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UERMMMCI College of Medicine 2016B

Medical History & Physical Exam Guide


Pediatrics
Name of Student: __________________________ Ward: __________ Bed# ____ Date/Time of Interview: ___________________
IV. Current Medications
Drug
Dosage

IDENTIFYING DATA
Name of Patient: ____________________________________
Sex: _____ Age: _____ Birth date: ____________________
Place of residence: __________________________________
__________________________________________________
Place of birth: ______________________________________
Race: __________________ Religion: __________________
Number of admissions: _______________________________

Frequency
& Duration
of Intake

Compliance

SOURCE & RELIABILITY


Source/Reliability: __________________________________
CHIEF COMPLAINT/S
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
HISTORY OF THE PRESENT ILLNESS
V. Progress
What happened to the symptom/s during the total duration
of illness?
___ Better ___ Worse ___ Unchanged ___ Disappeared
Notes _____________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

I. Onset
Date of onset: ______________________________________
Manner of onset: ___ Gradual
___ Acute
Precipitating/Predisposing factors: ______________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
II. Characteristics
Character (Quantity, Quality, Consistency, Appearance):
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Location/Radiation: __________________________________
Intensity/Severity (Pain Scale): _________________________
Timing:
___ Continuous
___ Intermittent
___ Rhythmic
___ Remittent
Aggravating/Relieving Factors: _________________________
__________________________________________________
__________________________________________________
__________________________________________________
Associated Symptoms: _______________________________
__________________________________________________
__________________________________________________
__________________________________________________
III. Course since Onset
Incidence:
___ Single acute attack
___ Recurrent acute attack
___ Daily occurrences
___ Periodic occurrences
___ Continuous chronic episode

PAST HISTORY
I. Maternal & Birth History
Age of Mother: _____ y/o
OB Score: G ____ P ____
Known problems of the mother prior to pregnancy: ________
__________________________________________________
Drug intake during pregnancy: _________________________
__________________________________________________
__________________________________________________
Exposure to infection during pregnancy:
___ Fever
___ Rash
___ Other viral infections: _____________________
Exposure to radiation during pregnancy: Yes ___
No ___
Age of Gestation: _____ wks ___ Full-term ___ Pre-term
Manner of Delivery: ___ Natural spontaneous vaginal delivery
___ Caesarian section
___ Forceps delivery
___ Vacuum extraction
Place of Delivery: ___ Hospital
___ Lying-in
___ Home
Condition at birth:
APGAR Score: _____ 1st minute
_____ 5th minute
Birth weight: _____ kg/lbs.
1

Resuscitation: ______________________________________
Congenital Anomalies: _______________________________
__________________________________________________
Length of stay at the nursery: __________________________
Other problems surrounding birth: _____________________
__________________________________________________
__________________________________________________

Others:
______________
Tuberculin Test

V. Past Diseases
___ Measles
___ Mumps
___ Rubella
___ Varicella
___ Chickenpox
___ Typhoid fever
___ Dengue fever ___ URTIs
___ Tonsillitis
___ Pyoderma
___ Convulsions
___ TB
Others: ____________________________________________
Injuries: ___________________________________________
__________________________________________________
__________________________________________________

II. Feeding History


___ Breastfed
___ Formula-fed
Interval: _______________________________________
Duration: ______________________________________
Volume: _______________________________________
Caloric intake (if formula fed): ___ oz/day x 20 cal = ____
Appetite: ___ Good
___ Fair
___ Poor
Vitamin supplement/s: _______________________________
Start of supplemental feeding at _________________ months
Adverse of food reactions: ____________________________
__________________________________________________
Vomiting: __________________________________________
Bowel Habits: ______________________________________
Stool Characteristics: ________________________________
Present Diet: _______________________________________
__________________________________________________
__________________________________________________

Previous Hospitalizations:
Date
Hospital

III. Developmental History (See attached Denver II)


Regard: ___________________________________________
Social smile: _______________________________________
Turned on abdomen: ________________________________
Crawled: __________________________________________
Sat alone: __________________________________________
Stood: ____________________________________________
First step: __________________________________________
Uttered words: _____________________________________
Sentences: _________________________________________
Bladder control: ____________________________________
Dentition: _________________________________________
Walked: ___________________________________________
Present milestones: __________________________________

Surgeries:
Date

Number
of Doses

Date (of Last


Dose) Given

Diagnosis

Indication

Procedures
Done

Type of Operation

VI. Family History

IV. Immunization History


Immunization

Result:

Grandparent

Age

Health Status

Cause of Death/
Age at Death

Parent

Age

Health Status

Cause of Death/
Age at Death

Adverse
Reactions

BCG
Hepatitis B
DPT
OPV
Measles
Rotavirus
HiB
Varicella
MMR
Rotavirus
2

Sibling

Sex

Age

Health Status

Familial incidences of:


___ Diabetes Mellitus
___ Cardiovascular Disease
___ Allergies
___ Mental Illness

No. of sexual partners


in the last 6 months __________________________
in the last 5 yrs ______________________________
in the patients lifetime _______________________
History of sexually transmitted infections: ________________
__________________________________________________
__________________________________________________
Routine contraceptive use: Yes ___
No ___
Natural Method:
___ Withdrawal
Rhythm Method:
___ Calendar
___ Basal Body Temperature
___ Cervical Mucus
___ Symptothermal
___ Lactation Amenorrhea Method (LAM)
Artificial Method:
___ Chemical barriers (spermicides,
vaginal sponge)
Physical barriers:
___ Diaphragm
___ Cervical cap
___ Condom (male/female)
___ Oral contraceptive pills
___ Injectables
___ Subdermal implants
___ Morning-after pill
___ Contraceptive patch
___ Intrauterine device (IUD)

Cause of Death/
Age at Death

___ Hypertension
___ Cerebrovascular Disease
___ Cancer
___ Others: _____________

VII. Social/Environmental History


Parent/Caregiver
Educational
Attainment

Occupation

NOTES
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Adequacy of income: ________________________________


__________________________________________________
Typical day of patient: ________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Living environment
Description of community: __________________________
________________________________________________
Density of population in the neighborhood: ____________
________________________________________________
Basic facilities: ___________________________________
House structure: __________________________________
No. of persons living in the place of habitat: ____________
State of hygiene: __________________________________
Access to potable water: ___________________________
Waste & garbage disposal: __________________________
Electricity: _______________________________________
ADDENDUM: SEXUAL HISTORY (for Adolescent Patients)
Age at first coitus: _____ y/o
Date of last sexual intercourse: ________________________
Sexual orientation/preference: ________________________
3

