Paediatric History Taking and Physical Examination

Pead Series · Week 1: Year 4 MBChB notes on paediatric history, birth and feeding history, growth and development, age-appropriate examination, vital signs, danger signs, OSCE checklist, practice questions and 20 exam-style MCQs with explained answers.

Learning objectives

By the end of this topic, you should be able to take a structured history from a child and caregiver, perform a systematic age-appropriate examination, interpret key findings in context, recognise danger signs, and present your findings clearly.

1. Why paediatric assessment is different

Children are growing and developing, so normal findings depend on age. Infants and young children may not describe symptoms reliably; the caregiver often provides most of the history. A child can also deteriorate quickly, and the first assessment should identify airway, breathing, circulation, disability and exposure concerns before a long history.

Core rule: observe the child before touching them. Note alertness, interaction, colour, posture, breathing effort, cry, hydration and whether the child can feed or speak normally for their age.

2. Preparation and communication

Perform hand hygiene and use appropriate infection-prevention measures.
Introduce yourself to the child and caregiver; confirm the child's identity and age.
Explain what you need to do in language suited to the child's developmental level.
Obtain caregiver consent and seek the child's assent when appropriate. Respect confidentiality, especially with adolescents, while explaining its safeguarding limits.
Ask permission before exposing or examining each area. Keep the child warm and expose only what is necessary.
Use a calm approach, allow the child to remain with a trusted caregiver when possible, and examine from least to most distressing.
Use a chaperone according to local policy for intimate examinations.
If the child appears critically ill, begin urgent assessment and treatment while obtaining essential history.

3. Structured paediatric history

Start with an open question such as, “What has brought your child in today?” Then clarify the details systematically.

A. Identification and presenting complaint

Record the child's name or identifier, age, sex where clinically relevant, residence, caregiver and relationship, date/time, and source of the history. Note the presenting complaint(s) in the caregiver's or child's own words and the duration of each.

Assess reliability and whether information comes from the child, parent, guardian, referral note or another source.

B. History of presenting illness

For each complaint, establish:

Onset and duration: sudden or gradual; first episode or recurrent.
Progression: improving, stable or worsening.
Character and severity: what it looks or feels like; effect on normal activity.
Associated symptoms: fever, cough, difficulty breathing, vomiting, diarrhoea, pain, rash, seizures, reduced urine or altered behaviour.
Triggers and relieving factors: feeding, position, activity, medicines or exposure.
Intake and output: ability to breastfeed/drink, amount taken, vomiting, urine frequency and stool pattern.
Treatment so far: medicine name, dose if known, timing, response, traditional remedies and allergies.
Exposure and contacts: sick contacts, travel, outbreaks, TB contact, animal or environmental exposures as relevant.
Effect on function: sleep, play, school attendance, feeding and interaction.

Ask directly about danger signs: inability to drink or breastfeed, vomiting everything, convulsions, lethargy or unconsciousness, severe breathing difficulty, blue colour, markedly reduced urine, or rapid deterioration.

C. Antenatal, birth and neonatal history

Ask about maternal illnesses and medicines during pregnancy, antenatal care, infections, substance exposure where relevant, and pregnancy complications. Record gestational age, singleton or multiple pregnancy, mode and place of delivery, birth weight if known, and complications during labour or delivery.

For the newborn period, ask about delayed crying or resuscitation, breathing difficulty, jaundice, suspected sepsis, feeding problems, admission to a newborn unit, congenital abnormalities and duration of hospitalisation. A history of prematurity should prompt questions about complications and follow-up.

D. Feeding and nutrition

For infants, ask whether feeding is breast, formula or mixed; exclusivity and frequency of breastfeeding; latch and swallowing; duration and effectiveness of feeds; formula preparation when relevant; and complementary foods, including when introduced and their variety and frequency.

For older children, ask about usual meals, dietary diversity, appetite, food insecurity where appropriate, restrictive diets, pica, supplements and recent weight change. Ask about choking, coughing or fatigue during feeds. Compare growth measurements over time rather than relying on a single weight.

E. Growth and development

Ask whether the child is gaining weight and growing as expected, and whether there has been loss of previously acquired skills.

Review development in four domains:

Gross motor: head control, sitting, standing, walking and running.
Fine motor/vision: reaching, grasping, transferring objects and age-appropriate hand skills.
Language/hearing: response to sound, babbling, words, understanding and sentences.
Social/adaptive: eye contact, smiling, interaction, play, feeding and self-care.

