long do u feed your child (normal breast feeding time 8 times per day for 30min
15min from right side and 15min from left side)
 How many times at night and day
 Did you face any problems regarding breast feeding
 Only breast fed or bottle too
 For how long the baby was breastfed
 If bottle fed then what was the proportion of water n powder (normal: 5ounce / 5
spoon)

b) Weaning
 Quantity of diet
 Fresh food or not
 Did u face any issue regarding weaning (in celiac disease the child suffers from severe
diarrhea because of wheat)
 Do you wash your hands & utensils before feeding the child

a) Feeding Prior to Illness

 Diet before illness
 Calorie intake before the onset of symptoms
 Sentence: prior to the illness the patient was consuming _______ cal/day

b) Feeding During Illness

Made by: Farzeen Khan (Batch 10)

  Sentence: feed during illness has decreased to 200cal/day

 IMMUNIZATION HISTORY:
a) At Birth
 BCG & OPV 0

b) At 6 weeks
 Pentavalent 1
 Pneumococcal 1
 OPV 1

c) At 10 weeks
 Pentavalent 2
 Pneumococcal 2
 OPV 2

d) At 14 weeks
 Pentavalent 3
 Pneumococcal 3
 OPV 3
 IPV

e) At 9 month
 Measles 1

f) At 12 months
 Measles 2

COLD CHAIN: All the persons involved from the manufacturing of a vaccine to the delivery to the
patient, keeping it at the required temperature is referred to as Cold chain.

 DEVELOPMENTAL HISTORY:

a) At 6th week
 Social Smile

Made by: Farzeen Khan (Batch 10)

 b) At 3-4 months
 Neck Holding

c) At 6-7 months
 Sitting

d) At 9 months
 Stand with Support

e) At 12 months

 Without support

f) At 15 months
 Walking

g) At 1 year
 1 word

h) At 2 years
 2 words

i) At 3 years
 3 words

 EXPENDED PROGRAM OF IMMUNIZATION (EPI) SCHEDULE:

ROUTE OF
AGE VACCINES ADMINISTRATION DOSE
1st At birth BCG Intradermal 0.05 ml
OPV 0 Oral 2 drops
2nd At 6 weeks Pentavalent 1 Intramuscular 0.5 ml
Pneumococcal 1 Intramuscular 0.5 ml
OPV 1, Rota virus Oral 2 drops
1
3rd At 10 weeks Pentavalent 2 Intramuscular 0.5 ml
Pneumococcal 2 Intramuscular 0.5 ml
OPV 2, Rota virus Oral 2 drops
2
4th At 14 weeks Pentavalent 3 Intramuscular 0.5 ml
Pneumococcal 3 Intramuscular 0.5 ml
OPV 3 Oral 2 drops
Made by: Farzeen Khan (Batch 10)
IPV Intramuscular or 0.5 ml
Subcutaneous
5th At 9 months Measles 1 Subcutaneous 0.5 ml
6th At 12 months Measles 2 Subcutaneous 0.5 ml
  NON EPI VACCINES:

ROUTE OF
VACCINES AGE ADMINISTRATION DOSE
1 Measles, Mumps, At 13 months Subcutaneous 0.5 ml
Rubella (MMR)
2 Meningococcal 11-15 years
(MCV) Intramuscular 0.5 ml
3 Typhoid (ViCPS) 2 years & older Intramuscular 0.5 ml
(Ty21a) 6 years & older Oral 4 capsules (one
capsule every 2
days)
4 Cholera After 2 years Subcutaneous or Upto 12 years: 2
Intramuscular doses of 0.25ml
After 12 years: 2
doses of 0.5 ml
5 Hepatitis A 1-18 years Intramuscular 2 doses of 0.5 ml,
separated by 6-12
months
After 18 Intramuscular 2 doses of 1 ml
6 Influenza 6-35 months Intramuscular 0.25 ml
Younger than 9 Intramuscular 2 doses
years
Older children Intramuscular Only 1 dose 0.5 ml
7 Varicella After 12 months Intramuscular 2 doses 0.5 ml
8 Rabies After an animal Intramuscular 1 ml
bite

Note: Rota virus is added in the EPI schedule according to the 9th edition of Basis of Pediatrics.

