Age Groups Neonatal l Infant l Childhood l

Age Groups: Neonatal l Infant l Childhood l Preschool l School l Adolescent l 1 st 4 weeks 1 st year 1 to 15 Years 2 to 4 years 5 to 15 years 13 to 19 Years

History&Physical Examination l Chief Complaint l History l Physical Examination

History : History of Present Illness l Previous History l Family History l Developmental History l Social & Environmental History l

History of Present Illness: l l l l Age &Sex Explain CC Feeding&Appetite Vomiting Thirst Abdominal pain Bowel habit Weight gain or loss l l l Discharge from eyes , ears, nose Sore throat Cough Breathlessness Mouth breathing Localized pain or swelling

History of Present Illnes l l l l Skin Lesions or rash Jaundice Cyanosis Pallor Musculature Walking Coordination Speech l l l l Headache Vision Hearing Dysuria &Frequency Bed Wetting Character of urine Mood ……….

Previous History Pregnancy Hx Delivery Hx Neonatal Hx Nutritional Hx Vaccination Hx Previous infection Dis. ….

Family History Parents l Abortion l Other brothers &Sisters l Hx of SIDS l …. l

Developmental History Smiling l Sitting l Standing l Walking l Speech l …. l

gross motor milestones

fine motor milestones

Social & Environmental History Divorce l Addiction l Disabilities l Death l Economy l …. . l

Physical Examination: l l l l l General Inspection Physical Measurements Head &Neck Chest & Lung Cardiovascular System Abdomen Perineum &Genitalia Nervous System Locomotion System

Physical signs of allergy The allergic salute Angioedema Eczema lesions Cholinergic urticaria

Physical Measurements: Weight 15% weight loss during first 7 -10 days l 1 st 4 mo. : BW + (Age in mo. * 0. 8) l 2 nd 4 mo. : BW + (Age in mo. * 0. 7) l 3 rd 4 mo. : BW + (Age in mo. * 0. 6) l Infants birth weight double by 5 mo. l Infants birth weight triple by 1 year l

Physical Measurements: Weight l 1 -9 years add 4 to the age in years and multiply by 2 l 9 -12 triple the age in year

Physical Measurements: length At birth 50 cm l 6 mo. 68 cm l 1 year 75 cm l 2 years 85 cm l 3 years 95 cm l 4 years 100 cm l Over the next 8 years 5. 5 cm each year l

This 5. 5 -year-old boy with growth hormone deficiency (left) was significantly smaller than his twin sister (right).

Physical Measurements Head circumference At birth l 6 mo. l 1 year l 2 years l 2 -7 years l 35 cm 43. 5 cm 46. 5 cm 49 cm 0. 5 cm annually

microcephaly

Physical Measurements Temperature Low reading thermometers(29 -43 c) Diurnal variation Rectal 37. 5 c (>38 c) Groin &Auxiliary 37 c (>37. 3 c) oral 37 -37. 5 (>37. 6 c)

Physical Measurements Blood pressure Right arm Newborn(Flush method) 70/35 Infancy(Systolic/Diastolic) 80/55 Preschool child (Systolic/Diastolic) 85/60 School child (Systolic/Diastolic) 90/60

Head &Neck Cranium l Ant. Fontanel: 2. 5 * 2. 5 cm and closed until 18 mo. l Post. Fontanel: 0. 5 cm and closed shortly after birth. l Sutures l Cranium

Head &Neck Facial appearance Large tongue Marked nasolabial line Nasal bridge(Low, Wide) Facial palsy

Low hair line Hypertelorism Microganetia

Russell-Silver dwarfism

Vitiligo Pityriasis alba

Alopecia areata Tinea capitis

Head &Neck l Ear Anomalies l Low set ear l Canal(Wax, Forign body, Discharge…) l Tympanic membrane(Color, Perforation l , Buldging or Retraction) l Cone of light l

Preauricular skin tag

Eyes: l l l l Telecantus: Apert, Hypertelorism, Crouzon Ptosis Sunset sign Exophtalmus Enophtalmus(Horner) Buphtalmus Pupils(Myosis, Myderiasis) l l Conjunctivitis Icterus(Hepatitis) Ctaract(Rubella) Opacity of cornea

Exophtalmus Enophtalmus