RAJIV GANDHI INSTITUTE OF MEDICAL SCIENCES

MEDICAL COLLEGE, KADAPA

DEPARTMENT OF PEDIATRICS

STUDENT CLINICAL CASE SHEET

RECORD

NAME : -------------------------------------------------------------------

REG NO : -------------------------------------------------------------------

YEAR : -------------------------------------------------------------------
 RAJIV GANDHI INSTITUTE OF MEDICAL SCIENCES
MEDICAL COLLEGE, KADAPA

DEPARTMENT OF PEDIATRICS

CERTIFICATE

This is to certify that this is the bonafied student case sheet

record of Mr. / Miss
---------------------------------------------------------and that he / she
has attended his / her practical work regularly / irregularly during
his / her study period . His / her work is satisfactory /
unsatisfactory.

ASSISTANT PROFESSOR PROFESSOR & HOD

 I/C of the batch Department of Pediatrics
RIMS, KADAPA

LIST OF CASE SHEETS

SNO DATE NAME AGE DIAGNOSIS

PEDIATRIC CASESE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

NEONATAL CASE SHEETS

1
2
3
 4
5

RULES AND REGULATIONS

ATTENDANCE

75% of attendance in a subject is compulsory inclusive of attendance in non-lecture

teaching i.e. seminars, group discussion, tutorials, demonstrations, practicals, hospital
postings, bedside clinics, failing which the student will not be permitted to appear for
the University exam with his batch of students. Attendance shall be calculated from
the total number of hours prescribed by UHS / MCI and not the number of classes
conducted.

INTERNAL ASSESSMENT

1) Internal assessment marks including 50% theory and 50% practicals/clinical in

all subjects
2) A student must secure at least 35% marks of the maximum marks fixed for
internal assessment in a particular subject to be eligible to appear for the final
university exam of that subject.
3) Regular, periodical notified examinations with notified syllabus shall be
conducted
4) Last exam conducted is pre final. It is mandatory and should be conducted in
university exam pattern i.e. in theory and prcticals/clinical.
5) 5 marks are earmarked for record work to be included in practical internal
assessment examinations for all subjects.
6) If only one practical examination is conducted, those marks are mandatory for
considering the internal assessment marks. If the candidate is absent for any of
the exams, the marks in that exam shall be taken as zero.
7) The internal assessment marks shall be displayed in the notice board and shall
be dispatched to the university soon after each internal assessment examination.
As per the existing rules internal assessment marks should be sent so as to reach
the University at least two weeks before the University theory examination.
8) While forwarding the examination application forms of the students, the
Principals should check the attendance, internal assessment marks and name in
intermediate or equivalent certificate. Fresh internal assessment examination is
mandatory to the referred students. The previous internal assessment marks will
not be considered. (Vide 183rd resolution of Executive Council of Dr. NTR
UHS, dated 06.06.2009).

SCHEME OF PEDIATRIC EXAMINATION

 1) Pediatrics has one theory paper of 40 marks of 2 hours duration. It consists
of : A) One structured question of 10 marks B) Five short answer questions
of 4 marks each C) Five brief answer questions 2 marks each amounting to
a total of 40 marks.
2) Practical / clinical examination consists of: A) One long case of 15 marks
(complete case sheet with diagnosis is mandatory) B) One short case of 10
marks (diagnosis and salient features suggestive of diagnosis are
mandatory) C) Spotters of 5 marks (only diagnosis) D) Viva of 10 marks
(covering nutrition/drugs & immunization/instruments & resuscitation/x-
rays).
3) Internal assessment of 20 marks to be added to make the total of 100
marks (40 + 40 + 20 =100).

CLASSIFICATION OF RESULTS

1) A candidate is declared as passed in second class if he/she secures 50% marks

in aggregate in all subjects of the phase with a minimum of 50% in theory plus
orals and 50% in practicals in that subject. A candidate securing fewer marks is
failed.

2) First class in a particular phase may be awarded to a candidate who secures

65% or more of aggregate marks in all the subjects of the phase and passes all
the subjects in the first regular appearance.

3) First class with distinction in a phase may be awarded to a candidate who

secures 75% of aggregate marks and above in all the subjects and passes all the
subjects in the first appearance.