 FAMILY HISTORY:

a) There is no history of Tuberculosis, Diabetes or Hypertension

b) Age of the parents

Made by: Farzeen Khan (Batch 10)

 c) Family Tree

 SOCIOECONOMIC:
 Father is a labourer. He earns 20K per month and 5 membered family lives in a 1 room
cemented house with water, electricity & average facility available. The family lives in a
slum area with unhygienic conditions surrounding their home.

GENERAL PHYSICAL EXAMINATION:

 A 6 year old male child of average height and built is lying comfortably on the bed with
no dismorphic features. His temperature is 98.6 F, pulse is 100 beats per min,
respiratory rate is 20 breaths per min and the blood pressure is 100/60 mm of mercury.
There is no anemia, jaundice, cyanosis or pigmentation. There is no edema or
dehydration. There is no clubbing, koilonychia, leukonychia or paronychia. Regarding
anthropometric measurements his weight is 20kg, height is 110 cm, FOC is 51.5, midarm
circumference is 16 cm and the midchest circumference is 100cm. There is no
lymphadneopathy and the ENT examination is normal.

 ABNORMAL POSTURES:
a) Decorticate posture: encephalitis
b) Decerebrate posture:
c) Opisthotonus posture:
d) Frog like posture: severe hypotonia

 DISMORPHIC FEATURES:
a) Frontal n maxillary prominence: thalassemia
b) Cushing facies:
c) Microcephaly:
d) Sever hydrocephalus: meningomyocelia
e) Facial nerve palsy

 TEMPERATURE:
Made by: Farzeen Khan (Batch 10)
 a) Hyperpyrexia: High grade fever
b) Hypothermia: lower than the normal temperature

 NORMAL HEART RATES:

AGE HEART RATE PER MINUTE

Neonate 140/min
1 year 110/min
4 years 100/min
7 years 90/min
10 years 80/min
13 years 70/min

 NORMAL RESPIRATORY RATES:

AGE BREATHS PER MINUTE

Neonate 40 breaths/min
1 year 35 breaths/min
4 years 30 breaths/min
7 years 25 breaths/min
10 years 20 breaths/min
13 years 15 breaths/min

 BLOOD PRESSURE:
a)
b) Add 55 to age disystolic

 NORMAL WEIGHTS:

AGE WEIGHT IN KG
At birth 3
5 months 6
6 months 7.5
1 year 10
2 years 12
3 years 14
4 years 16
5 years 18
6 years 20

Made by: Farzeen Khan (Batch 10)

 7 years 22
8 years 25.5
9 years 29
10 years 32.5
11 years 36
12 years 39.5
13 years 43
14 years 46.5

 NORMAL HEIGHTS:

AGE HEIGHT (cm)

At birth 50cm
1 year 75cm
2 years 87cm (85)
3 years 95cm (90)
4 years 100cm (95)
5 years 105cm (100)
6 years 110cm (105)
7 years 115cm (110)
8 years 120cm (115)
9 years 125cm (120)
10 years 130cm (125)
11 years 135cm (130)
12 years 140cm (135)
Note: The formula for height is different in the new edition of Basis of Pediatrics. Heights
according to the old formula are written in brackets (learn the old ones for the ward test).

 NORMAL FOCs:

AGE FOC
At birth 35cm
3 months 41cm
6 months 44cm
9 months 46cm
1 year 47cm
2 years 49cm
3 years 50cm
5 years 51cm
6 years 51.5cm

Made by: Farzeen Khan (Batch 10)

 7 years 52cm
8 years 52.5cm
9 years 53cm
10 years 53.5cm
11 years 54cm
12 years 54.5cm

 NORMAL MID CHEST CIRCUMFERENCE:

AGE MID CHEST CIRCUMFERENCE

At birth 2-3 < FOC
By 9 months Equal to the FOC
After 1 year Takes the lead

 NORMAL MID ARM CIRCUMFERENCE:

AGE MID ARM CIRCUMFERENCE

At birth 11cm
At 1 year 15-16cm
At 5 year Remains 15-16cm

 EXAMINATION FOR JAUNDICE:

a) Ideally daylight examination for jaundice should be done

b) Sites:

 Eyes (conjunctiva & sclera)

 Oral mucosa
 Undersurface of the tongue
 Palm

 EXAMINATION FOR ANEMIA:

a) Sites:
 Conjunctiva
 Palm
 Lips
 EXAMINATION FOR CYANOSIS:
Made by: Farzeen Khan (Batch 10)
 a) Cyanosis Peripheral: Tip of the nose, Ear lobules, Lips & Nails
b) Central: Tongue (dorsal Surface) is blue, Tip of the nose, Ear lobules, Lips, Oral mucosa & Nails.