PHYSICAL EXAMINATION
I. General Survey
Sensorium: ___ Calm
___ Crying
___ Awake, alert, responsive
___ Consolable
___ Inability to feed
___ Irritable
___ Stuporous
___ Lethargic
___ Obtunded
___ Comatose
Signs of distress:
___ Cardiorespiratory distress
___ Anxiety
___ Pain
___ Depression
Apparent state of health: ___ Acutely ill
___ Chronically ill
Color: ___ Pinkish
___ Pallor
___ Acrocyanosis
___ Jaundice
___ Cyanosis
___ Redness/flushing
Activity: ___ Good
___ Poor

DESCRIPTION
BLOOD PRESSURE
Blood Pressure
Average Systolic and/or Diastolic BP
Category
for Age, Sex & Height
Normal
< 90th percentile
Prehypertensive
90th-95th percentile
Hypertensive
95th percentile
For 0-5 y/o:
z-score

Above 3
Above 2

II. Vital Signs


Temperature = ________ C (oral/axillary/tympanic/rectal)
BP = ________ mm Hg
PR = ________ bpm
___ Regular
___ Irregular
HR = ________ bpm
___ Regular
___ Irregular
RR = ____/min
___ Eupnea
___ Tachypnea
___ Bradypnea
___ Apnea
___ Periodic breathing

Length/
Height for
Age
Very tall

Above 1

Median
Below 1
Below 2
Below 3

III. Anthropometrics
Weight = ________ kg/lbs
z-score: ________
Length/Height = ________cm/in
z-score: ________
Waterlow Classification: Wasting = _____%
Stunting = _____%
BMI = ________ kg/m2
Head circumference = ________ in/cm
Chest circumference = ________ in/cm
Abdominal circumference = ________ in/cm

Stunted
Severely
stunted

For 5-19 y/o:


z-score
Length/
Height for
Age
Above 3
Very tall

IV. Skin
Color: ___ Cutis marmorata
___ Hypopigmentation
___ Harlequin dyschromia
___ Hyperpigmentation
Moisture: ___ Dry
___ Wet/clammy
___ Oily
Turgor: ___ Good
___ Fair
___ Poor
___ Rash: Distribution __________________________________
____________________________________________
Color: ______________________________________
Pruritus: ____________________________________
Description: _________________________________
____________________________________________
Common skin conditions:
___ Vernix caseosa
___ Milia
___ Edema
___ Eyelid patch
___ Desquamation
___ Salmon patch
___ Miliaria rubra
___ Caf-au-lait spots
___ Erythema toxicum
___ Mongolian spots
___ Pustular melanosis
Lesions: ______________________________________________
Hemorrhages: ___ Petechiae
___ Hematoma
___ Ecchymoses

Above 2
Above 1
Median
Below 1
Below 2
Below 3

Moderately
stunted
Severely
stunted

GROWTH INDICATOR
Weight for
Weight for
Age
Length/
Height
Use weight
Obese
for length or
Overweight
BMI for age
charts
Possible risk
of
overweight

Underweight
Severely
underweight

BMI for age

Obese
Overweight

Possible risk
of
overweight

Wasted
Severely
wasted

GROWTH INDICATOR
Weight for
Weight for
Age
Length/
Height
Use weight
Morbidly
for length or
obese
BMI for age
Obese
charts
Overweight

Moderately
underweight
Severely
underweight

Wasted
Severely
wasted

BMI for age

Moderately
wasted
Severely
wasted

WEIGHT FOR AGE (%)


90
80-89
70-79
< 70

WASTING
Normal
Mild
Moderate
Severe

WEIGHT FOR AGE (%)


95
87.5-95
80-87.5
< 80

STUNTING
Normal
Mild
Moderate
Severe

Morbidly
obese
Obese
Overweight

Wasted
Severely
wasted

Nails: ___ Oil spots


___ Crumbling
Hair: ___ Lanugo
___ Smooth, soft

___ Loosening
___ Pitting
___ Dry
___ Coarse

___ Lesions

DESCRIPTION

___ One color


___ Colored tufts

V. Head
Fontanelles: ___ Soft, flat
___ Depressed
___ Tense and bulging
___ Pulsations
Diameter: Anterior ____ cm
Posterior ____ cm
Sutures: ___ Open, ridged
___ Mobile
___ Immobile
Scalp: ___ Clean
___ Dandruff
___ Parasites
___ Lesions
___ Dilatation of veins
Skull: ___ Symmetrical
___ Asymmetrical
___ Molding
___ Plagiocephaly
___ Caput succedaneum
___ Dolichocephaly
___ Cephalhematoma
___ Craniotabes
___ Craniosynostosis
___ Cranial bruit
___ Biparietal enlargement
___ Macewens Sign
Cranial Index: _____ cm (width) x 100/_____ cm (length)
Face: ___ Symmetrical
___ Asymmetrical
___ Micrognathia
___ Facies
___ Chovsteks sign
___ Mass

Cranial Index:
> 85 Brachycephalic (short head)
75-85 Mesocephalic (medium head)
< 75 Scapocephalic (long head)

Characteristics of Mass (FACE)


Location: _____________________________________________
Size: _________________________________________________
Shape: _______________________________________________
Consistency: __________________________________________
Tenderness: __________________________________________
Pulsations: ___________________________________________
Mobility with respiration or with the examining hand: _________
_____________________________________________________

VI. Eyes
Lids: ___ Symmetrical
___ Edema/swelling (R/L)
___ Ptosis (R/L)
___ Lesions
Periorbital region: ___ Edema
___ Discoloration
___ Sunken
___ Ecchymoses/hematoma
Conjunctiva: ___ Pinkish ___ Redness
___ Pale
___ Subconjunctival hemorrhages
___ Eye discharge: ___ Watery ___ Colored
Sclera: ___ Anicteric
___ Icteric
___ Hemorrhages
Cornea & lens: ___ Clear ___ Cloudy
___ Opaque
Iris: ___ Coloboma
___ Brushfield spots
VII. Ears
External ear: ___ Normoset
___ Symmetrical
___ Low set
___ Asymmetrical
___ Ear tags
___ Cup ear
___ Ear pits
___ Loop ear
Ear canal: ___ Patent
___ Discharge: ___Serous
___ Purulent
___ Mucoid
___ Foul-smelling
Tympanic membrane: ___ Dull, gray
___ Whitish
___ Redness
___ Distorted
___ Bulging
___ Perforated
___ Retracted
___ Thickened
___ Effusion
___ Lesions
___ Cone of light at R - _____
L - _____
VIII. Nose
Nasal Passages: ___ Patent (breathes with mouth closed)
___ Occluded
___ Foreign body
___ Nasal flaring
___ Nasal polyps
Septum: ___ Midline
___ Deviated
___ Perforation
Mucosa: ___ Pinkish
___ Pale
___ Reddish
Discharge: ___Serous
___ Purulent
___ Mucoid
___ Foul-smelling
6