Ask about the age at which milestones were reached, caregiver concerns, regression, hearing or vision concerns, school performance and prior developmental screening. Milestones are guides, not a diagnosis by themselves; interpret them using the child's age, corrected age when appropriate, context and validated tools.

F. Immunisation history

Check the child's immunisation card or reliable records whenever possible. Record vaccines received, dates if available, missed or delayed doses, adverse reactions and relevant special-risk vaccines. Compare with the current national schedule rather than relying on memory.

G. Past, medication and allergy history

Ask about previous illnesses, admissions, operations, injuries, transfusions, chronic conditions, recurrent infections and specialist follow-up. Record prescribed, over-the-counter and traditional medicines, including dose and frequency when known. Clarify the substance and reaction for any reported allergy; distinguish an adverse effect from a true allergy.

Ask about similar illness in the family, inherited disorders, asthma, atopy, epilepsy, diabetes, TB exposure and relevant family deaths. Explore who lives with and cares for the child, caregiver wellbeing, housing, sanitation, clean water, smoke exposure, school or daycare, safeguarding concerns and access to healthcare. Ask sensitively and without blame.

For adolescents, provide appropriate private time, explain confidentiality and its limits, and ask about mood, safety, relationships, substance use, sexual health and other relevant risks in a respectful, developmentally appropriate manner.

I. Review of systems

Screen relevant systems not already covered:

Respiratory: cough, wheeze, stridor, fast or difficult breathing.
Cardiovascular: cyanosis, sweating or tiring during feeds, syncope, exercise intolerance, oedema.
Gastrointestinal: abdominal pain/distension, vomiting, stool changes, blood in stool.
Renal: urine volume, colour, pain, frequency or swelling.
Neurological: headache, weakness, seizures, altered behaviour or regression.
Skin/musculoskeletal: rash, bruising, joint pain, swelling or limp.
General: fever, fatigue, appetite, sleep and weight change.

Summarise pertinent positives and important negatives rather than listing every normal symptom without context.

4. Initial assessment: look, listen, feel

Before a detailed examination, assess whether the child is stable. Use an age-appropriate paediatric early-warning or emergency assessment system where available.

Appearance/disability: alertness, interaction, tone, consolability, speech/cry, seizure activity and response to caregivers.
Breathing: respiratory rate, chest movement, recession, nasal flaring, grunting, stridor, wheeze, pauses and oxygen saturation.
Circulation: colour, temperature of extremities, pulse quality, capillary refill, heart rate and signs of shock.
Exposure: temperature, rash, injury, bleeding, hydration and other urgent visible findings while preventing heat loss.

Do not delay urgent care to complete a routine examination or obtain every vital sign.

5. Vital signs and growth measurements

Measure and interpret vital signs against age-specific reference ranges and the child's clinical state. Fever, crying, pain, sleep, recent activity and dehydration can alter measurements.

Temperature: use an appropriate validated method and document the site/method. Fever thresholds and the urgency of fever depend on age and clinical context; fever in a young infant requires prompt assessment under local guidelines.
Heart rate and respiratory rate: count for a full minute when feasible, especially in infants or if the rhythm is irregular. Count respirations while the child is calm; repeat an unexpected value.
Oxygen saturation: ensure a suitable probe and a good signal; interpret alongside work of breathing and perfusion.
Blood pressure: use the correct cuff size and age/height-appropriate interpretation. A cuff that is too small can falsely elevate the result.
Weight and length/height: use calibrated equipment and appropriate technique.
Head circumference: particularly important in infants and young children; measure the largest occipitofrontal circumference and plot serial measurements.
Growth charts: plot weight, length/height, head circumference and, when appropriate, BMI or weight-for-length on the relevant age- and sex-specific chart. Look at the trajectory and z-scores/centiles, not a single number alone. Use corrected age for preterm infants where recommended.

Exam tip: state the child's age, actual measurement, relevant reference range/chart and whether the result is concerning. Never apply adult vital-sign ranges to a child.

6. General physical examination

Observe from the end of the bed, then examine systematically.

