PEDIATRIC PHYSICAL DIAGNOSIS

Module 1: Vaccination

VACCINATION SKILLS
Explains to mother the diseases prevented by the vaccines to be administered (BCG, Hepa B,
MMR)
Explains to mother possible complications and gives instructions on what to do in case there
are any (rashes, irritability, vomiting, fever, seizures)
Washes hands or uses alcohol to clean hands, wears gloves
Cleans the area to be vaccinated using cotton with alcohol
Changes the needle used to aspirate vaccine with a new one for injection to patient
Correctly administers BCG – Intradermal
vaccine using the right Hepa B - Intramuscular
route (with proper Measles - Subcutaneous
angle) and technique
Places dry cotton with tape on vaccination site

MODULE 2: Observed History-taking (Syncope Case)

HISTORY TAKING SKILLS YES NO Information gathered

Opening Greets the patient and
the relative
interview Introduces self and role on
healthcare team
Acknowledges
caregiver/child and calls
them by name
Data Name
gathering: Age or date of birth
General Gender
data Address
Informant/relationship to
patient
Chief Asks reason for seeking
complaint care/presenting problem
History of Onset: when the problem
present started, chronologic order
illness of events, previous
episodes
Activity prior to syncope
Duration of loss of
consciousness
Last meal intake prior to
syncope
Relieving factors
Associated symptoms like
seizure, pallor, fever,
cyanosis, etc.
 Were medications given?
Was consultation done?
Review of General: weight loss, fever,
systems decreased appetite,
Skin: rashes
Eyes: discharge, redness
Ears: discharge, redness,
swelling
Respiratory: cough, colds.
Difficulty breathing
Neuromuscular: seizures,
weakness, increased
sleeping time
Past Medical illnesses
illnesses
Previous hospitalizations
Drug reactions/allergies
Accidents, surgeries
Feeding Sample Diet
history: Any feeding problem?
Infancy
Maternal Maternal check-ups,
and birth illnesses, medications taken
history: Alcohol intake, smoking,
Prenatal attitude towards pregnancy
OB score, miscarriages
Natal Type of delivery, assisted
by: OB or midwife, location,
complications
Postnatal Apgar score, condition upon
birth, birth weight, duration
of hospital stay ,
complications: jaundice,
sepsis, cyanosis
Develop- Behavioral problems?
mental School performance
history: Any incident of bullying at
school?
Immuni- Date of administration
zations Allergic/adverse reactions
to vaccines
Family Size of family
history Illnesses in other family
members, causes of death
Heredofamilial diseases
Personal Home conditions; economic
and social status
history Parents’ occupations
Principal caregiver
Religion/ cultural beliefs
HEADSSS • H- ome (relationships
(you may at home)
ask the • E- ducation (school
parent if it performance, subjects
is ok for doing well and
her to subjects having
leave the difficulty, any learning
room so disability?),
you can E-Employment, Eating
privately habits
speak to
the child • A- ctivities (sports,
only. Be hobbies)
very • D- rugs (use of illicit
careful drugs, alcohol,
with your cigarette smoking)
questions, • S- exuality (sexual
and be preference, sexual
sensitive. relationships and
Avoid experience)
laughing. )
• S- afety (risk-taking
behavior)
• S- uicidal
ideations/Depression

Closing Asks caregiver if he/she has

the any question, concerns
interview Closes the interview with
appropriate gestures and
statements

PEDIATRIC PHYSICAL DIAGNOSIS

MODULE 2: Observed Physical Exam

SKILLS Yes No PE FINDINGS

PREPARATION a. Minimizes patient discomfort/anxiety
b. Explains to child and caregiver what
he/she is doing
VITAL SIGNS a. Measures temperature Temp:
b. Counts heart rate for 1 minute HR:
c. Counts respiratory rate for 1 minute RR:
d. Measures blood pressure (for >3yo) BP:
 with age appropriate cuff
ANTHROPO- a. Weight Wt:
METRIC b. Height Ht:
MEASURE-
MENTS
GENERAL a. Level of consciousness:
SURVEY awake/lethargic/unconscious
comfortable/irritable
b. Ambulatory/carried by caregiver
c. Poorly/fairly/well nourished
d. Cyanotic/pale/pinkish
e. With or without respiratory distress –
shortness of breath
HEENT a. Checks pupillary response to light
b. Looks for sunken eyes
c. Inspects for dryness of lips and oral
mucosa
d. Inspects oropharynx using a light
source and tongue depressor if
necessary
e. Examines tympanytic membranes
using otoscope
f. Checks nares for polyps/congestion
g. Palpates neck for lymph
nodes/mass/enlarged thyroid
HEART a. Palpates point of maximal impulse
b. Palpates for heaves/thrills
c. Auscultates the heart in 4 areas
(ULSB, URSB, LLSB, apex)
d. Notes if there is regular or irregular
heart rate and/or murmur
e. Palpates pulses on wrists (radial
pulse) and feet (dorsalis pedis pulse)
and reports whether full, fair or poor
f. Checks capillary refill time
LUNGS a. Inspects chest for deformities and
chest retractions
b. Auscultates all lung fields starting at
apices and works downward
comparing symmetric points
sequentially (anteriorly and
posteriorly)
c. Demonstrates egophony (“E” to “A”)
in an older, cooperative child
d. Checks for symmetric chest
expansion by palpation and
inspection
e. Percusses the thorax and reports if it
is resonant