1. Pediatric Diagnosis Observation –Eye contact –Establish rapport with the parents & the child History taking –Investigation –Asking “relevant” questions

2. Personal History Taking Active listening –silence –non-verbal indications of interest facilitation –“door openers” –“rocking” –“repeating”

3. Questioning –probe & seek clarification reflection confrontation

4. History taking –Outline of history General Data Chief complaint History of present illness Past medical history Family history Maternal & perinatal history Developmental history Nutritional history Immunization history Personal & Social history

5. Pediatric Diagnosis –Review of the Systems –Physical Examination –Assessment

6. General Data: –Patient’s name –Religion –Date of birth –Age of the patient –Sex –Patient’s address –Birth place –Nationality –Admission (First, 2nd, or third) –Informant – Reliability

7. Chief Complaint: –What is the problem of the patient? Respiratory CNS –Cough? Dizziness? –Colds? Headache? –Difficulty of breathing Drowsy? Gastrointestinal disorders –vomiting? General –Difficulty of swallowing? Fever? –diarrhea Loss of appetite?

8. History of Present Illness: –Nature and date of onset –time of manifestations –describe the signs and symptoms –occurrence and progression –inquire about recent exposure to infectious disease

9. Past Medical History –State the previous illnesses of the patient –Age of occurrence Example: –Had measles at 2 years old –Previous hospitalization Example: –He was admitted at fatima medical center due to bronchial asthma on August 8, 2005

10. Family History: –Birth order of the patient –Number of living siblings –Total number of siblings –Heredo-familial disease (+) PTB-father(+) diabetes-mother –Are parents alive and healthy? –Size of the family? –Health and problems of the other children To known if there’s any history of associated congenital/genetics disorder in the family

11. Maternal & Perinatal History: –Chronological order of pregnancies –Illnesses during pregnancy –X-ray exposure during pregnancy –Drug intake during pregnancy –Age of gestation – full term? Pre-term? Post-term? –Place of delivery – hospital? Home? –Type of delivery? –Complications? –Apgar?Birth weight?

12. Developmental History Developmental milestone of the patient –At what age the patient started to Sit? Walk? Talk? – Secondary sexual characteristics (adolescent)

13. Nutritional History Type of feedings –Breast feeding? –Artificial feeding? –Supplementary feeding? Example: Patient was breastfed until 6 months old then shifted to Promil Gold at 1:2 dilution up to 1 year old

14. Immunization History Type of immunization Age immunized Example: Patient received 1 dose of BCG at birth, 3 doses of DPT, 3 doses of TOPV at 2, 4 & 6 months old & 1 dose of measles vaccine at 9 months old.

15. Personal & Social History Living condition Housing condition Educational attainment of the parents Family income Example: The family lived in a 10 X 8 sq meter house. Water supply by MWSS. Electricity by Meralco. Family income of 8,000 per month.

16. Review of System Occurrence Duration Skin jaundice 1 month HEENT eye discharge 3 days Chest & Lungs wheezing 2 days Heart chest pain 5 days Abdomen epigastric pain Genitalia yellowish discharge Extremities joint pain

17. Examining a Pediatric Patient Keen Observation

18. Physical Examination: General Survey –? Level of consciousness –? Respiratory distress Vital signs –Wt. (% percentile) Expected body wt. (EBW) –Ht. (% percentile)Temp. –CRRRBP

19. HEENT –? Color of conjunctivae pinkish/pale –? Nasal/aural discharges –? Cervical masses/lymphadenopathy –? Conditions of the throat color & sizes of the tonsils –congestion/pectechiea/swelling Lungs –retractions –breath sounds-wheezes, rhonchi, rales

20. Heart –precordium-? bulging, adynamic/dynamic –heart sounds- ? Rate, rhythms, murmur Abdomen –Symmetrical- ? Bulging –bowel sounds - normoactive, hypoactive, hyperactive –organomegaly liver span, spleen & other palpable masses

21. Genitalia –? Testis descended –? Ambiguous genitalia Extremities –? Pulses e.g. full & equal –? Capillary refill - 2 sec –? Clubbing Neurologic Examination

22. Assessment Diagnosis? Impression?