General appearance: alert or lethargic, comfortable or distressed, interaction, posture, cry/speech, movement and nutritional state.
Hydration and perfusion: mucous membranes, tears, eyes, skin turgor in context, extremity temperature, pulse and capillary refill. No single sign reliably confirms or excludes dehydration.
Colour and skin: pallor, jaundice, cyanosis, mottling, rash, bruises, petechiae, scars, birthmarks and signs of infection.
Dysmorphism and congenital features: describe objective findings and consider whether they form a pattern; avoid premature diagnostic labels.
Hands and limbs: clubbing, peripheral perfusion, oedema, deformity, tone, spontaneous movement and symmetry.
Lymph nodes: examine relevant groups and document site, size, tenderness, consistency and mobility when indicated.
Oral cavity: lips, tongue, mucosa, teeth, hydration, tonsils and palate when clinically appropriate.
Anthropometry: obtain and plot measurements as above.

7. System-based examination

A. Respiratory system

Inspect respiratory rate and pattern, chest shape, symmetry, recession, nasal flaring, grunting and use of accessory muscles. Palpate chest expansion when appropriate. Percuss if indicated. Auscultate systematically for air entry, crackles, wheeze, stridor transmitted to the chest, or asymmetry.

Document work of breathing and oxygen saturation as well as auscultatory findings. Severe recession, grunting, exhaustion, apnoea, cyanosis or poor air entry are urgent concerns.

B. Cardiovascular system

Assess colour, pulses, capillary refill, extremity temperature and oedema. Inspect the precordium and observe for activity intolerance or sweating during feeds. Palpate the apex beat and heaves/thrills where appropriate. Auscultate rate, rhythm, heart sounds and murmurs, and assess the liver for possible congestion when indicated.

A murmur must be described (timing, location, intensity, radiation and associated signs); do not label all murmurs as pathological or benign without context. Cyanosis, weak pulses, shock, syncope, or sweating/tiring with feeds warrant prompt clinical assessment.

C. Abdominal system

Inspect distension, scars, visible veins, masses and movement. Auscultate bowel sounds when indicated, then palpate gently, beginning away from any painful area. Assess tenderness, guarding, masses, liver and spleen size, and signs of ascites when relevant. Percuss if indicated. Examine the groins and external genitalia only when clinically necessary, with consent, privacy and a chaperone according to policy.

A distended tender abdomen, bilious vomiting, guarding, a painful irreducible hernia or gastrointestinal bleeding requires urgent assessment.

D. Central nervous system

Assess level of consciousness, behaviour, speech/cry, posture, tone, power, symmetry, coordination and gait when age-appropriate. Examine pupils and cranial nerves as indicated, and assess reflexes and sensation where feasible. In infants, observe spontaneous movement, tone, head control and age-appropriate interaction. Examine fontanelle only when appropriate and interpret it in context.

A seizure, new focal deficit, altered consciousness, neck stiffness with systemic illness, or loss of developmental skills requires urgent assessment.

E. Head, eyes, ears, nose and throat

Inspect head shape and scalp; assess fontanelle when relevant. Check pupils, eye movements, red reflex and visual behaviour as appropriate. Inspect ears and assess hearing concerns; otoscopy requires appropriate equipment and technique. Examine the nose for discharge or obstruction and the mouth/throat for hydration, lesions, inflammation and structural abnormalities.

F. Musculoskeletal system

Observe posture, spontaneous movement, symmetry, limb alignment, joints, gait and ability to bear weight when developmentally appropriate. Assess range of motion, tenderness and swelling. In infants, assess hips using the appropriate age-specific examination technique and trained clinical judgement; do not force manoeuvres.

G. Skin

Describe the distribution, morphology, colour and blanching of a rash. Look for petechiae or purpura, bruising, infection, eczema, jaundice and signs of neglect or injury where relevant. A non-blanching rash in an unwell child is an emergency warning sign.

8. Age-specific approach

Neonate: prioritise temperature, breathing, colour, tone, feeding, jaundice, cord, birth history and congenital abnormalities. Minimise heat loss.
Infant: observe interaction and spontaneous movement first; examine while calm or in the caregiver's arms. Measure growth and head circumference.
Toddler/preschool child: use play and simple explanations; allow the caregiver to help. Auscultate while calm before procedures likely to cause distress.
School-age child: explain each step, involve the child directly, and compare function with age expectations.
Adolescent: respect privacy, assent/consent rules and confidentiality; include psychosocial and safeguarding assessment when indicated.