SYLLABUS FOR PRACTICAS/CLINICALS

LIST OF USUAL CLINICAL CASES TO BE COVERED

1. Normal New born 2. Normal development in a child. 3. Low birth weight babies 4.
Temperature regulation in new born. 5. Neonatal Infections. 6. Neonatal Respiratory
distress 7. Jaundice in New born. 8. Malaria and Typhoid Fever 9. Immunization. 10.
Adolescent growth and disorders of puberty 11. Common exanthematous illness 12.
Infant Feeding. 13. Xerophthalmia & Rickets. 14. Protein energy malnutrition. 15. Fluid
and electrolyte imbalance. 16. Acute diarrhea 17. Persistent diarrhea 18. Chronic liver
disease 19. Seizure disorders. 20. Acute flaccid paralysis 21. Cerebral palsy & mental
retardation. 22. Leukemias 23. Hemolytic anemias & Thalassemia 24. Bleeding and
coagulation disorders 25. Iron deficiency anemia. 26. Ac.Glomerulonephritis &
Hematuria. 27. Nephrotic Syndrome. 28. Rheumatic fever and heart disease 29. Acute
respiratory infections. 30. Congenital heart disease 31. Congestive heart failure 32.
Meningitis 33. Bronchial asthma 34. Behavioural Disorders 35. Childhood tuberculosis.

SUGGESTED LIST OF INSTRUMENTS AND X-RAYS

List of Instruments: Lumber puncture needle, Ambu bag and mask, Liver biopsy
needle, Tongue depressor Bone marrow aspiration needle, Tuberculin syringe,
Intravenous Cannula, Endotracheal tube, Ryles tube, Laryngoscope Emergency drugs
Vaccines. List of X-rays: Pneumonia, primary complex – hilar and parahilar
lymphadenopathy, military tuberculosis, obstructive emphysema, Pleural effusion,
pneumothorax, normal thymus, primary complex, Congenital heart disease, increased
and decreased pulmonary vascularity, cardiomegaly, Rickets, Scurvy, Hemolytic
anemia, skull (sutural seperation, enlarged sella and raised intracranial tension).

***
 MODEL PEDIATRIC CASE SHEET

INFORMANT & RELIABILITY: For this case the informant is Rama Devi, the mother of
the child. History given by her is fairly reliable.

BASIC DATA: This is Raju a 5 year old boy of Raghuram and Rama Devi, resident of 46-
7A, Sitharam nagar, near Apsara theater, Kadapa district which comes under urban
slum, was brought by her mother and got admitted in this hospital on 12.10.2017 at
10 PM for the following complaints. Child is being examined after 2 days of admission.

COMPLAINTS & DURATION:

Fever/Cough/Cold: 5 days
Breathlessness: 2 days
Convulsions: 1 day

HISTORY OF PRESENT ILLNESS:

Child was apparently normal 5 days prior to the illness. On day one of illness he
presented with fever. Fever was high grade and was associated with chills and rigors.
Child was given some syrup for fever (probably paracetamol) three times a day and
fever used to subside and recur after 4-5 hours. Though the nature of fever was
altered by paracetamol I still feel it is continuous. Fever was not associated with any
rash.

Simultaneously child had cold and cough. Cold was in the form of running nose initially
watery later mucopurulent. Cough was dry to start with and then turned to wet cough
associated with gurgling sounds in the throat and small quantity of white colored
sputum. After 3 days child developed fast breathing with retractions of the chest wall.
H/o difficulty in feeding and grunt were noticed. Within 24 hours child had
convulsions.

Convulsions were generalized tonic clonic lasting for 15 minutes with postictal
drowsiness of 1 hour. Child was taken to private hospital where he received some
injections and oxygen. At this stage child was referred to this hospital.

Mother was not able to comment on cyanosis. No h/o PND or orthopnea. No history
suggestive of puffiness of face or edema. No h/o oliguria or anuria or hematuria. No
h/o headache /vomiting/ or altered sensorium prior to convulsions. No h/o anemia or
swelling of upper abdomen. No h/o clinically significant swellings in neck/axilla/other
areas. No h/o loose stools or vomiting. Bowels and micturition are normal.
At the end of present history probable DD thought off: Very severe
pneumonia/pneumonia with septicemia with meningitis/ACHD with very severe
pneumonia/pneumonia with atypical febrile seizers/meningoencephalitis with or
without aspiration pneumonia.

PAST HISTORY:

NO H/S/O Recurrent respiratory tract infections. No H/S/O tuberculosis in the past.

NO h/o measles or whooping cough in the last 3 months. No H/S/O ACHD. No h/o
febrile seizers. No h/o acquired immunodeficiency diseases. No h/o Hypertension or
Diabetes Mellitus.

