Pediatric History and Physical Examination Mastery Assessment: Prenatal Birth History Analysis, Developmental History Evaluation, Family Social Environmental Risk Assessment, Immunization Documentation Verification, Pediatric Chief Complaint Interpretatio

Pediatric History and Physical Examination Mastery Assessment: Prenatal Birth History Analysis, Developmental History Evaluation, Family Social Environmental Risk Assessment, Immunization Documentation Verification, Pediatric Chief Complaint Interpretation, Past Medical Surgical Trauma History Review, Medication Allergy Identification, Parent-Child Interaction Observation, Developmentally Appropriate Pediatric Communication, Age-Specific Vital Sign Interpretation, Pediatric Growth Parameter Plotting, Occipital Frontal Head Circumference Measurement, Skin Lesion and Lymphatic Assessment, Fontanelle and Cranial Suture Evaluation, Pediatric Ocular Alignment and Red Reflex Screening, Tympanic Membrane and Hearing Assessment, Nasal Patency and Sinus Examination, Oral Cavity and Tonsillar Assessment, Thyroid and Cervical Mass Evaluation, Pediatric Respiratory Pattern and Retraction Assessment, Cardiac Murmur and Peripheral Pulse Examination Questions Verified and Provided with Complete A+ Graded Rationales Latest Updated 2026 The differences of a pediatric history compared to an adult history I. Content Differences A. Prenatal and birth history B. Developmental history C. Social history of family - environmental risks D. Immunization history II. The Historian: Parent/Guardian, Child, Grandparent A. Parent's interpretation of signs, symptoms 1. Reliability of parents' observations varies 2. Adjust wording of questions B. Observation of parent-child interactions 1. Distractions: parenting may interfere with history taking 2. Quality of relationship C. Parental behaviors/emotions are important 1. Parent/caregiver health beliefs 2. Parental/caregiver emotions (upset, guilt) pediatric history - chief complaint Brief statement of visit purpose Past medical history Major medical illnesses Major surgical illnesses - list operations and dates Trauma-fractures, lacerations Previous hospital admissions with dates and diagnoses Current medications Known allergies (not just drugs) Immunization status - be specific, not just up to date General approach pediatrics A. Gather as much data as possible by observation first B. Position of child: parent's lap vs. exam table C. Stay at the child's level as much as possible. Do not tower!! D. Order of exam: least distressing to most distressing E. Rapport with child 1. Include child - explain to the child's level 2. Distraction is a valuable tool F. Examine pain or most invasive areas last (different for each child) G. Be honest and explain what you are doing. H. Understand developmental stages' impact on child's response. ie: Stranger anxiety is a normal stage of development, which tends to make examining a previously cooperative child more difficult. Vital signs A. Normals differ by chronological age (HR & RR decrease with age, BP increases with age) B. Temperature 1. Tympanic vs. oral vs. axillary vs. rectal C. Heart rate 1. Auscultate or palpate apical pulse or palpate femoral pulse in infant 2. And, palpate antecubital or radial pulse in older child D. Respiratory rate 1. Observe for a minute. Infants normally have periodic breathing so that observing for only 15 seconds will result in a skewed rate. 2. Infant apnea (15-20 seconds) - more common in prematurity E. Blood pressure 1. Appropriate size cuff - 2/3 width of upper arm 2. Site F. Growth parameters - must plot on appropriate growth curve 1. Weight 2. Height/length 3. OFC: Across frontal-occipital prominence so greatest diameter (Occipital Frontal Circumference) Outline of a pediatric physical exam - general A. Statement about striking and/or important features. Nutritional status, level of consciousness, toxic or distressed, cyanosis, cooperation, hydration, mental state B. Obtain accurate weight, height (and head circumference) Outline of a pediatric physical exam - skin and lymphatics A. Birthmarks (nevi, nevus flammeus, hemangiomas, café au lait, mongolian spots, etc) B. Rashes, petechiae, desquamation, pigmentation, jaundice, texture, turgor C. Lymph nodes (enlargement, location, mobility, consistency) D. Scars or injuries, especially in patterns suggestive of abuse Outline of a pediatric physical exam - head A. Size and shape B. Fontanelle(s) (anterior/posterior) 1. Size 2. Tension C. Sutures - (separated, overriding?) 1. Coronal, sagittal, lambdoid D. Scalp and hair Outline of a pediatric physical exam - eyes A. General 1. Position 2. Strabismus? 3. Slant of palpebral fissures B. EOM/visual fields C. Pupils D. Conjunctiva, sclera, cornea E. Nasolacrimal ducts (patent)