 First of all introduce yourself.

 Develop rapport

Main important points..

 Patient particulars( both patient and informant)

1. Patient( NAme, age, sex,religion,address,date of examination,date

of admission(prefer.......days back instead of exact dates like 24th
April,May etc.. ,mode of admission:(via OPD or emergency))
2. INformant(NAme,age,sex,relation to
the child,religion,address,education,occupation,there only assess
whether the source is reliable or not...if the informant is educated
and stays with the child most of the times, informant is reliable...if
the informant is illiterate and doesn't stay with the child,consider it
unreliable....It can be asessed while asking socio-economic history
and can be presented later on in history...so need not jump directly
into its reliability)

 Chief complaints (say chief complaints only when paan is there....for

others presenting complaints can also be said)

1. Should be 1 or 2 and in chronological order...

2. If the complaint is gradual and over a long duration of time ask what
has brought the patient to the hospital and record days since when
the complaint got severe...ex...the patient may have chest pain for 5
years but since last 1 week he might have been more severe...)

 History of presenting illness

1. Elaboration of chief complaints

2. Current drug and medications taken and their effects on the course
of disease
3. Focused relevant history(symptom and system overview, keep
differential diagnosis in mind and rule out the other diseases on the
basis of chief complaints and associated symptoms.......Do not say
negative history in front of Paan)

The following symptoms must be asked :

1. CRY
  Sudden or gradual
 Type or character of the cry(shrill cry is the characteristic cry of child
in pain, continuous cry as if the child is irritated, hoarse cry –
cretinism, laryngitis, laryngotracheobronchitis, paralysis of left
recurrent laryngeal nerve)
 Whether pacified by cuddling of feeding
 Associated with breath holding spells or not??
 Cyanotic spell or not( Ask for bluish discoloration during the cry)

1. FEVER

 Onset (Sudden or gradual)

 Duration
 CHaracter(Continuous,remittent or intermittent)
 Severity(either the body is excessively hot,mild hot ,look of the
babies,whether irritable or not,toxic look or not, urine output)
 Associated symptoms
 Whether associated with chills and rigors or not
 Diurnal variations
 MAximum temperature recorded
 Relieving factors(paracetamol,antibiotics,taped water sponging)

(Fever considered when axillary temperature >99degree F ,oral >99.5 F

and rectal>100.4 F)

1. COUGH

 Onset(sudden or gradual)
 Duration
 Frequency
 Character(paroxysmal,barking or chesty)Ask if the cough was
blood tinged or not...In pediatrics (esp. small babies the cough
is always dry..hence do not ask for dry or productive)
 Postural relationships
 Diurnal variations
 Associated symptoms(Vomiting,difficulty breathing..Do not use
words like shortness of breath because SOB is a subjective
symptom that physician or older people expre.....difficulty
breathing is objective symptom as seen by the mother as the
child himself/herself cannot complain of such things..)
 See for any nasal flaring (indicates difficulty breathing)
 Aspiration of any foreign body or not(may cause aspiration
pneumonia in the long run)

1. VOMITING

 Onset
 Duration
 Frequency
 Severity(ASk for the symptoms of dehydration...If the child is
irritable or not,drinks eagerly and most important urine
output...How often does he/she go to urinate??)
 COntents of the vomitus(bile or faecal matter,blood)
 Projectile or non-projectile (ask if the vomitus gets stuck on the
clothes during vomiting or is spread away from the body)
 Associated symptoms (nausea,loss of appetite,neck rigidity(difficulty
moving the neck))
 Ask if cough preceded vomiting(Post tussive vomiting is the most
common cause of vomiting in children).
 Character
 Amount(character and amount ask before others)

1. PAIN ABDOMEN

 SOCRATES
 Position of body/posture
 Hand position
 Cry
 Relieving factors

1. DIARRHOEA

 Onset
 Duration
 frequency
 severity( Asses via dehydration status)
 Character(BLood ,mucus, rice
watery)(odor,colour,consistency,bulk ,amount)
 passage of flatus or not
 History of past illness