PERINATAL HISTORY:

Prenatal: No h/o rubella vaccination. No h/o folic acid supplementation. No h/o any
treatment for any chronic illnesses in the mother.
Antenatal: Booked case, Had regular antenatal checkups. No h/o fever with rash,
exposure to radiation or intake of teratogenic drugs in the first trimester. No h/o
chronic diseases like tuberculosis, bronchial asthma, CCF, CRF or Connective tissue
disorders. No h/o pregnancy induced HTN or toxemias of pregnancy. No h/o
oligohydramneos or polyhydramneos.
Natal: Normal spontaneous, vaginal, hospital delivery.
Post natal: Term, AFD with BWT 2.8 KG, Cried immediately after birth, no h/o
respiratory distress or convulsions. Breast feeding initiated within one hour of
delivery. No h/o delayed passage of meconium or urine. No h/o noticing any
congenital abnormalities.

FEEDING HISTORY:

Exclusive breast feeding was continued for 4 months later supplementary feeding with
cow’s milk started along with breast milk. Complementary feeding started around 8
months. Breast feeding discontinued after 1 year of age.

IMMUNIZATION HISTORY:

SNO VACCINE RECOMMENDED GIVEN AT

AGE AGE
1 BCG/ Hepatitis B (0)/Oral polio (0) At birth At birth
2 DPT (1)/OPV (1)/Hepatitis B 6 weeks 6 weeks
(1)/Hib (1)
3 DPT (2)/OPV (2)/Hepatitis B 10 weeks 10 weeks
(2)/Hib (2)
4 DPT (3)/OPV (3)/Hepatitis B 14 weeks 14 weeks
(3)/Hib (3)
 5 Measles 9 months 10 m0nths
6 Measles 15 months Not given
7 DPT (B1)/OPV (4)/ 18 MONTHS 18 months
8 DPT (B2)/OPV (5) 5 years Not given

DEVELOPMENTAL HISTORY:

Gross motor: Neck holding 3 mo/sitting without support not able to tell/standing with
support 10 month /walking without support 1 year/ riding tricycle 3 years/skipping 5
years = Appears normal.
Fine motor & adaptive: mouthing of objects 3 mo/transfer of objects 6 mo/pincer
grasp 1 yr/copies triangle 5 yrs = Appears normal.
Persona-social: Social smile 2 m0/recognizing mother 3 mo/waving bye-bye 9
m0/brushing and dressing without help 4 yrs = Appears normal.
Language: cooing 2 m0/babbling 5 mo/monosyllables 7 mo/bisyllables 9 mo/true
speech 12 mo/narrate a story 5 yrs= Appears normal.

DIETARY HISTORY:

SNO ITEM CALORIES PROTEINS

(grams)
1 BREAK FAST
Idlies 2 50x2=100 2x2=4
Chutney 4 tsp 30x4=120 1x4=4
Tea (100 ml) 40 1
2 MORNING SNAKS
Biscuits 2 60 2
3 LUNCH
Rice 2 cups 200 4
Dhal 2 tblsp 90 2
4 EVENING SNAKS
Tea (100 ml) 40 1
5 DINNER
Rice 2 cups 200 4
Dhal 2 tblsp 90 2
Rasam (50 mi) 10 0

Total intake 950 23

Calorie requirement 1400 Protein requirement 27

Calorie intake 950 Protein intake 23
Calorie deficit 450 Protein deficit 04

FAMILY AND SIBLING HISTORY:

This child is born to non consanguineous couple.
No siblings. Noh/o TB/CHD/HTN/DM/Bronchial asthma

SOCIOECONOMIC HISTORY:
Total number of family members 5
Total income per month 6000
Per capita income (6000/5) 1200
Family is living in a pakka house with safe drinking water supply & sanitary disposal of
waste with overcrowding (5 members in 2 rooms). According to Kuppuswami
classification family comes under Lower class.

GENERAL EXAMINATION:

Child is looking sick with respiratory distress and not interested in surroundings. No
special decubitus. On head to toe examination: head appears normal in size and
shape. No frontal bossing or receding fore head. Eyes and ears are normally set. Nose,
mouth and chin normal. Neck is normal. Trunk and limb proportions appear normal.
Spine and limbs are normal. Pallor of conjunctiva and palms present AND can be
classified as anemia according to IMNCI classification. No jaundice, no cyanosis, no
clubbing, no edema and no significant lymphadenopathy.