The exact order is flexible. Adapt it to the child's distress, age and clinical urgency.

9. Paediatric danger signs

Seek immediate senior/urgent clinical help and follow local emergency protocols if the child has any of the following:

Apnoea, severe respiratory distress, grunting, central cyanosis or exhaustion.
Shock features such as reduced consciousness, weak pulses, cold extremities, prolonged capillary refill or collapse.
Inability to drink/breastfeed, vomiting everything, convulsions, lethargy or unconsciousness.
Severe dehydration, markedly reduced urine or rapidly worsening condition.
A young infant with fever or hypothermia, poor feeding, reduced movement or other signs of serious infection.
A non-blanching rash with systemic illness, severe headache/neck stiffness with illness, or a new focal neurological deficit.
Bilious vomiting, acute severe abdominal pain, significant bleeding or suspected serious injury/abuse.

This is not an exhaustive list. Use local paediatric triage, emergency treatment and referral guidance; do not rely on a written checklist instead of clinical assessment.

10. Documentation and presentation

Document the date/time, source and reliability of history, relevant positive and negative findings, vital signs with units, growth-chart interpretation, examination findings, and any action taken. Separate observed facts from caregiver reports and clinical interpretation.

A concise presentation might follow this order:

Identification and reason for presentation.
Key history and relevant background.
Important positives and negatives.
Vital signs and growth.
General and system examination findings.
Problem list and working differential diagnosis.
Severity, immediate concerns and proposed next steps.

Use respectful, non-judgemental language and protect the child's confidentiality.

11. OSCE checklist

Before finishing, ask yourself:

Did I introduce myself, confirm identity, explain the examination and obtain consent/assent?
Did I assess immediate stability before taking a lengthy history?
Did I cover the presenting illness, birth/neonatal, feeding, development, immunisation, past, medication/allergy, family and social history?
Did I ask about intake, urine output and danger signs?
Did I measure vital signs correctly and interpret them for age?
Did I assess growth and plot measurements where possible?
Did I perform a systematic, age-appropriate general and relevant system examination?
Did I thank the child and caregiver, help the child get comfortable, and perform hand hygiene?
Did I summarise findings, identify red flags, and explain what should happen next?

12. Practice questions

1. Why should a respiratory rate be counted while a child is calm?
Crying, agitation, fever and activity can increase the rate and make it less representative. If the result is unexpected, settle the child and repeat it.

2. A caregiver reports that a child has been drinking poorly and passing much less urine. What should you assess?
Assess general appearance, consciousness, pulse, perfusion, capillary refill, mucous membranes, tears, intake/output and other signs of dehydration or shock. Escalate urgently if the child is unwell.

3. Name the four developmental domains.
Gross motor; fine motor/vision; language/hearing; and social/adaptive development.

4. Why is serial growth measurement more useful than one weight?
A trajectory shows whether the child is following their growth pattern or crossing centiles; one value alone may not reveal faltering growth.

5. What should happen before a full history if a child has severe respiratory distress?
Immediate assessment and management of airway, breathing and circulation, with urgent help and monitoring. Obtain only essential history without delaying stabilisation.

6. What is the difference between a pertinent positive and a pertinent negative?
A pertinent positive is a present finding that supports or changes the differential diagnosis. A pertinent negative is an absent finding that helps assess likelihood or severity of a diagnosis.

7. Why ask about feeding and sweating during feeds?
Feeding difficulty, tiring or sweating can reflect respiratory effort, cardiac disease, poor intake or other illness, especially in infants.

8. What makes an adolescent interview different?
The clinician should speak directly to the adolescent, offer appropriate private time, explain confidentiality and its limits, and assess psychosocial risks respectfully.

13. Exam-style MCQs with answers and explanations

Choose the single best answer for each question. Try answering all questions before checking the answer and explanation beneath each one.

1. What is the most appropriate first step when you meet a child who appears severely breathless?

A. Complete the birth history
B. Ask about immunisation status
C. Assess and support airway, breathing and circulation, and call for urgent help
D. Measure head circumference
E. Begin a full developmental assessment

Answer: C. A critically ill child must be assessed and stabilised immediately. A detailed history must not delay emergency care.

