Age Groups: Neonatal 1st 4 weeks Neonatal 1st 4 weeks Infant 1 st year Infant 1 st year Childhood 1 to 15 Years Childhood 1 to 15 Years Preschool 2 to 4 years Preschool 2 to 4 years School 5 to 15 years School 5 to 15 years Adolescent 13 to 19 Years Adolescent 13 to 19 Years

History&Physical Examination Chief Complaint Chief Complaint History History Physical Examination Physical Examination

History : History : History of Present Illness History of Present Illness Previous History Previous History Family History Family History Developmental History Developmental History Social & Environmental History Social & Environmental History

History of Present Illness: Age &Sex Age &Sex Explain CC Explain CC Feeding&Appetite Feeding&Appetite Vomiting Vomiting Thirst Thirst Abdominal pain Abdominal pain Bowel habit Bowel habit Weight gain or loss Weight gain or loss Discharge from eyes,ears,nose Discharge from eyes,ears,nose Sore throat Sore throat Cough Cough Breathlessness Breathlessness Mouth breathing Mouth breathing Localized pain or swelling Localized pain or swelling

History of Present Illnes Skin Lesions or rash Skin Lesions or rash Jaundice Jaundice Cyanosis Cyanosis Pallor Pallor Musculature Musculature Walking Walking Coordination Coordination Speech Speech Headache Headache Vision Vision Hearing Hearing Dysuria &Frequency Dysuria &Frequency Bed Wetting Bed Wetting Character of urine Character of urine Mood Mood ………. ……….

Previous History Pregnancy Hx Delivery Hx Neonatal Hx Nutritional Hx Vaccination Hx Previous infection Dis. ….

Family History Parents Parents Abortion Abortion Other brothers &Sisters Other brothers &Sisters Hx of SIDS Hx of SIDS …. ….

Developmental History Smiling Smiling Sitting Sitting Standing Standing Walking Walking Speech Speech …. ….

gross motor milestones

fine motor milestones

Social & Environmental History Divorce Divorce Addiction Addiction Disabilities Disabilities Death Death Economy Economy ….. …..

Physical Examination: General Inspection General Inspection Physical Measurements Physical Measurements Head &Neck Head &Neck Chest & Lung Chest & Lung Cardiovascular System Cardiovascular System Abdomen Abdomen Perineum &Genitalia Perineum &Genitalia Nervous System Nervous System Locomotion System Locomotion System

Physical signs of allergy The allergic salute Eczema lesions Cholinergic urticaria Angioedema

Physical Measurements: Weight 15% weight loss during first 7-10 days 15% weight loss during first 7-10 days 1st 4 mo. : BW + (Age in mo. * 0.8) 1st 4 mo. : BW + (Age in mo. * 0.8) 2nd 4 mo. : BW + (Age in mo. * 0.7) 2nd 4 mo. : BW + (Age in mo. * 0.7) 3rd 4 mo. : BW + (Age in mo. * 0.6) 3rd 4 mo. : BW + (Age in mo. * 0.6) Infants birth weight double by 5 mo. Infants birth weight double by 5 mo. Infants birth weight triple by 1 year Infants birth weight triple by 1 year

Physical Measurements: Weight 1-9 years add 4 to the age in years and multiply by years add 4 to the age in years and multiply by triple the age in year 9-12 triple the age in year

Physical Measurements: length At birth 50 cm At birth 50 cm 6 mo. 68 cm 6 mo. 68 cm 1year 75 cm 1year 75 cm 2 years 85 cm 2 years 85 cm 3 years 95 cm 3 years 95 cm 4 years 100 cm 4 years 100 cm Over the next 8 years 5.5 cm each year Over the next 8 years 5.5 cm each year

This 5.5-year-old boy with growth hormone deficiency (left) was significantly smaller than his twin sister (right).

Physical Measurements Head circumference At birth 35cm At birth 35cm 6 mo cm 6 mo cm 1 year 46.5 cm 1 year 46.5 cm 2 years 49 cm 2 years 49 cm 2-7 years 0.5 cm annually 2-7 years 0.5 cm annually

microcephaly

Physical Measurements Temperature Low reading thermometers(29-43 c) Diurnal variation Rectal 37.5 c (>38 c) Groin &Auxiliary 37 c (>37.3 c) oral (>37.6 c)

Physical Measurements Blood pressure Right arm Newborn(Flush method) 70/35 Infancy(Systolic/Diastolic) 80/55 Preschool child (Systolic/Diastolic) 85/60 School child (Systolic/Diastolic) 90/60

Head &Neck Cranium Head &Neck Cranium Ant. Fontanel: 2.5 * 2.5 cm and closed until 18 mo. Ant. Fontanel: 2.5 * 2.5 cm and closed until 18 mo. Post. Fontanel:0.5 cm and closed shortly after birth. Post. Fontanel:0.5 cm and closed shortly after birth. Sutures Sutures Cranium Cranium

Head &Neck Facial appearance Large tongue Marked nasolabial line Nasal bridge(Low,Wide) Facial palsy

Low hair line HypertelorismMicroganetia

Russell-Silver dwarfism

Vitiligo Pityriasis alba

Alopecia areata Tinea capitis

Head &Neck Ear Ear Anomalies Anomalies Low set ear Low set ear Canal(Wax,Forign body,Discharge…) Canal(Wax,Forign body,Discharge…) Tympanic membrane(Color,Perforation Tympanic membrane(Color,Perforation,Buldging or Retraction),Buldging or Retraction) Cone of light Cone of light

Preauricular skin tag

Eyes: Telecantus:Apert, Telecantus:Apert, Hypertelorism,Crouzon Hypertelorism,Crouzon Ptosis Ptosis Sunset sign Sunset sign Exophtalmus Exophtalmus Enophtalmus(Horner) Enophtalmus(Horner) Buphtalmus Buphtalmus Pupils(Myosis,Myderiasis) Pupils(Myosis,Myderiasis) Conjunctivitis Conjunctivitis Icterus(Hepatitis) Icterus(Hepatitis) Ctaract(Rubella) Ctaract(Rubella) Opacity of cornea Opacity of cornea

Enophtalmus Exophtalmus