ANTHROPOMETRY:

SN PARAMETER PRESENT EXPECTED REMARKS

O
1 WEIGHT (KG) 12 18 Percentage of expected is
67%.
According to IAP
classification child comes
under Grade ii PEM
2 HEIGHT (CMS) 100 107 Percentage of expected is
93%.
According to Waterlow
classification child comes
under Grade I stunting
3 HEAD 50 50 Normal
CIRCUMFERENCE
(CMS)
4 CHEST 55 > CC Normal
CIRCUMFERENCE
(CMS)
5 MUA C (CMS) 13 >13.5 Mild PEM
6 US:LS 1.3:1 1.3:1 Normal
7 ARM SPAN: HT 101:100 101:100 Normal

VITAL DATA:
 HR = 130/mt RR = 68/mt Temp: 38.50C BP = 90/60
mmHg

SYSTEMIC EXAMINATION:

Because child presented with fever, cough, cold and breathlessness respiratory system
has been selected.
Upper respiratory tract:

Ala nasi are actively working. Mucopurulent discharge from the nose found. No
excoriation of skin around the nose. Oropharynx appears red. Tonsils appear normal.

Lower respiratory tract: (examination of the chest)

INSPECTION
Chest appears normal in size and shape with transverse diameter more than
anteroposterior diameter giving elliptical shape on cross section. Chest is bilaterally
symmetrical and moving equally on both sides. Trachea is in the midline. Respiratory
distress noticed with respiratory rate of 62 breaths /minute. There is inspiratory in
drawing of intercostal and sub costal space. There is no localized or generalized
fullness or depression of the chest wall. There is no bulging or crowing of intercostal
spaces on either side of chest. Apical impulse is seen in 5 th intercostal space just
medial to midclavicular line on left side. No undue prominence or deepening of
supraclavicular and infraclavicular fossae on both sides. No engorged veins, no scars
and sinuses and skin over the chest are normal. No scoliosis, no kyphosis, no drooping
of shoulders and no deformities of spine.

PALPATION
No local raise of temperature no tenderness. Size and shape of chest, symmetry and
equality of movements of chest are confirmed (have to write measurements of chest).
Tracheal position and apex beat are confirmed. Vocal fremitus is equal on both sides.
No friction fremitus or rhonchial fremitus.

PURCUSSION
Chest is tympanic on percussion. Liver dullness found on 5 th ICS down on right side.
Cardiac dullness on left side is within normal limits.

AUSCULTATION:
Breath sounds are vesicular on both sides. Bilateral crepitations heard on all over the
chest. Vocal resonance is equal on both sides.

OTHER SYSTEMS: Normal

PROVISIONAL DIAGNOSIS:
Very severe pneumonia with hypoxic convulsions with Grade I PEM and Grade I
stunting with anemia.
 MODEL NEONATAL CASE SHEET

INFORMANT & RELIABILITY:

For this case the informant is Laxmi Devi, the mother of the neonate. History given by
her is fairly reliable.

BASIC DATA:

This is 2 days old baby boy of Laxmi Devi and Venkatesh, born on 8.10.2017 at 8 AM,
resident of 4-4-1A, near Chitanya School, Sriramanagar, Kurnool district which comes
under urban slum, was brought by her grandmother and got admitted in this hospital
on 10.10.2017 at 10 AM for the following complaints. Child is being examined after 2
days of admission. Birth weight: 3 kg/Length 50 cm/HC 34 cm/CC 31 cm.

COMPLAINTS & DURATION:

Yellowish discoloration of eyes 1 day

BABY’S HISTORY:

PRESENT HISTORY
Prior to 2 days baby was normal. On 3 rd day mother noticed yellowish discoloration
of eyes. Baby is sucking well at breast. No h/o birth asphyxia. No h/o convulsions. No
h/o fast breathing. No h/o retractions of chest wall. No h/o fever or hypothermia. No
h/o pustules or boils. No h/o lethargy or decreased movements of body. No h/o Rh or
ABO incompatibility.

PAST HISTORY
At birth baby was pink in color and eyes were normal in color.

FEEDINH HISTORY
Baby was put to breast within half an hour of delivery. Accepting breast feeds at the
frequency of 8-10 times per day.