Sinuses: ___ Tender


___ Non-tender
Transillumination: ___ Presence of glow
___ Absence of glow

DESCRIPTION

IX. Mouth and Pharynx


Lips: ___ Pinkish
___ Pale
___ Dry/cracks
___ Cyanosis
___ Perioral cyanosis
___ Lesions ______________________________________
___ Congenital deformities: _________________________
Teeth: ___ Dental caries
___ Erosion
___ Staining
___ Malocclusion ___ Overbite
___ Underbite
Gums: ___ Pinkish
___ Pale
___ Bleeding
Mucosa: ___Pinkish
___ Redness/erythema
___ Pale
___ Cyanosis
___ Ulcerations
___ Oral thrush
Palates: ___ Intact
___ Soft
___ Mobile
___ Cleft palate
___ Epsteins Pearls
___ Petechiae
Tongue: ___ Symmetrical
___ In midline
___ Enlarged/protruding ___ Deviated
___ Tongue tie
___ Coated
Odor of breath: ________________________________________
___ Excessive salivation
Uvula: ___ Midline
___ Deviated
___ Bifid uvula
X. Throat
Tonsils: ___ Enlarged
___ Inflammation
___ Exudates
Posterior pharynx: ___ Pinkish
___ Pale
___ Reddish
___ Post-nasal drip
XI. Neck
Length: ___ Normal
___ Webbed
Thyroid gland: ___ Non-palpable
___ Enlarged
Carotids: ___ Thrills
___ Bruit
Trachea: ___ In midline
___ Deviated
___ Stiffness/torticollis
___ Nuchal rigidity
___ Mass
___ Cysts: ___ Branchial cleft
___ Pre-auricular
___ Thyroglossal
___ Others: ___________________
Lymph nodes: ___ Non-palpable
___ Non-tender

XII. Breast
___ Midclavicular
___ Enlarged
___ Mass
___ Gynecomastia

Characteristics of Mass (NECK)


Location: _____________________________________________
Size: _________________________________________________
Shape: _______________________________________________
Consistency: __________________________________________
Tenderness: __________________________________________
Pulsations: ___________________________________________
Mobility with respiration or with the examining hand: _________
_____________________________________________________

___ Palpable/enlarged
___ Tender

Lymph Nodes:
___ Pre-auricular
___ Post-auricular
___ Tonsillar
___ Submandibular
___ Submental
___ Anterior cervical

___ Supraclavicular
___ Posterior cervical
___ Axillary
___ Epitrochlear
___ Inguinal

Characteristics of Mass (BREAST)


Location: _____________________________________________
Size: _________________________________________________
Shape: _______________________________________________
Consistency: __________________________________________
Tenderness: __________________________________________
Pulsations: ___________________________________________
Mobility with respiration or with the examining hand: _________
_____________________________________________________

___ Accessory nipple/s


___ Discharge: ___ Witchs milk
___ Others
Tanner Stage: __________________

XIII. Chest & Lungs


Signs of distress: ___ Grunting
___ Audible wheezing
___ Stridor
___ Paradoxical breathing
___ Lack of breath sounds
___ Retractions/chest indrawing
(supraclavicular, intercostal, subcostal)
Inspiration-Expiration Ratio: ______ : ______
Chest shape: AP/L Ratio: __________
___ Deformities: ___ Pectus excavatum (funnel)
___ Pectus carinatum (pigeon)
Chest movement: ___ Symmetrical
___ Asymmetrical
Tactile fremitus: ___ Symmetrical
___ Decreased at ________
Note on percussion: ___ Flat
___ Hyperresonant
___ Dull
___ Tympanic
___ Resonant
Breath sounds: ___ Symmetrical
___ Decreased at _____
___ Vesicular
___ Bronchial
___ Bronchovesicular ___ Tracheal
Adventitious breath sounds:
___ Crackles
___ Stridor
___ Wheezes
___ Pleural friction rub
___ Rhonchi
___ Mediastinal crunch

DESCRIPTION

XIV. Cardiovascular
Periorbital region: ___ Edema/Swelling
___ Sunken
Conjunctiva: ___ Pinkish ___ Pale
Lips: ___ Pallor
___ Cyanosis
___ Dry/Cracked
___ Lesions
Gums: ___ Pinkish
___ Pallor
___ Bleeding
___ Tenderness
Buccal mucosa: ___ Pinkish ___ Pale
Pharynx: ___ Pinkish
___ Reddish
___ Pale
Jugular venous pulse: ____ cm w/ head of bed elevated at ____
Precordium: ___ Flat
___ Adynamic
___ Bulging
___ Dynamic
___ Tenderness
___ Heaves
___ Thrills
PMI at: ______________________________________________
Heart Sounds: ___ Distinct
___ Faint
S1 _____ S2 at the base
S1 _____ S2 at the apex
Extra heart sounds: ___ S3
___ S4
___ Murmurs: Grade _____
Nails: ___ Cyanosis
___ Pallor
___ Clubbing
___ Spooning
Capillary refill time: _____ secs
___ Edema of the extremities: ___ Bilateral
___ Unilateral
___ Pitting
___ Non-pitting
Peripheral pulses: ___ Symmetrical
___ Regular
___ Asymmetrical
___ Irregular
___ Weak
___ Strong
___ Faint
___ Bounding
___ Absent
Grade: _________

Characteristics of murmur:
Location: ___________________________________________
Radiation: __________________________________________
Intensity: __________________________________________
Quality: ____________________________________________
Peripheral pulses:
Temporal __________________________________________
Brachial ___________________________________________
Femoral ___________________________________________
Posterior tibial ______________________________________
Dorsalis pedis _______________________________________

XV. Abdomen
Skin: ___Scars
___ Striae
___ Dilated veins
___ Rashes & lesions
Umbilical cord: ___ 2 arteries, 1 vein
___ Single umbilical artery
8

___ Clear Whartons jelly


___ Colored Whartons jelly
___ Discharge
Umbilicus: ___ Sunken
___ Bulging
___ Granuloma
___ Herniation
Contour: ___ Globular
___ Bulging of flanks
___ Distended
___ Symmetrical
___ Flat
___ Asymmetrical
___ Scaphoid
___ Visible organs/masses

DESCRIPTION

___ Visible peristalsis


___ Diastasis recti

___ Increased pulsations


___ Malformations (omphalocele,
gastroschisis)
Bowel sounds: _____ /min
___ Borborygmi
___ Increased
___ Abdominal bruits
___ Decreased
___ Friction rub
___ Absent
___ Venous hum
Note on Percussion: ___ Hypertympanic
___ Tympanic
___ Dullness at _____________________
___ Shifting dullness
___ Voluntary guarding
___ Muscle rigidity
___ Fluid wave
___ Ballotment
___ Psoas Sign