 EXAMINATION FOR EDEMA:

a) Press thumb for 5-10 secs on the medial malleolus and5cm above the medial malleolus.
If you see a dimple or depression that means its edema.

 DEHYDRATION SIGNS:
NO SOME SEVERE
CNS Active Irritable Drowsy
Eyes Normal Sunken Very Sunken
Thirst Normal Eager Not Able To Drink
Skin Turgor Goes back Quickly Slowly Very Slowly

 EXAMINATION OF THE NAILS:

a) Clubbing: The normal angle is lost. Anteroposterior convexity
b) Shamroth’s sign: absence of a closed triangular space described by the nails of the
two index fingers when their distal phalanges are held in dorsal opposition, seen in
clubbing.
c) Leukonychia: White nails seen in protein deficiency; hypoproteinemia.
d) Koilonychia: Spoon shaped Nails seen in iron deficiency anemia.
e) Paronychia: Infection of the nailbed

GIT EXAMINATION:
a) Oral cavity
b) Inspection of abdomen
c) Palpation of abdomen
d) Percussion of abdomen
e) Auscultation of the abdomen

 EXAMINATION OF THE ORAL CAVITY:

 On examination of the oral cavity the lips are normal, there is no angular stomatitis or
cheilosis. There are no cracks on the lips. There is no cleft lip. The tongue is of normal
size and shape. There is no coating of the tongue. There are no fissures on the tongue.
There is no cleft palate. Oral mucosa is normal. It's neither yellow nor blueish. Tonsils
are normal. Oropharynx is normal. Teeth are normal. Gums are healthy looking.

Made by: Farzeen Khan (Batch 10)

  INSPECTION OF THE ABDOMEN:
 Protocol:
The patient should be naked. One piece of cloth at the level of nipples. And one piece at
the level of mid thigh. Start from the right side. From above and the level of the
abdomen then at the back of the abdomen then from the foot end while standing and
then at the level of the foot. Then the left side.

 On inspection of the abdomen, the abdomen is of normal contour and shape and is
moving with respiration. Umbilicus is centrally placed and inverted. There are no visible
veins, pigmentation, scar, pulsations or any peristaltic activity. Hernial orifices are
normal. Genitalia are normal and anal opening is visible.

 PALPATION OF THE ABDOMEN:

 On superficial palpation of the abdomen, the abdomen is soft, non tender and there is
no mass palpable. On the deep palpation of the abdomen, the liver is enlarged 3cm
below the right subcoastal margin, in the right mid clavicular line. Overall the liver span
is 7cm. The surface is smooth. The margins are sharp, it is firm in consistency, non
tender and is moving with respiration. Spleen is enlarged 5cm below the left subcoastal
margin in its long axis. The surface is smooth. The margins are rounded and is firm in
consistency, non tender and is moving with respiration. There is a notch palpable on the
anterior border of the spleen. Kidneys are not palpable. Urinary bladder is also not
palpable. And anal opening is Open.

 PERCUSSION OVER THE ABDOMEN:

a) When you percuss, your elbow joint shouldn't move. You should use your wrist joint.
b) The pleximeter (finger) where you want to percuss should be firmly placed and the rest
of the fingers should be kept elevated. The strike should be on the distal or proximal
interhalangeal joint.
c) The plexer should strike the pleximeter at 90° angle.
d) Finger should be lifted immediately after striking.
e) Pleximeter should be parallel to the expected area of the dullness.

 Percussion node is tympanitic all over the abdomen. There is no fluid thrill or shifting
dullness

Made by: Farzeen Khan (Batch 10)

  AUSCULTATION OF THE ABDOMEN:
a) 4 sites:
 Right side medially for 3min below and lateral to the umbilicus
 Right side medially for 3min above and lateral to the umbilicus
 Left side medially for 3min above and lateral to the umbilicus
 Left side medially for 3min below and lateral to the umbilicus

Made by: Farzeen Khan (Batch 10)