FAMILY HISTORY
Baby is a product of non consanguineous couple. Only child and there is no h/o
congenital abnormalities in the family.
MOTHERS HISTORY

Mother is 28 years old with 50 kg weight and 157 cm height, illiterate, coming from
low socio-economic status.
Prenatal: No h/o rubella vaccination. No h/o folic acid supplementation. No h/o any
treatment for any chronic illnesses in the mother.
Antenatal: Booked case, Had regular antenatal checkups. No h/o fever with rash,
exposure to radiation or intake of teratogenic drugs in the first trimester. No h/o
chronic diseases like tuberculosis, bronchial asthma, CCF, CRF or Connective tissue
disorders. No h/o pregnancy induced HTN or toxemias of pregnancy. No h/o
oligohydramneos or polyhydramneos.
Natal: Normal spontaneous, vaginal, hospital delivery.
Post natal: Term, AFD with BWT 3 KG, Cried immediately after birth, no h/o
respiratory distress or convulsions. Breast feeding initiated within one hour of
delivery. No h/o delayed passage of meconium or urine. No h/o noticing any
congenital abnormalities. No h/o birth trauma/birth injuries.

ASSESSMENT OF GESTATIONAL AGE

1) History: From the h/o LMP, Quickening and antenatal u/s gestational age
appears to be 40 weeks.
2) Rough estimation to decide term/preterm: Scalp hair is thick/black/and silky
and difficult to make out individual hair. Ear cartilage is well curved and firm.
Breast nodule is 10 mm in size. Testes are descended and scrotum is black with
deep rugae. Sole creases-deep extending all over. All features are suggestive of
term baby.
3) Exact estimation of GA by New Ballard Scoring: 40±2 weeks.

EXAMINATION OF THE BABY

Baby is pink in color. Cry and activity are good. Head is normal in shape and size. Fore
head normal without any prominence/receding. Eyes are normal in size and setting.
Bulbar conjunctiva is yellow in color. On blanching skin of nose and face is yellow in
color. Ears and nose are normal in size shape and setting. Filtrum is normal. No cleft
lip/cleft palate. Neck is normal. Trunk and limb proportions are normal. Size and shape
of chest appears normal with AP and Transverse diameters being equal giving circular
shape on cross section. RR IS 48/mt; HR 130/mt .There is no fast breathing, no
retractions of the chest. Apex beat is in the 3 RD ICS lateral to midclavicular line on left
side. Trachea is in the midline. Skin over the chest is normal. On auscultation breath
sounds are vesicular and no adventitious sounds. S1/S2 are normally heard, no
murmurs. Abdomen is soft and liver is just palpable. External genitalia are normal.
Limbs and spine are normal. No cranial nerve palsies. Power and tone normal.
Superficial and deep tendon reflexes are normal. Plantar is bilateral reflex extensor.
Neonatal reflexes: Moro’s reflex is complete and is symmetrical. Grasp reflex with
traction response is good. Asymmetric tonic neck reflex is present. Sucking /rooting /
swallowing reflexes are good. Trunk incurving/stepping/ and placing reflexes are
present.

PROVISIONAL DIAGNOSIS:
Term baby with normal birth weight and appropriate for gestational age baby with
neonatal jaundice on 3rd day probably physiological jaundice.

INFORMATION ESSENTIAL FOR GOOD CASE SHEET WRITING

MODIFIED KUPPUSWAMY SCALE (PROPOSED UPDATING FOR JANUARY 2017)

EDUCATION OF HEAD OF FAMILY SCORE

Profession or honours 7
Graduate or postgraduate 6
Intermediate or post high school diploma 5
High school certificate 4
Middle school certificate 3
Primary school certificate 2
Literate 1
Occupation of head of family
Profession 10
Semi-profession 6
Clerical, Shop-owner 5
Skilled worker 4
Semi-skilled worker 3
Unskilled worker 2
Unemployed 1
Monthly income of family
In 1976 In 1998 In 2007 in 2017 (January CPI)
>=2000 13408 19844 >41430 12
1000-1999 6704-13407 9922-19843 20715-41429 10
750-999 5028-6703 7441-9921 15536-20714 6
500- 3352-5027 4961-7440 10357-15535 4
749
300-499 2011-3351 2976-4960 6214-10356 3
101- 677-2010 1002-2975 2092-6213 2
299
 <=100 <676 <1001 <2091 1
Socioeconomic Total
class score
I Upper 26-29
II Upper middle 16-25
III Lower middle 11-15
IV Upper lower 5-10
V Lower <5