___ Direct tenderness


___ Rebound tenderness
___ Rovsings Sign
___ Obturator Sign
___ Murphys Sign

LIVER SIZE IN HEALTHY TERM NEWBORNS


By palpation and percussion
Mean, 5.9 0.7 cm
Projection below R costal margin
Mean, 2.5 1.0 cm
th

from Bates Guide to Physical Examination 10 Ed, pg. 784

EXPECTED LIVER SPAN OF CHILDREN BY PERCUSSION


Age in Years
Mean Estimated Liver Span (cm)
Males
Females
2
3.5
3.6
3
4.0
4.0
4
4.4
4.3
5
4.8
4.5
6
5.1
4.8
8
5.6
5.1
10
6.1
5.4

LIVER:
Liver size: ________________ cm/in
Tenderness on percussion: ___ Yes
___ No
Tenderness on palpation: ___ Yes
___ No
___ Soft, sharp, regular edge with smooth surface
___ Firm/hard, blunt/rounding of edge, irregular contour
SPLEEN:
Dullness on percussion: ___ Yes
___ No
___ Splenic percussion sign
___ Non-palpable
___ Palpable
___ Non-tender
___ Tender
AORTA:
Aortic pulsations: ___ Yes

___ No

GROIN:
___ Symmetrical creases
___ Palpable pulses

___ Inguinal hernia


___ Non-palpable pulses

XVI. Genitourinary
KIDNEYS:
___ Non-palpable
___ CVA tenderness

th

from Bates Guide to Physical Examination 10 Ed, pg. 824

___ Palpable

BLADDER:
___ Non-palpable
___ Palpable
___ Non-tender
___ Tender
Dullness on percussion: ___ Yes
___ No

Male
Skin: ___ Redness
___ Discoloration
___ Papules
___ Pustules
___ Macules
___ Vesicles
___ Ulcers
___ Nodules
___ Plaques
___ Excoriations
___ Others: ______________________________________
Pubic Hair: Distribution: _________________________________
___ Nits
___ Lice
Prepuce: ___ Phimosis
___ Paraphimosis
___ Smegma
Penis: ___ Discharge
___ Tenderness
___ Ulcers
___ Scars
___ Swelling
___ Nodules
___ Induration
Urethral Meatus: ___ Hypospadia ___ Epispadia
Scrotum: ___ Equal
___ Unequal
___ Edema at R/L
___ Enlargement at R/L
___ Tenderness
___ Undescended at R/L
___ Rashes
___ Nodules
___ Veins
___ Lumps
___ Epidermoid Cysts
___ Bulging
Prostate: ___ Smooth
___ Firm
___ Rubbery
___ Non-tender
___ Swelling
___ Tender
___ Bogginess
___ Warm
___ Nodules
Others: ___ Ambiguous genitalia
___ Cremasteric reflex
Tanner Stage: __________________________________

DESCRIPTION

Female
Mons Pubis: ___ Excoriations
___ Itchiness
___ Redness
___ Papules
___ Macules
___ Pustules
___ Plaques
___ Vesicles
___ Ulcers
___ Nodules
___ Others: ________________________________
Pubic Hair: Distribution: _________________________________
___ Nits
___ Lice
Clitoris: ___ Enlargement
Urethral Meatus: ___ Caruncle
___ Prolapse
Labia: ___ Symmetrical
___ Asymmetrical
___ Tenderness
___ Discoloration
___ Redness
___ Edema/Swelling
___ Adhesions
Hymen: ___ Intact
___ Imperforated
___ Hymenal tag
Vaginal Introitus: ___ Inflammation
___ Swelling
___ Vesicles
___ Pustules
___ Ulcerations
___ Nodules
___ Others: ____________________________
___ Discharge: ___Serous
___ Purulent
___ Mucoid
___ Foul-smelling
___ Whitish, curd-like
___ Bleeding
Others: ___ Ambiguous genitalia
Tanner Stage: ___________
XVII. Musculoskeletal
Posture, gait, motor activity:
___ Coordinated
___ Unable to walk alone

___ Uncoordinated
___ Walks w/ assistive devices
10

Clavicles: ___ Intact


___ Tenderness
___ Lumps
___ Crepitus
Upper extremities: ___ Subluxation
___ Skin tags
___ Simian crease
___ Remnants of digits
___ Syndactyly
___ Polydactyly
Spine: ___ Erect position of the head
___ Smooth, coordinated neck movement
___ Neck stiffness
___ Head & neck in midline
___ Lateral deviation & rotation of the head
___ Equal shoulder heights
___ Shoulder tilt
___ Pelvic tilt
___ Deviation to the R/L
___ Abnormal curvatures: ___ Gibbus
___ Lordosis
___ Kyphosis
___ Others
Hips: ___ Ortolani Sign
___ Barlow Sign
___ Trendelenburg Sign
Lower extremities: ___ Symmetrical
___ Asymmetrical
___ Valgus
___ Varus
___ Tibial torsion
___ Clubfoot
___ Asymmetry
___ Contractures
___ Swelling
___ Decreased ROM
___ Tenderness
___ Palpable crepitus/clicking
___ Redness
___ Deformities
___ Warmth
___ Displacement
___ Thickness
___ Deviations
___ Nodules
___ Ballottement

DESCRIPTION

Location
___ Temporomandibular joints (TMJ)
___ Shoulder girdle (sternoclavicular,
acromioclavicular, glenohumeral joints)
___ Wrist joints (radiocarpal, distal
radioulnar, intercarpal joints)
___ Hand joints (MCPs, PIPs, DIPs)
___ Anatomical snuffbox
___ Spinous processes
___ Facet joints
___ Sacroiliac joints
___ Knee joints (tibiofemoral, patellofemoral joints)
___ Suprapatellar pouch
___ Ankle joints (tibiotalar, subtalar joints)
___ Transverse tarsal & metatarsophalangeal joints
___ Bursae (Indicate: _______________________)
___ Biceps tendon
___ Patellar tendon
___ Achilles tendon
Decreased ROM on:
___ Flexion
___ Abduction
___ Internal rotation
___ Pronation
___ Opposition
___ Inversion

XVIII. Neurologic
Cranial Nerves
CN I (Olfactory): ___ Intact
___ Anosmia (unilateral/bilateral)
CN II (Optic):
Visual acuity:
VA (w/correction)
OD ________
OS ________
(w/out correction) OD ________
OS ________
___ Counting fingers at _____ ft
___ Hand movement at ___ RUQ
___ LUQ
___ RLQ
___ LLQ
___ R temporal ___ L temporal
___ R nasal
___ L nasal
___ Light projection at _________________ quadrant/s
___ Light perception: ___ Vague
___ Erratic