2. Which information belongs in the perinatal history?

A. School performance
B. Gestational age, mode of delivery and birth complications
C. Current household income only
D. Pubertal development only
E. The child's favourite food

Answer: B. Perinatal history includes pregnancy, gestational age, delivery, birth weight where known, resuscitation and early neonatal problems.

3. Which combination best represents the four broad developmental domains?

A. Cardiac, respiratory, abdominal and neurological
B. Gross motor, fine motor/vision, language/hearing and social/adaptive
C. Feeding, sleeping, crying and bathing
D. Height, weight, temperature and pulse
E. Pregnancy, labour, delivery and puerperium

Answer: B. Developmental surveillance covers gross motor, fine motor/vision, language/hearing and social/adaptive skills.

4. Why should a child's vital signs be interpreted using age-appropriate ranges?

A. All children have the same normal pulse
B. Normal respiratory and heart rates vary with age
C. Vital signs are unreliable in every child
D. Age matters only for blood pressure
E. A normal temperature excludes serious illness

Answer: B. Normal heart rate, respiratory rate and blood pressure change with age; the child's condition and measurement method also matter.

5. A child is crying vigorously while you count the respiratory rate. What is the best response if the count is unexpectedly high?

A. Record it without qualification
B. Ignore respiratory rate in children
C. Settle the child if safe and repeat the count while calm
D. Diagnose pneumonia from the rate alone
E. Ask the caregiver to estimate the rate

Answer: C. Crying, agitation, activity and fever can raise respiratory rate. Repeat an unexpected measurement when the child is settled, without delaying care if the child is distressed or unwell.

6. Which history question is especially useful when assessing hydration?

A. “What is the child's favourite game?”
B. “How many times has the child passed urine, and is this less than usual?”
C. “Which hand does the child write with?”
D. “What time does the child go to school?”
E. “Does the child prefer indoors or outdoors?”

Answer: B. Urine output, intake, vomiting and diarrhoea help assess fluid balance. Reduced urine output can be a warning sign, especially with poor perfusion or lethargy.

7. Which finding is a paediatric danger sign requiring urgent assessment?

A. A child playing normally
B. A stable appetite
C. Inability to drink or breastfeed
D. A longstanding, unchanged birthmark
E. Normal interaction for age

Answer: C. Inability to drink or breastfeed is a danger sign, particularly when accompanied by lethargy, convulsions, respiratory distress or other evidence of serious illness.

8. Why is the child's growth chart useful?

A. It replaces the clinical history
B. A single measurement always diagnoses malnutrition
C. Serial measurements help identify growth faltering or changes in trajectory
D. It measures developmental milestones directly
E. It is useful only during adolescence

Answer: C. Serial measurements plotted on an appropriate chart show the child's growth trajectory. Interpret measurements alongside age, clinical context and measurement accuracy.

9. Which measurements are commonly important in assessing growth in children?

A. Weight only, regardless of age
B. Weight, length or height, and head circumference when age-appropriate
C. Pulse and temperature only
D. Chest circumference in every child as the sole measure
E. Blood pressure only

Answer: B. Weight and length/height are core measurements; head circumference is particularly important in infants and young children. Use the appropriate chart and technique.

10. Which approach is most appropriate when examining a frightened toddler?

A. Force the child to lie still immediately
B. Begin with the most painful procedure
C. Use a calm, playful approach, involve the caregiver and perform less distressing parts first
D. Avoid speaking to the caregiver
E. Skip observation and proceed directly to palpation

Answer: C. A flexible, age-appropriate examination reduces distress and can improve the quality of findings. Adapt the sequence to clinical urgency.

11. What is the best approach to interviewing an adolescent?

A. Direct every question to the caregiver
B. Never discuss confidentiality
C. Speak directly to the adolescent and offer appropriate private time, explaining confidentiality and its limits
D. Promise absolute secrecy in every circumstance
E. Avoid asking about psychosocial wellbeing

Answer: C. Adolescents should be engaged respectfully and directly. Explain confidentiality and its limits, including circumstances involving serious safety or safeguarding concerns, in line with local law and policy.

12. Which is the best example of a pertinent negative?

A. “The child has had three episodes of vomiting.”
B. “The caregiver reports fever.”
C. “No history of bilious vomiting was reported,” when evaluating a child with vomiting
D. “The child looks unwell.”
E. “The child is two years old.”

Answer: C. A pertinent negative is the absence of a finding that helps assess a differential diagnosis or severity. It should be relevant to the presenting problem.