DEVELOPMENTAL MILESTONES BIRTH TO 6 YEARS

AGE GROSS MOTOR FINE MOTOR SOCIAL LANGUAGE

2 mo - - Social smile cooing

3 mo Neck holding Opens hands Recognizes mother -
spontaneously
5 mo Sitting with supp Bi-dexterous approach -- Babbling
6 mo -- Transfer of objects Smiles at his image --
in mirror/shoes
likes & dislikes
7 mo Sitting without Radial rasping grasp -- monosyllables
supp
8 mo Creeping Uni-dexterous Stanger anxiety
approach
9 mo Standing with supp Immature pincer Object constancy Bisyllables
grasp / release object Play peep-a-boo
on command game/pat a cake
game
Waves bye-bye
10 mo Walking with supp -- -- --
11 mo Standing without -- -- --
sup/crawling
12 mo Walking without Mature pincer grasp Comes when called 2 words
supp (True speech)
15 mo Walks backwards Scribbles/stacks 2 uses spoon & fork 3-6 words
blocks Follows
commands
18 mo Runs Stacks 4 blocks/kicks a Removes garments Says at least 6
ball Feeds doll words
2 yrs Walks up & down Stakes 6 blocks Wash & dry hands 2word
the stairs copies a line Brushes teeth with sentences
help. Puts on points to
clothes pictures
knows body
parts
3 yrs Walks steps Stakes 8 blocks uses spoon with Names pictures
alternating feet/ less spilling/puts 3 word
jump on T –shirt. Rides a sentences
tri-cycle
4 yrs Hops on one foot copies’ 0’Draws a man Brushes teeth Names colors
with 3 parts without help. Understands
Dresses without adjectives
help
5 yrs skips heel to toe copies -- Counts/under
stands
opposites
6 yrs Balances on each Copies -- under stands
foot for 6 sec right/left

IAP IMMUNIZATION SCEDULE

IAP IMMUNIZATION SCEDULE
(Continued…)
UNIVERSAL IMMUNIZATION PROGRAMME
SCHEDULE - 2016
 FOR PREGNANT WOMEN

SNO PREGNANT WOMEN VACCINE

1 Early in pregnancy TT 1
2 4 weeks after TT 1 TT 2
3 WITHIN 3 years of last pregnancy with both TT BOOSTER
doses of TT

FOR INFANTS AND CHILDREN

SNO AGE VACCINE

1 At birth BCG/OPV-0/Hepatitis B
2 6 weeks OPV-1 + Pentavalent-1 + Rota virus-1
3 10 weeks OPV-2 + Pentavalent-2 + Rota virus-2
4 14 weeks OPV-3 + Pentavalent-3 + Rota virus-3 + IPV
5 9 months Measles + Vitamin-A 1st dose
6 16 to 24 months DPT booster-1 + OPV booster-1 + Measles-2
Vitamin-A 2nd dose followed by every 6 months till
5 years of age +JE (in endemic areas
7 5 to 6 years DPT booster-2 + OPV booster-2
8 10 and 16 years TT

VACCINE-SPECIFIC REPORTABLE EVENTS INCLUDE:

 Tetanus – Brachial neuritis within 28 days

 Pertussis – Encephalopathy or encephalitis within seven days
 Measles, mumps, and/or rubella – Encephalopathy or encephalitis within 15
days
 Rubella – Chronic arthritis within six weeks
 Measles – Thrombocytopenic purpura within 7 to 30 days; vaccine-strain
measles infection in an immunodeficient recipient within six months of measles
vaccination
 Oral polio – Paralytic polio or vaccine-strain polio within 30 days to 6 months
(this vaccine is no longer used for routine childhood immunization)
 Rotavirus – Intussusception within 30 days of rotavirus immunization

CLASSIFICATION OF BABIES AT BIRTH

CLASSIFICATION OF BIRTH WEIGHT

SNO DIRTH WEIGHT CATEGORY
1 >2500 grams Normal weight
2 1500 – 2500 grams Low birth weight
3 1000 – 1500 grams Very low birth weight
4 <1000 grams Extremely low birth weight

CLASSIFICATION OF GESTATIONAL AGE

SNO GESTATIONAL AGE CATEGORY

1 < 37 weeks Preterm baby
2 34 to36 w + 6 days Late preterm
3 >25 to ≤ 32 weeks very preterm
4 ≤ 25 weeks Extreme preterm
5 ≥ 37 to < 42 weeks Term baby
6 ≥ 42 weeks Post term baby