Laterality

___ Extension
___ Adduction
___ External rotation
___ Supination
___ Lateral bending
___ Eversion

VISUAL MILESTONES
Birth
Blinks, may regard face
1 month
Fixes on objects
1 - 2 months
Coordinated eye movements
3 months
Eyes converge, baby reaches
12 months
Acuity around 20/50
3 months
Eyes converge, baby reaches
12 months
~20/200
Less than 4 years
20/40
4 years and older
20/30
th

from Bates Guide to Physical Examination 10 Ed, pg. 769, 811


11

___ Shows regard


___ Object tracking
Visual fields: (see column 2: Confrontation field diagram)
Fundoscopy: ___ Dark light reflex
___ White retinal reflex
___ Retinal hemorrhages
___ Papilledema
Reflexes: ___ Optic blink reflex
___ Red orange reflex
CN III, IV, VI (Oculomotor, Trochlear, Abducens):
Primary gaze: ___ In midline
___ Disconjugate
Eye Movements: ___ Esotropia
___ Strabismus
___ Exotropia
___ Diplopia
___ Sun-setting eyes ___ Ptosis (R/L)
Convergence: ___ Equal
___ Unequal
Pupil size: ___ Equal ___ Unequal
R = _____ mm L = _____ mm
Pupillary response to light: ___ Reactive
___ Parallel
___ Brisk
___ Sluggish
___ Fixed
Accommodation: ___ Responsive
___ Non-responsive
CN V (Trigeminal):
Reflexes: ___ Jaw jerk reflex
___ Corneal reflex
*Facial sensation: ___ Intact
___ Impaired
Motor function: ___ Intact
___ Paralysis at R/L
___ Weakness at R/L
CN VII (Facial):
Motor function: ___ Intact
___ Weakness at R/L
___ Symmetrical
___ Paralysis at R/L
___ Asymmetrical
Taste sensation (anterior 2/3): ___ Intact
___ Impaired
CN VIII (Vestibulocochlear):
Rubbed hair/fingers heard at ____ cm (AD) & ____ cm (AS)
Webers Test: ___ In midline
___ Lateralizes to R/L ear
Rinnes Test: ___ : ___ (air conduction to bone conduction)
___ Acoustic blink reflex
___ Tracking (to sound)
CN IX & X (Glossopharyngeal & Vagus):
Gag reflex: ___ Intact
___ Absent
Uvula: ___ In midline
___ Deviated to R/L
Palate: ___ Intact
___ Weakness on the R/L
Taste sensation (posterior 1/3): ___ Intact
___ Impaired
Speech: ___ Hoarseness
___ Nasal twang
Swallowing: ___ Coordinated
___ Impaired
CN XI (Spinal Accessory):
SCM: ___ Intact ___ Weakness at R/L ___ Paralysis at R/L
Trapezius: ___ Intact
___ Paralysis at R/L
___ Weakness at R/L
CN XII (Hypoglossal):
Tongue: ___ In midline
___ Deviation to R/L
___ Atrophy
___ Fasciculations

DESCRIPTION
Confrontation Field Diagram:
T

LE

RE

*Pain, temperature, light touch

SIGNS THAT AN INFANT CAN HEAR


Sign
Startle response and blink to sudden noise
Calming down with soothing voice or music
2 3 months Change in body movements in response to sound
Change in facial expression to familiar sounds
3 4 months Turning eyes and head to sound
6 7 months Turning to listen to voices and conversation
Age
0 2 months

th

from Bates Guide to Physical Examination 10 Ed, pg. 770

NUMERICAL SCALE TO RECORD MUSCLE STRENGTH


(British Medical Research Council)
Score
Description
5
Normal strength
4
Moves joint through full range against resistance
greater than gravity but examiner can overcome
the action (make a percentage estimate of
strength to compensate for broad range of this
number)
3
Moves part full range against gravity but not
against any resistance
2
Moves part only when positioned to eliminate
gravity
1
Only flicker of contraction of muscle but cannot
move joint
0
Complete paralysis

Motor Function
Involuntary movements: ___ Tics
___ Choreoathetosis
___ Myoclonus ___ Tremors
Strength: _____/5 located at (see column 2 Muscle Groups)
___ Tenderness
___ Pronator drift
___ Gowers Sign
Tone: ___ Normal
___ Scarf Sign
___ Inverted U-shape on horizontal position
___ Slipping through armpit on vertical suspension
___ Head lag on pull-to-sit

*Compare proximal/distal, right/left, upper/lower


th
from De Myers Neurologic Examination 6 Ed, pg. 248
12

___ Opisthotonus
___ Fisting
___ Scissors legs on vertical suspension
Bulk: ___ Atrophy
___ Hypertrophy
___ Pseudohypertrophy

DESCRIPTION
Muscle Groups
___ Muscles of mastication (masseter,
temporal, pterygoid ms.)
___ Axioscapular group (trapezius, rhomboids,
serratus anterior, levator scapulae)
___ Axiohumeral group (pectoralis major &
minor, latissimus dorsi)
___ Scapulohumeral/SITS ms.
___ Biceps ms.
___ Triceps ms.
___ Thenar ms.
___ Hypothenar ms.
___ Paravertebral ms.
___ Iliopsoas ms.
___ Gluteal ms.
___ Quadriceps femoris
___ Hamstring ms.
___ Gastrocnemius ms.
___ Soleus ms.
___ Plantar and dorsiflexor ms.

Sensory function
Crude
Touch: ___ Intact & symmetrical
___ Impaired at _____________________________
Pain: ___ Intact & symmetrical
___ Impaired at ______________________________
Temperature: ___ Intact & symmetrical
___ Impaired at ______________________
Vibration: ___ Intact & symmetrical
___ Impaired at __________________________
Joint position sense: ___ Intact & symmetrical
___ Impaired at _________________
Rombergs Test: ___ Positive
___ Negative
Cortical
Graphesthesia: ___ Intact
___ Impaired at R/L palm
Stereognosis: ___ Intact
___ Impaired at R/L hand
Two-point discrimination: R _____ cm L _____ cm
Bilateral simultaneous stimulation: ___ Intact
___ Extinction at R/L
Point localization: ___ Intact
___ Extinction at R/L side
Cerebellar
***Coordination: ___ Intact
___ Dysmetria
___ Dysdiadochokinesia
___ Nystagmus
___ Tremors (at rest/intention)
Stance: ___ Wide base
Feet _____ cm apart
**Gait: ___ Staggering
___ Shuffling
___ Cerebellar ataxia ___ Waddling
___ Drunken/Reeling ___ Toppling
___ Sensory ataxia
___ Frontal lobe disorder
___ Steppage/Equine ___ Parkinsonian gait
___ Marche a petit pas ___ Hemiplegic/Paraplegia
___ Hysterical
___ Choreoathetotic/Dystonic

***Finger-to nose, alternating pronation-supination, finger


tapping, heel-to-shin, tibial tapping

**Natural, tandem walking


Reflexes (grade):

