1. 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

2. History&Physical Examination Chief Complaint Chief Complaint History History Physical Examination Physical Examination

3. 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

4. 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

5. 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 ………. ……….

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

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

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

9. gross motor milestones

10. fine motor milestones

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

12. 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

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

15. 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

16. Physical Measurements: Weight 1-9 years add 4 to the age in years and multiply by 2 1-9 years add 4 to the age in years and multiply by 2 9-12 triple the age in year 9-12 triple the age in year

17. 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

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

19. Physical Measurements Head circumference At birth 35cm At birth 35cm 6 mo. 43.5 cm 6 mo. 43.5 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

20. microcephaly

21. 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 37-37.5 (>37.6 c)

22. 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

23. 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

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

25. Low hair line HypertelorismMicroganetia

26. Russell-Silver dwarfism

28. Vitiligo Pityriasis alba

29. Alopecia areata Tinea capitis

30. 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