CLASSIFICATION OF BIRTH WEIGHT FOE GESTATIONAL AGE

SNO CATEGORY DEFINITION

1 SFD Birth weight below 10 percentile for GA
th

2 AFE Birth weight between 10th and 90th percentile for GA

3 LFD Birth weight > 90th percentile for GA

BIRTH WEIGHT GESTATIONAL AGE PERCENTILE CHART

WEECH FORMULAE

SNO AGE GROUP FORMULA

Calculating expected weight
1 Birth to 12 months Age in months + 9 /2
2 1 to 6 years Age in years x 2 +8
3 7to 12 years Age in years x 7-5/2
Calculating expected length/height
1 At birth 50 cm
2 1 year 75 cm
3 2 years 85 cm
4 2 to 12 years Age in years x 6 +77

HEAD CIRCUMFERENCE

SNO AGE GROUP FORMULA

1 At birth 33 to 35 cm
2 1 to 3 mo 2 cm per month
3 3 to 6 mo 1 cm per month
4 6 to 12 mo 0.5 cm per month
5 During 2nd year 2 cm
6 2 to 5 years 0.25 cm per year

MID UPPER ARM CIRCUMFERENCE

SNO CIRCUMFERENCE CLASSIFICATION OF PEM

1 >13.5 cm Normal
2 12.5 cm to 13.5 cm Mild
3 11.5 cm to 12.5 cm Moderate
4 <11.5 cm Severe
***Decrease in MUAC indicate acute PEM

UPPER SEGMENT LOWER SEGMENT RATIO

SNO AGE GROUP US :LS

1 At birth 1.7:1
2 1 year 1.6;1
3 2 years 1.5: 1
4 3 years 1.4:1
5 4 years 1.3:1
6 5 years 1.2: 1
7 10 years 1:1
***Ratio decreases by 0.09 to 0.1 per year

PEM CLASSIFICATIONS
 IAP CLASSIFICATION

SNO PERCENTAGE OF EXPECTED GRADE OF PEM

WEIGHT FOR AGE
1 >80 Normal
2 70 to 80 Grade I (Mild)
3 60 to 70 Grade II (Moderate)
4 50 to 60 Grade III(Severe)
5 <50 Grade IV (Severe)
***if edema is there K should be added after grade

WATERLOW CLASSIFICATION

SNO PERCENTAGE OF EXPECTED GRADE OF UNDER NUTRITION

WEIGHT FOR AGE
1 >95 Normal
2 90 to 95 Mild
3 85 to 90 Moderate
4 <85 Severe

SNO PERCENTAGE OF EXPECTE GRADE OF STUNTING

HEIGHT FOR AGE
1 >95 Normal
2 90 to 95 Mild
3 85 to 90 Moderate
4 <85 Severe

SNO PERCENTAGE OF EXPECTE GRADE OF WASTING

WEIGHT FOR HEIGHT
1 90 to 11o Normal
2 80 to 90 Mild
3 70 to 80 Moderate
4 < 70 Severe

WHO CLASSIFICATION

SNO PARAMETER MODERATE SEVERE

MALNUTRITION MALNUTRITION
1 Symmetrical edema No Present
2 Weight for height ≥ -3 SD to -2 SD (70-80%) < - 3 SD (<70%)
3 Height for age ≥ -3 SD to -2 SD (80-85%) < - 3 SD (<80%)

WELCOME TRUST CLASSIFICATION

SNO % OF EXPECTED WITH EDEMA WITHOUT EDEMA

 WEIGHT
1 60 to 80 Kwashiorkor under nutrition
2 <60 Marasmic kwashiorkor Marasmus

CLASSIFICATION OF MARASMUS

SNO LOSS OF SUBCUTANEOUS FAT GRADE OF MARASMUS

(REGION INVOLVED)
1 Axilla and groin Grade I
2 Abdomen and buttocks Grade II
3 Chest and trunk Grade III
4 Buccal pad of fat Grade IV

CALORIE REQUIREMENT BY HOLYDAY SEGAR FORMULA

(Calculated for expected weight)

SNO EXPECTED WEIGHT FORMULA

1 1st 10 kg 100 calories /kg/day
2 10 to 20 kg 1000 + 50 calories per kg/day between 10 t0 20
kg
3 >20 kg 1500 + 20 calories per kg/day above 20 kg

***Water requirement is also calculated by the same Holyday Segar formula but the
difference is that water requirement is calculated for present weight

PROTEIN REQUIREMENT
(Calculated for expected weight)