Reflexes
Superficial/Primitive Reflexes:
___ Snout
___ Moro/startle
___ Tonic neck
___ Righting
___ Palmar grasp
___ Plantar grasp
___ Rooting
___ Sucking
___ Abdominal
___ Beevors Sign
___ Anal
___ Cross-adductor
___ Placing/stepping
___ Babinski
___ Buttress response
___ Parachute response
___ Trunk incurvation
___ Positive support
___ Landau
Deep Tendon Reflexes (grade using diagram on column 2):
Biceps
Triceps
Brachioradialis
Knee
Ankle jerk
___ Hoffmans
___ Clonus
Meninges: ___ Kernigs Sign

Laterality

4+
3+
2+
1+
0

___ Brudzinskis Sign

SCALE FOR GRADING REFLEXES


Very brisk, hyperactive, with clonus (rhythmic
oscillations between flexion and extension
Brisker than average; possibly but not necessarily
indicative of disease
Average; normal
Somewhat diminished; low normal
No response
th

from Bates Guide to Physical Examination 10 Ed, pg. 696


13

APPENDIX

ANNOTATIONS (from DOH Childhood Immunization Schedule 2014):


Vaccines in the pink box, enclosed in parentheses, are vaccines given in the Philippine
Expanded Program of Immunization (PEPI) of the Department of Health. Vaccines in the
EPI include:
a.
b.
c.

BCG
DTwP-HiB-HepB
OPV

VACCINE

ROUTE

d.
e.
f.

Measles
MMR
Rotavirus vaccine
1st DOSE

g.
h.

2nd DOSE

Other Recommended Vaccines are vaccines outside the pink box. These vaccines are not
part of the Philippine EPI but because of merit are advocated by the Philippine Pediatric
Society (PPS), Pediatric Infectious Disease Society of the Philippines (PIDSP), and the
Philippine Foundation for Vaccination (PFV). Other Recommended Vaccines include:

PCV
Td

a.
b.
c.
3rd DOSE

DTaP
Tdap/Td
IPV

ADDL DOSE/S

d.
e.
f.

MMRV
Varicella
Hepatitis A

g.
h.

Influenza
Human Papillomavirus Vaccine (HPV)
NOTES

For healthy infants and children > 2 mos. who are not given
BCG at birth, PPD prior to BCG vaccination is not necessary.
Earliest possible age after birth
(preferably within the 1st 2 months of life)
BCG

Intradermal
(ID)

However, PPD is recommended prior to BCG vaccination if any


of the following are present:
Suspected congenital TB
History of close contact to known or suspected
infectious cases of TB
Clinical findings suggestive of TB and/or chest x-ray
suggestive of TB

0.05 ml for
< 12 months of age
0.1 ml for
> 12 months of age

In the presence of any of these conditions, an induration of > 5


mm is considered positive.

Diphtheria,
Tetanus &
Pertussis (DTP)

Hepatitis B
Vaccine

Intramuscular
(IM)

Intramuscular
(IM)

6 weeks

1st 12 hrs of life


(may be counted
as part of the
3-dose primary
series)

10 weeks

6 weeks

14 weeks

10 weeks

May be given as
early as 12
months of age
provided there is
a minimum
interval of
6 months from
the 3rd dose

14 weeks

The 5th dose may not be given if the 4th dose was administered
at age 4 yrs or older.
The pertussis component may either be an acellular or whole
cell formulation.

Another dose of hepatitis B is needed for the following (to be


administered not earlier than 24 weeks of age):
Preterms < 2 kgs whose 1st dose was received at birth
Infants for whom the 3rd dose is given at age < 24 wks
Preterm infants born to HBsAg (-) mothers who are medically
stable may be given the 1st dose of HBV at 30 days of
chronological age regardless of weight, and this can be
counted as part of the 3-dose primary series.

VACCINE

Hepatitis B
Vaccine

ROUTE

Intramuscular
(IM)

Haemophilus
Influenza Type
B Conjugate
Vaccine (HiB)

Intramuscular
(IM)

Measles
Vaccine

Subcutaneous
(SC)

Measles,
Mumps, Rubella
(MMR)

Subcutaneous
(SC)

1st DOSE

1st 12 hrs of life


(may be counted
as part of the
3-dose primary
series)

6 weeks

2nd DOSE

3rd DOSE

ADDL DOSE/S

6 weeks

10 weeks

14 weeks

10 weeks

14 weeks

Booster dose:
between 12-15
months of age,
with an interval
of 6 months from
the 3rd dose

9 months

12 months

4-6 years
May be administered at an earlier age (16 months)
provided the interval between the 1st and 2nd dose
is at least 4 weeks

NOTES
If the mother is HBsAg (+), administer HBV and HBIG (0.5 ml)
within 12 hrs of life. If HBsAg status is unknown, administer
HBV within 12 hrs of birth and determine mothers HBsAg as
soon as possible. If HBsAg (+) administer HBIG no later than 7
days of age.
In the EPI schedule, HBV is given as monovalent hepatitis B
vaccine at birth then subsequent doses are given at 6, 10, 14
weeks of age as combination vaccines containing DTwP-HepBHiB.
If the 1st dose was given between 7-11 months of age, the 2nd
dose should be given at least 4 weeks later, and the 3rd dose at
least 8 weeks from the 2nd dose.
One dose of the HiB vaccine should be considered for
unimmunized children aged 5 yrs or older who have sickle cell
disease, leukemia, HIV infection or who had splenectomy.
May be given as early as 6 months of age in cases of outbreaks
as declared by public health officials.
Two doses of MMR are recommended.
Children below 12 months of age given any measles containing
vaccine (measles, MR, MMR) should be given 2 additional
doses of MMR. The 1st dose is given at age 12-15 months and
should be separated by at least 4 weeks from measles
containing vaccine. The 2nd dose is administered at age 4-6 yrs,
but may be given at an earlier age provided the interval
between the 1st and 2nd dose is at least 4 weeks.
In the Philippine EPI, a 2nd dose of MMR is given to high school
students (Grades 7-10) enrolled in public schools in selected
cities and provinces.
In the Philippine EPI, OPV is administered together with DwTPHepB-HiB vaccines at 6, 10 and 14 weeks of age.

Poliovirus
Vaccine
(OPV/IPV)

Per orem
(PO)
or
Intramuscular
(IM)

6 weeks

10 weeks

14 weeks

Given at a minimum age of 6 weeks with a minimum interval of


4 weeks.
The final dose in the series should be on or after the 4th
birthday and at least 6 months from the previous dose. If 4 or
more doses have been given prior to age 4 yrs, an additional
dose should be given at age 4 through 6 yrs.

