REVIEW OF SYSTEMS--‐ Child Brief Cardiovascular A.

Gestational age at delivery

Name: _______________________________ □ Chest pain or discomfort
DOB: __________________ □ Chest 8ghtness
**Please check only the symptoms your child □ Palpitatons (rapid
currently has** heartbeat)
□ Shortness of breath
General B. Labor and delivery -
□ abnormal weight gain GastrointesInal  length of labor,
□ abnormal weight loss □ Difficulty swallowing  fetal distress,
□ Fa8gue/weakness □ Heartburn  type of delivery (vaginal, cesarean section),
□ frequent fevers □ Nausea  use of forceps,
□ Trouble sleeping □ Frequent vomi8ng  anesthesia,
□ Cons8pa8on  breech delivery
Skin □ Diarrhea
□ Rash □ Blood in stool C. Neonatal period
□ Lumps  Apgar scores,
□ Itching Urinary
 breathing problems, use of oxygen,
□ excessively dry skin □ frequent urination
 need for intensive care,
□ Sun sensitivity □ Urgency to urinate
□ Hair and nail changes □ Burning/painful urination  hyperbilirubinemia,
□ Lower back pain  birth injuries,
Head/Neck □ Dark or bloody urine  feeding problems,
□ Frequent headaches □ Decreased urine  length of stay,
□ Head injury  birth weight
□ Neck pain Musculoskeletal
□ Neck s8ffness □ Painful joints V. Developmental History
□ Swollen glands □ Frequent muscle aches A. Ages at which milestones were achieved and
□ Lumps □ Swollen joints current developmental abilities –
□ Joint redness  smiling
Eyes □ Back pain  rolling
□ Eye redness □ Trauma  sitting alone
□ Eye pain □ Difficulties walking !  crawling
□ Eye discharge  walking
□ Blurry or double vision Neurologic  running, 1st word, toilet training, riding tricycle,
□ Vision loss □ Dizziness etc (see developmental charts)
□ Wear glasses/contacts □ Fain8ng
□ Other: ______________ □ Seizures B. School-
□ Weakness  present grade,
Ears □ Tingling/numbness  specific problems
□ Decreased hearing □ Tremor (shaky hands)  interaction with peers
□ Frequent ear pain □ Tics
□ Ear drainage □ Balance difficulty C. Behavior -
□ Gait abnormality  enuresis
Nose □ Headache
 temper tantrums
□ Constant nasal □ Loss of strength
 thumb sucking
conges8on
□ Nasal discharge/drainage Psychiatric/Behavioral  pica
□ frequent nosebleeds □ Frequent temper  nightmares etc.
□ Sinus pain tantrums
□ Decreased sense of smell □ Severe separation VI. Feeding History
!!Throat/Mouth anxiety A. Breast or bottle fed
□ Bleeding gums □ Sleep difficul8es B. types of formula
□ Dry mouth □ Behavioral problems C. frequency and amount,
□ Constantly sore throat □ School problems D. reasons for any changes in formula
□ Hoarse voice
□ Thrush IV. Pregnancy and Birth History E. Solids –
□ Non--‐healing sores  Maternal health during pregnancy: when introduced
 bleeding, problems created by specific types
 trauma,
Respiratory F. Fluoride use
 hypertension,
□ frequent cough  fevers, infectious
□ coughing up phlegm  illnesses,
□ Shortness of breath  medications,
□ Wheezing  drugs, alcohol, smoking, rupture of membranes
□ Pain with breathing

pascualtrishamae
 Outline of a Pediatric Physical Examination D. Discharge 3. Edema
4. Clubbing
I. General VI. Mouth and Throat E. Gait
A. Statement about striking and/or important A. Lips (colors, fissures) 1. In-toeing, out-toeing
features. B. Buccal mucosa (color, vesicles, moist or dry) 2. Bow legs, knock knee
 Nutritional status, C. Tongue (color, papillae, position, tremors) a. “Physiologic” bowing is frequently seen under 2
 level of consciousness D. Teeth and gums (number, condition) years of age and will spontaneously resolve
 toxic or distressed E. Palate (intact, arch) 3. Limp
 cyanosis F. Tonsils (size, color, exudates) F. Hips
 cooperation, G. Posterior pharyngeal wall (color, lymph hyperplasia, 1. Ortolani’s and Barlow’s signs
 hydration bulging)
 dysmorphology, H. Gag reflex X. Neurologic - most accomplished through
observation alone
 mental state
V. Neck A. Cranial nerves
A. Thyroid B. Sensation
B. Obtain accurate weight, height and OFC
B. Trachea position C. Cerebellum
C. Masses (cysts, nodes) D. Muscle tone and strength
D. Presence or absence of nuchal rigidity E. Reflexes
1. DTR
VI. Lungs/Thorax 2. Superficial (abdominal and cremasteric)
III. Skin and Lymphatics
A. Inspection 3. Neonatal primitive
A. Birthmarks - nevi, hemangiomas, mongolian spots
1. Pattern of breathing
etc
a. Abdominal breathing is normal in infants XI. GU
b. Period breathing is normal in infants (pause < 15 A. External genitalia
B. Rashes, petechiae, desquamation, pigmentation,
seconds) B. Hernias and Hydrocoeles
jaundice, texture, turgor
2. Respiratory rate 1. Almost all hernias are indirect
3. Use of accessory muscles: retraction location, 2. Can gently palpate; do not poke finger into the
C. Lymph node enlargement, location, mobility,
degree/flaring inguinal canal
consistency
4. Chest wall configuration C. Cryptorchidism
1. Distinguish from hyper-retractile testis
D. Scars or injuries, especially in patterns suggestive
B. Auscultation 2. Most will spontaneously descend by several months
of abuse
1. Equality of breath sounds of life
2. Rales, wheezes, rhochi D. Tanner staging in adolescents - See Tanner
3. Upper airway noise Staging handouts
IV. Head
E. Rectal and pelvic exam not done routinely –
A. Size and shape
C. Percussion and palpation often not possible and special indications may exist
rarely helpful
B. Fontanelle(s)
VII. Cardiovascular
1. Size
A. Auscultation
2. Tension - calm and in the sitting up position
1. Rhythm
2. Murmurs
C. Sutures - overriding
3. Quality of heart sounds
D. Scalp and hair
B. Pulses
1. Quality in upper and lower extremities
V. Eyes
A. General
VIII. Abdomen
1. Strabismus
A. Inspection
2. Slant of palpebral fissures
1. Shape
3. Hypertelorism or telecanthus
a. Infants usually have protuberant abdomens
b. Becomes more scaphoid as child matures
B. EOM
2. Umbilicus (infection, hernias)
3. Muscular integrity (diasthasis recti)
C. Pupils
B. Auscultation
D. Conjunctiva, sclera, cornea
C. Palpation
E. Plugging of nasolacrimal ducts
1. Tenderness - avoid tender area until end of exam
F. Red reflex
2. Liver, spleen, kidneys
G. Visual fields - gross exam
a. May be palpable in normal newborn
3. Rebound, guarding
VI. Ears
a. Have child blow up belly to touch your hand
A. Position of ears
1. Observe from front and draw line from inner canthi
IX. Musculoskeletal
to occiput
A. Back
1. Sacral dimple
B. Tympanic membranes
2. Kyphosis, lordosis or scoliosis
C. Hearing - Gross assessment only usually
B. Joints (motion, stability, swelling, tenderness)
C. Muscles
V. Nose
D. Extremities
A. Nasal septum
1. Deformity
B. Mucosa (color, polyps)
2. Symmetry
C. Sinus tenderness
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