SNO AGE GROUP FORMULA

1 Birth to 3 mo 2.75 g/kg/day
2 3 to 6 mo 2.50 g/kg/day
3 6 to 9 mo 2.15 g/kg/day
4 9 to 12 mo 2 g/kg/day
5 1 to 3 years 1.75 g/kg/day
6 3 to 6 years 1.5 g/kg/day
7 6 to 9 years 1.25 g/kg/day
8 9 to 12 years 1g/kg/day
9 >12 years 0.8 to 1 g/kg/day

*** Once calorie and protein requirements are met fat/vitamin/mineral and
electrolyte requirements are automatically met with

CALORIE AND PROTEIN CONTENT OF COMMON FOOD ITEMS

 (ROUDED OFF FIGURES)

SNO FOOD ITEM QUANTITY CALORIES PROTEINS

(grams)
1 IDLY 1 50 2
2 VADA 1 50 2
3 DOSA 1 50 2
4 POORI 2 50 2
5 CHAPATI 1 50 2
6 JOWAR ROTI 1 100 3
7 PAROTA 1 150 3
8 UPMA 100 G 100 2
9 PONGAL 100 G 250 5
10 PULIHORA 100 G 250 5
11 RAGI ROTI 1 150 3
12 RICE (COOKED) 100 G 100 2
13 DHAL (COOKED) 1 Table Spoon (15 ml) 50 2
14 VEG CURRY 1 Table Spoon (15 ml) 70 1
15 DGLV CURRY 1 Table Spoon (15 ml) 60 1
16 SAMBAR 1 Table Spoon (15 ml) 50 2
17 RASAM 100 ml 20 0
18 CURDS 30 ml 25 1
19 MILK + SUGAR 100 ml + (2 TSF sugar) 100 3
20 COFFEE / TEA 100 ml 80 1
21 BREAD 1 SLICE 50 2
22 BISCUITS 2 70 2
23 OMLET 1 77 6
24 FISH 100 G 80 22
25 MEAT 100 G 100 22
26 SUGAR 1 TSP 20 0
27 GHEE 1 TSP 40 0
28 BANANA 1 80 1
29 EGG 1 60 6
30 CHATNI 1 TSF 30 1

PEDIATRIC CASE SHEET

INFORMANT & RELIABILITY

BASIC DATA

COMPLAINTS AND DURATION

HISTORY OF PRESENT ILLNESS

PAST HISTORY
PERINATAL HISTORY

PRENATAL:

ANTENATAL:

NATAL:

POST NATAL:

FEEDING HISTORY

IMMUNIZATION HISTORY

DIETARY HISTORY

FAMILY AND SIBLING HISTORY

SOCIOECONOMIC HISTORY

GENERAL EXAMINATION

ANTHROPOMETRY

SN PARAMETER PRESENT EXPECTED REMARKS

O
1 WEIGHT (KG)

2 HEIGHT (CMS)

3 HEAD CIRCUMFERENCE
(CM)
4 CHEST
CIRCUMFERENCE (CM)
5 MUAC (Cms)
6 US:LS
7 ARM SPAN: HT

VITAL DATA

HR: RR:

BP: TEMP:

SYSTEMIC EXAMINATION

(RESPIRATORY/CARDIOVASCULAR/ABDOMEN/CENTRAL NERVOUS SYSTEM)

SUMMARY
DIFFERENTIAL DIAGNOSIS

PROVISIONAL DIAGNOSIS & POINTS IN FAVOUR

INVESTIGATIONS

TREATMENT

SIGNATURE OF STUDENT SIGNATURE OF STAFF

NEONATAL CASE SHEET

INFORMANT & RELIABILITY

BASIC DATA

COMPLAINTS & DURATION

BABY’S HISTORY

PRESENT HISTORY

PAST HISTORY

FEEDINH HISTORY

FAMILY & SIBLING HISTORY

MOTHERS HISTORY

Age Weight Height

Literacy SES IPI

Prenatal:

Antenatal:
Natal:

Post natal:

ASSESSMENT OF GESTATIONAL AGE

1) From History:
2) Rough estimation of GA to decide Term/Preterm:

3) Exact estimation of GA by New Ballard Scoring:

ANTHROPOMETRY

EXAMINATION OF THE BABY

NEONATAL REFLEXES
SUMMARY

DIFFERENTIAL DIAGNOSIS

PROVISIONAL DIAGNOSIS & POINTS IN FAVOUR

INVESTIGATIONS

TREATMENT

SIGNATURE OF STUDENT SIGNATURE OF STAFF