VACCINE

ROUTE

1st DOSE

2nd DOSE

3rd DOSE

ADDL DOSE/S

NOTES
*In children who are fully immunized, Td booster should be
given every 10 yrs. A single dose of Tdap can be given in place
of the due Td dose, and can be administered regardless of the
interval since the last tetanus and diphtheria toxoid containing
vaccine.
Children aged 7 through 18 yrs who are not fully immunized
with DPT vaccine should receive Tdap as the 1st dose in the
catch-up series. If additional doses are needed use Td vaccine.

Tetanus and
Diphtheria
Toxoid
(Td)/Tetanus
and Diphtheria
Toxoid and
Acellular
Pertussis
Vaccine (Tdap)

Intramuscular
(IM)

10 years

Subsequent doses every 10 yrs after the last dose*

Children and adolescents aged 7 through 18 years who have


never been immunized with DPT vaccine should receive the 3dose series of tetanus and diphtheria containing vaccines using
the 0-1-6 months schedule. A single dose of Tdap is given,
preferably as the 1st dose. The remaining doses are given as Td.
Fully immunized is defined as 5 doses of DTap or 4 doses of
DTap if the 4th dose was administered on or after the 4th
birthday.
In the Philippine EPI, a single dose of Td is given to high school
students (Grades 7-10) enrolled in public schools in selected
cities and provinces.
For the fully immunized pregnant adolescent, administer one
dose of Tdap vaccine between the 3rd or late 2nd trimester of
pregnancy (after 20 weeks gestation).
Unimmunized pregnant adolescents should receive the 3-dose
series of tetanus and diphtheria containing vaccines (Td/Tdap)
following a 0-1-6 months schedule. Tdap should replace one
dose of Td given preferably during the 3rd or late 2nd trimester
of pregnancy (after 20 weeks gestation).

Hepatitis A
Vaccine

Intramuscular
(IM)

> 12 months

At least 6 months after the 1st dose


At least 4 weeks after the 1st dose, not later
than 32 weeks*

Rotavirus
Vaccine (RV)

Per orem
(PO)

6 weeks

At least 4 weeks
after the
1st dose

At least 4 weeks after the


2nd dose, not later than 32 weeks**

*The monovalent human rotavirus vaccine (RV1) is given as a


two-dose series. If RV1 is administered for the 1st and 2nd dose,
a 3rd dose is not recommended.
**The pentavalent human bovine rotavirus vaccine (RV5) is
given as a 3-dose series.

VACCINE

Varicella
Vaccine

ROUTE

Subcutaneous
(SC)

1st DOSE

12 15 months

2nd DOSE

3rd DOSE

ADDL DOSE/S

4 6 yrs or at an earlier age provided the interval


between the 1st and 2nd dose is at least
3 months

NOTES
Two doses of varicella vaccine are recommended.
A 2nd dose of the vaccine is recommended for children,
adolescents and adults who previously received only one dose
of the vaccine. For children below 13 yrs, the recommended
minimum interval between doses is 3 months. However, if the
2nd dose was administered at least 4 weeks after the 1st dose, it
can be considered as valid.
All individuals aged > 13 yrs and without immunity should
receive 2 doses of varicella vaccine given at least 4 weeks
apart.

Measles,
Mumps,
Rubella,
Varicella
(MMRV)

Human
Papillomavirus
Vaccine (HPV)

Subcutaneous
(SC)

Intramuscular
(IM)

12 months 12 yrs

9 yrs

At least 3 months
after the 1st dose

At least 1 month
after the 1st dose

Combination MMRV may be given as an alternative to


separately administered MMR and varicella vaccine for healthy
children 12 months to 12 yrs of age.

At least 3 months after the 2nd dose


At least 6 months after the 1st dose

Primary vaccination consists of a 3-dose series. The


recommended schedule is as follows:
Bivalent HPV at 0, 1 and 6 months
Quadrivalent HPV* at 0, 2 and 6 months
*The quadrivalent HPV can be given to males 10 18 yrs of age
for the prevention of anogenital warts.

All children from 6 months to 18 yrs should receive influenza


vaccine.

Influenza
Vaccine

Intramuscular
(IM)
or
Subcutaneous
(SC)

6 months 8 yrs

At least 4 weeks
after the 1st dose

9 18 yrs of age:
Revaccination every year

Children 6 months to 8 yrs receiving influenza vaccine for the


1st time should receive 2 doses of the vaccine separated by at
least 4 weeks. If only one dose was administered during the
previous influenza season, administer 2 doses of the vaccine
then one dose yearly thereafter.
Annual vaccination should be given preferably between
February to June, but may be given throughout the year.

VACCINE

Pneumococcal
Vaccines
(PCV/PPV)

ROUTE

1st DOSE

2nd DOSE

3rd DOSE

ADDL DOSE/S

NOTES
Primary vaccination of PCV consists of 3 doses with an interval
of at least 4 weeks between doses, plus a booster at 6 months
after the 3rd dose.

Intramuscular
(IM)

6 weeks

10 weeks

14 weeks

Booster Dose:
6 months after
the 3rd dose

Healthy children 2 to 5 yrs old who have no previous PCV


vaccination may be given one dose of PCV13 or 2 doses of
PCV10 at least 8 weeks apart. Routine use of PCV is not
recommended for healthy children aged 5 yrs.
For high risk children 2 yrs of age, PPV is recommended after
completing PCV series (refer to Vaccines for Special Groups).
For health children, no additional doses of PPV are needed if
PCV series is completed.

VACCINES FOR SPECIAL GROUPS:


VACCINE

ROUTE

1st DOSE

2nd DOSE

3rd DOSE

MCV4:
Intramuscular
(IM)
Meningococcal
Vaccine

At least 9 months

2 months after the 1st dose

MPSV4:
Subcutaneous
(SC)

ADDL DOSE/S
If the person
remains at
increased risk:
Initial booster
dose of MCV4
3 years after
completing the
primary series
Continued
boosters at 5year intervals
after the initial
booster dose

Typhoid Vaccine

Rabies Vaccine

Intramuscular
(IM)

As early as 2 yrs

Intramuscular
(IM)
PVRV 0.5 ml or
PCECV 1 ml

Day 0

Revaccination every 2 to 3 yrs after the 1st dose


if there is continued exposure to S. typhi
Day 7

Day 21 or 28

NOTES
MCV4: Tetravalent meningococcal (ACYW-135)
conjugate vaccine
MPSV4: Tetravalent meningococcal polysaccharide vaccine
Two doses of MCV4 given 2 months apart should be given to
children aged 9 months and above at high risk for invasive
disease (persistent complement component deficiencies,
anatomic/functional asplenia, HIV, travelers to or residents of
area where meningococcal disease is hyperendemic or
epidemic, or belonging to a defined risk group during a
community or institutional meningococcal outbreak).
If MPSV4 is used for high-risk individuals as the 1st dose, a 2nd
dose using MCV4 should be given 2 months later.
Additional booster doses of polysaccharide vaccines are not
recommended.
Recommended for travelers to areas where there is risk of
exposure to S. typhi and for outbreak situations as declared by
public health officials.
The Anti-rabies Act of 2007 recommends routine rabies preexposure prophylaxis (PrEP) for children ages 5-14 yrs in areas
where there is high incidence of rabies and animal bites
(defined as more than twice the national average).