13. A caregiver says an infant sweats and tires during feeds. Which system deserves particular attention, alongside respiratory and general assessment?

A. Cardiovascular system
B. Hair and nails only
C. Ear examination only
D. Visual acuity only
E. Skin pigmentation only

Answer: A. Sweating, tiring and breathlessness during feeding may indicate increased work of breathing or cardiac disease, among other causes. Assess the infant comprehensively.

14. Which statement about immunisation history is most accurate?

A. Ask only whether the child has ever received any vaccine
B. Record the immunisations received and compare them with the current national schedule, noting missed doses
C. Immunisation history is unnecessary in a febrile child
D. Assume all doses are complete if the child looks well
E. Ask only about vaccines given at birth

Answer: B. Establish which vaccines and doses were received, check the child's record where possible, and identify missed doses using the current national schedule.

15. What should be documented when recording a clinical measurement?

A. The number without a unit or context
B. The caregiver's opinion only
C. The value, unit, relevant method/context and interpretation when appropriate
D. Only whether the measurement “looks normal”
E. A guessed value if the child is uncooperative

Answer: C. Record objective values with units and context, including the child's age and state when relevant. Repeat or qualify an unreliable measurement rather than inventing a value.

16. Which is the most appropriate sequence when a child presents with an acute illness?

A. Full family history, then decide whether the child is stable
B. Assess immediate stability and danger signs, then obtain a focused history and examination appropriate to the child's condition
C. Complete developmental history before checking breathing
D. Perform every examination manoeuvre in a fixed order regardless of distress
E. Wait for laboratory results before examining the child

Answer: B. Initial assessment prioritises immediate threats and stabilisation. The depth and order of the history and examination should reflect the child's acuity.

17. Which observation may suggest increased work of breathing in a child?

A. Comfortable breathing without recession
B. Chest indrawing or grunting
C. Normal interaction and colour
D. Quiet sleep with regular breathing
E. Normal feeding without respiratory symptoms

Answer: B. Chest indrawing, grunting, nasal flaring, marked tachypnoea, cyanosis or exhaustion can indicate respiratory distress and require prompt assessment.

18. Which action is appropriate at the end of a paediatric examination?

A. Leave without explaining anything
B. Avoid documenting abnormal findings
C. Make the child comfortable, perform hand hygiene, summarise findings and explain the next steps to the caregiver and child as appropriate
D. Give a definitive diagnosis even when evidence is insufficient
E. Ignore any danger signs found during the examination

Answer: C. Close the encounter respectfully, document findings, communicate concerns and the plan, and escalate urgent abnormalities.

19. Which statement about developmental milestones is most appropriate?

A. Every child acquires every skill on exactly the same date
B. Development should be assessed across domains and interpreted in the child's age and clinical context
C. Language is the only domain that matters
D. A caregiver's concerns should always be dismissed if the child can walk
E. Developmental assessment is unnecessary in children with chronic illness

Answer: B. Milestones vary, but assessment should cover all domains, consider corrected age where relevant for prematurity, and investigate regression or significant concerns.

20. A child is lethargic, has cold extremities and prolonged capillary refill. What is the most appropriate interpretation?

A. These findings confirm normal hydration
B. The child is simply tired; no further assessment is needed
C. The findings may indicate poor perfusion or shock and require urgent assessment and management
D. They are specific for an uncomplicated viral infection
E. They can be ignored if the child has no cough

Answer: C. Lethargy with cold extremities and prolonged capillary refill is concerning for impaired perfusion. Seek urgent help and follow local paediatric emergency protocols.

Quick answer key: 1 C · 2 B · 3 B · 4 B · 5 C · 6 B · 7 C · 8 C · 9 B · 10 C · 11 C · 12 C · 13 A · 14 B · 15 C · 16 B · 17 B · 18 C · 19 B · 20 C

14. High-yield summary

Observe first; stabilise first if critically ill.
Children are not small adults: history, examination and normal vital signs are age-dependent.
Always ask about feeding/intake, urine output, activity/alertness and danger signs.
Birth history, nutrition, development and immunisation are essential paediatric domains.
Plot growth measurements and interpret trends.
Adapt the examination to the child's age and distress.
Document objective findings, relevant negatives, severity and action taken.
Escalate danger signs promptly and follow current local paediatric protocols.