1. ask for past history of common childhood illness like recurrent upper
respiratory tract infections like
asthma,bronchitis,pneumonia.....diarrhoea
2. perinatal history (ask for history of jaundice(yellowish
discoloration),delayed cry at birth signifying
asphyxia,meningitis,any abnormal body movements like eye
fluttering,jerking movements, tongue biting etc..)
3. Ask for previous episodes of asthma ,epilepsy,nephrotic
syndrome,arthritis, rashes,discharge from ears(Most significant)
,nose ,eyes etc..
4. Recurrent episodes of pneumonia or chest infections

 Birth history(Antenatal/NAtal/POstnatal)

1. Antenatal:

 No.of antenatal visits(at least 4 in 16,24/28,32,36 weeks)..why 4

because TT(tetanus Toxoid ) vaccine can be given at the same time
to the mother during pregnancy....if the mother cannot reach to
health post often(KiLLing two birds with one stone )
 INtake of iron pills,folic acid
 ANy chronic or severe illness during pregnancy
 Weight gain during pregnancy

1. NAtal(Perinatal)

 Place of delivery(home or hospital)

 MOde of delivery(Normal vaginal or cessarian section)
 IF the gestation was term or not(normal 9 months or more or less)
 WEight of the baby after birth
 ANy foetal distress like meconium staining
 Cry after birth,jaundice ,seizures(abnormal body movements
during birth)

1. Postnatal

 Breast feeding done for how many months(check if it was exclusive

or not.......for 6 months only mother's milk with medical interventions
 done if required is exclusive...if water given in between it is not
exclusive.)
 Any supplements given afterwards
 Age at weaning

 Developmental history:

Ask under following headings

1. Gross motor
2. Fine motor
3. Language
4. SOcial

IF the child is greater than 5 years or adolescent, ask his

schooling(which class does he/she read and assess whether it is
appropriate for that age ,interaction of child with other children and
comparison of the development with the child of same age group or
siblings ).

 Family history

1. Ask how many children are there ....which one is the patient(eldest,
youngest)

2. Ask for any death of the previous child or family members (be
specific and find out if it was father,mother,grandparents,uncle or
any other )..Draw a pedigree of three generations ..(not done in
pedia posting...)
3. Ask if parents ,grandparents, mother ,uncle....are suffering from
chronic illnesses like diabetes,any genetic diseases...be specific
being relevant to the patients condition...

4. Ask for any consanguinity ...(not done )

5. History of contact (very important) should be asked..Ask if other

members are suffering from diseases like
pneumonia,tuberculosis,leprosy,infective or allergic disorders..

 Socio_Economic history:

1. HOusing (kuchha/pukka, spacious?crowded/sewage disposal/toilet

facilities/sanitation/status of drinking water)
2. Kuppuswamy scale(EDUcation/occupation/per capita income)
3. HArmful social and cultural practices
4. Ask who stays to take care of child most of the time...Is mother all
the time or someone else looks after??

 Nutrition history:

1. Ask for food habits before illness and after illness

2. Calorie chart and average calories consumed(in 1 day via calorie
chart...ex...1 bowl of rice,1 cup(250 ml) of milk, dal etc...and
calculate calories consumed accordingly in 24 hours
3. Breastfeeding,age at weaning,supplements frequency and duration
4. vegetarian or non-vegetariana and look for ask for food consumed
accordingly

 Immunization history:

1. See EPI schedule

2. BUt while presenting history,write which which vaccinations have
been given by thorough asking...rather than writing according
to EPI schedule In NEpal it is JUne 2016.....because there are
some recent vaccines included like pentavalent,MR,IPV which
were not in previous EPI so a 10 year old child of today may
not have received pentavalent,IPV or others..as they were not
included in previous EPIs...so it is not right to write according
to EPI ....so mention exact vaccines...ALso mention if other
vaccines have been taken like Typhoid,Herpes,Human
Papilloma, Varicella Zoster,PNEumococcal and meningococcal
vaccines if taken...
3. NOTE:Reason why IPV was introduced instead of OPV....because
OPV was known to induce VAPP(Vaccine Associated PAralytic
Polio) i.e.it was seen to induce paralysis in some individuals which
was detrimental...
4. NOTE: BCG can be given as soon as possible (not compulsory
as soon after birth) can be given to a non-immunized child
whenever encountered.
5. NOte:MEasles vaccine is given after 9 months
because..maternal Antibodies provide immunity upto 9
monnths...If given before 9 months, there will be Ag_Ab
reaction....and antibodies will bw nullified and there will be no
Abs left for protection.