VACCINE

ROUTE

1st DOSE

2nd DOSE

3rd DOSE

ADDL DOSE/S

NOTES
A repeat dose should be given if vaccine is inadvertently given
subcutaneously.
Rabies vaccine should never be given in the gluteal area since
the absorption is unpredictable.

Rabies Vaccine

Intradermal
(ID)
PVRV or
PCECV 0.1 ml

Day 0

Day 7

Day 21 or 28

Periodic booster doses in the absence of exposure are not


recommended for the general population.
In the event of subsequent exposures, those who have
completed 3 doses of pre-exposure prophylaxis, regardless of
interval between re-exposure and last dose of the vaccine, will
require only booster doses on day 0 and 3.
There is no need to give rabies immunoglobulin.

24 71 months
If 3 doses of any PCV were given previously:
Single dose of PCV13
24 71 months
If less than 3 doses
of any PCV were
previously given:
1st dose of PCV13
Pneumococcal
Vaccines
(PCV/PPV)

8 weeks after the


1st dose

No more than 2 PPV doses should be given.

6 18 yrs
If no previous doses of PCV given:
Single dose of PCV13

Intramuscular
(IM)

2 18 yrs with
underlying medical
conditions* should
receive PPV at least
8 weeks after PCV

5 yrs after the


1st dose**

*For children 2 yrs with the ff. underlying medical conditions


such as but not limited to anatomic/functional asplenia, HIV
infection or other immunocompromising condition, chronic
lung, heart and renal diseases, cochlear implant, or cerebral
spinal fluid leak.
**A 2nd dose of PPV is recommended 5 yrs after the 1st dose of
PPV only for those with anatomic/functional asplenia,
congenital immunodeficiency, HIV infection, chronic renal
failure or nephritic syndrome, malignancy, solid organ
transplantation, and other diseases associated with
immunosuppressive drugs or radiation therapy.

Clinical Sign
Heart Rate
Respiratory
Effort
Muscle Tone

Reflex
Irritability*

Color

APGAR SCORING SYSTEM


0
1
Absent
< 100
Absent
Slow &
irregular
Flaccid
Some flexion
of the arms
and legs
No
Grimace
responses

Blue, pale

Pink body, blue


extremities

Active
movement
Crying
vigorously,
sneeze, or
cough
Pink all over

*Reaction to suction of nares with bulb syringe

1-Minute Apgar Score


8 10
Normal
57
Some nervous
system depression

04

EXPECTED WEIGHT CHANGES


4 5 months
BW x 2
1 year
BW x 3
2 years
BW x 4
3 years
BW x 5
5 years
BW x 6
7 years
BW x 7
10 years
BW x 10

2
> 100
Good; strong

5-Minute Apgar Score


8 10
Normal
07
High risk for
subsequent central
nervous system and
other organ system
dysfunction

Severe depression,
requiring immediate
resuscitation

*Average length at birth is 50 cm


** Length is increased by 50% at 1 y/o

EXPECTED HEAD CIRCUMFERENCE


1st year
4 inches (10 cm) increase
st
1 4 months
inch per month = 2 inches
Next 8 months
inch per month = 2 inches
2nd year
1 inch (2.54 cm)
3rd 5th year
inch per year = 1 inches
6th 20th year
inch per 5 years = 1 inches
*Average head circumference at birth is 32 35 cm.
**Head circumference is taken up to 3 yrs of age.

CLASSIFICATION BY GESTATIONAL AGE & BIRTH WEIGHT


Gestational Age
Classification
Gestational Age
Preterm
< 37 weeks (< 259th day)
Term
37 42 weeks
Postterm
> 42 weeks (> 294th day)
Birth Weight
Classification
Gestational Age
Extremely low birth weight
< 1, 000 grams
Very low birth weight
< 1, 500 grams
Low birth weight
< 2, 500 grams
Normal birth weight
2, 500 grams
NEWBORN CLASSIFICATIONS
Category
Abbreviation
Small for gestational age
SGA
Appropriate for gestational age
AGA
Large for gestational age
LGA

DISTRIBUTION OF GAINS IN LENGTH (at 1 y/o)


Birth 3 months
9 cm
4 6 months
8 cm
7 9 months
5 cm
10 12 months
3 cm
Total
25 cm

Anterior
Posterior

FONTANELLES
4 6 cm, closes between 4 26 mos.
1 2 cm, closes at 2 mos.

EXPECTED HEIGHT CHANGES


Height in cm
Age in years x 5 + 80
1 year
30 in or 1 x BL
2 years
mature height (boys)
3 years
3 ft
4 years
BL x 2
13 years
BL x 3
AGE

Percentile
< 10th
10 90th
> 90th

EXPECTED WEIGHT
Age
Weight in grams
Infants < 6 months Age in months x 600 + BW
6 12 months Age in months x 500 + BW
2 yrs and up Age in years x 2 + 8
*Average BW of Filipinos is 3, 000 grams (3 kg)

Birth
1 year
6 years

THORACIC INDEX
1
1.25
1.35

Thoracic Index = Transverse Diameter


AP Diameter
*Abdominal circumference should be equal to the
chest circumference until 2 y/o

HEAD CIRCUMFERENCE VS CHEST CIRCUMFERENCE


At birth
HC > CC
6 months
HC = CC
12 months
HC < CC

BALLARD SCORING SYSTEM FOR DETERMINING GESTATIONAL AGE IN WEEKS

th

*From Nelson Textbook of Pediatrics 19 Edition pg. 558

DEVELOPMENT OF VERTEBRAL CURVATURES


Birth Thoracic and sacral only
3 months old Cervical
3 years old Lumbar
BRAIN DEVELOPMENT
Brain Weight
1 year old adult brain weight
3 years old adult brain weight
7 years old 9/10 adult brain weight
10 years old Fully developed

Age

EVOLUTION OF PAIN RESPONSE


Age
Response to Pain
< 1 2 months Generalized movement and crying
7 9 months Localize site of pain and withdraw
12 16 months Pulls away from painful stimulus and brings
hand to irritated area
*Images of the ff. tables are lifted from Nelson Textbook of Pediatrics
19th Edition:

Pain Assessment: Faces Scale

TANNER STAGING/SEXUAL MATURITY RATINGS IN ADOLESCENTS

Pubic Hair Stages (Male)

Pubic Hair Stages (Female)

Breast Changes (Female)

*Continuation: Blood Pressure Level for Boys by Height and Age Percentile

*Continuation: Blood Pressure Level for Girls by Height and Age Percentile

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