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Common Paediatric Histories

Presenting Exploding symptom Relevant system reviews Differential diagnoses Clues to differential
complaint Grouping Differentials
Failure to Ask to see growth chart and General Gastrointestinal Coeliac disease Presents any age after weaning
thrive determine age of onset Fever, behaviour, Diarrhoea (pale stools)
Input: detailed dietary activity/apathy/alertness, cough Bloating
history, feeding history (inc Dietary protein Cows milk protein allergy presents in first
time of weaning), hunger Gastrointestinal intolerance (e.g. few months
Use: energy, activity level, Work down body: dysphagia, cows milk protein Diarrhoea after being fed with formula milk
exercise, anorexic? reflux/vomiting, abdominal allergy) for a few months
Output: wet nappies, stools pain/colic, Carbohydrate Flatulence, diarrhoea, bloating and cramps
& GI symptoms diarrhoea/constipation, stools intolerance (e.g. within a few hours of consuming lactose
Others: behaviour, general (blood/mucus/pale) lactose intolerance) May be congenital (rare) or develop after
health, happiness, parents gastroenteritis (transient)
health Pyloric stenosis Projectile non-bilious vomiting after feeding
Starts around 3-6 weeks of age
GORD/oesophagitis Effortless regurgitation
Crying during feeding
Cystic fibrosis Recurrent chest infections
Pale stools that float
Inflammatory Older child (e.g. teenager)
bowel disease Abdominal pain
Diarrhoea with blood/mucus
Non- Not enough food Commonest cause
gastrointestinal being offered or
Nutritional neglect Not offered enough food
Hungry, food seeking/hoarding
Emotional neglect Poor interaction between child and parent
Withdrawn, fearful, anxious
Eating disorder Adolescent girls
Fear of weight gain
Feel fat when thin
Efforts to lose weight: diuretics/laxatives,
vomiting, excessive exercise
Consequential symptoms: amenorrhoea,
developmental delay, myopathy, poor sleep,
GI symptoms
Other Prenatal
differentials Prematurity
Chromosomal abnormalities
Toxins (alcohol, smoking, drugs)
Poor feeding
Inborn errors of metabolism (e.g. abetalipoproteinaemia)
Chronic infections (inc HIV)
Chronic illness

Weight Ask to see growth chart and General Endocrine Hypothyroidism Delayed growth/puberty
increase determine age of onset Fever, behaviour, Fatigue, cold intolerance
Input: detailed dietary activity/apathy/alertness, cold Dry skin, coarse hair
history, feeding history (inc intolerance Cushings Delayed growth/puberty
time of weaning), hunger syndrome Central obesity
Use: energy, activity level, Top to toe Easy bruising
exercise Stature (short/normal) Moon face, buffalo hump
Others: behaviour, general Appearance changes PCOS Adolescent female
health, happiness, parents (skin/hair/acne) Oligo/amenorrhoea
health and BMI Hirsutism Hirsutism, acne
Fat distribution Non-endocrine Simple obesity Snacking
Bowel habbit Lack of exercise
Pubertal changes (inc menstrual Familial Parents with high BMI
periods) Other Oedema (cardiac or renal)
differentials Steroid use
Genetic syndromes (e.g. Turners, Prader-Willis)

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Developmental Development General Generalised Chromosomal/genetic Dysmorphic features
delay Current developmental stage in Fever, behaviour, delay disorders e.g. Downs

each category (learn paeds history activity/apathy/alertness Alcohol/drugs in History of mother taking alcohol or drugs
table) (can also cause pregnancy in pregnancy
-Gross motor Neurological any of the TORCH infections in History of toxo/rubella/CMV/herpes
-Fine motor and vision General: fits/LOC, specific delays pregnancy
-Hearing and language headache, dizziness, below) Extreme prematurity Born very premature

-Social vision/hearing Hypoxic brain injury Prolonged difficult labour (dystocia)
Ages of key milestones in each Motor: Hypoglycaemia Period of neonatal hypoglycaemia
Intracerebral Risks = abnormal labour, prematurity
If motor problem
haemorrhage Usually diagnosed within first few days
How mobile?
Hand dominance Meningitis/ Onset after episode of

Balance problems encephalitis meningitis/encephalitis
Behavioural problem Head injury or Delay subsequent to episode
If language/social problem episode
Senses: vocals, hearing, vision Motor delay Cerebral palsy Muscle stiffness/weakness/floppiness
Comprehension: follows Spasm or dyskinetic or ataxic
commands, responds to voice Caused by prenatal/perinatal/postnatal
Non-verbal communication: (<3y) insult
pointing, gestures, facies Duchenne muscular Progressive muscle weakness (beginning
Socially responses: how acts in dystrophy (or other proximally)
new situations, tantrums, playing, muscular disorders) Onset 2-3 years
gestures Hip dysplasia Usually identified at birth but may
present later with a limp
As part of history Language delay Deafness e.g. due to chronic otitis media
Prenatal problems (e.g. Articulation problem Birth defects
alcohol/drugs in pregnancy, (e.g. cleft palate)
maternal infections) Familial Similar history in family
Perinatal problems (e.g. Lack of stimulus Poor interaction with parents
prolonged/difficulties in labour) May be signs of neglect
Postnatal problems (i.e. PMHx e.g. Autism Imposition of routines
meningitis/ encephalitis) Social delay Doesnt seek friendships, prefers own
The key is in a thorough history! Limited gestures and expressions
ADHD Hyperactivity, inattentiveness

Precocious Puberty staging and order General Gonadotrophin Familial/idiopathic Majority of girls
puberty Boys order: Fever, behaviour, dependant CNS abnormalities Relevant history
Testicular enlargement activity/apathy/alertness, (CENTRAL) e.g. hydrocephalus,
(boys <9y, Penis enlargement general health hypoxic brain injury
girls <8y) Pubic hair Intracranial tumour Associated neurological symptoms
Height spurt Neurological Gonadotrophin Adrenal Excessive pubic hair, penis/clitoris
General: fits/LOC, headache, independent tumour/hyperplasia enlargement
Girls order: dizziness, vision/hearing (PERIPHERAL) Weight gain
Breast development Motor: weakness/wasting (i.e. sex Ovarian/testicular Ovarian: bloating, menorrhagia, pelvic pain
Pubic hair hormones not tumour Testicular: painless lump
Axillary hair under pituitary
Height spurt control)
Menarche Other Premature thelarche (breasts only)
differentials Premature pubarche (pubic hair only)
Other development External sex hormones
Previous growth and
Weight and nutrition
Behavioural changes

Family history
Parents pubertal age (inc
mother menarche) and height

Delayed Puberty staging and order General Familial Constitutional Majority of cases
puberty Boys order: Fever, behaviour, Hypogonadotrophic Systemic disease Symptoms of underlying disease
Testicular enlargement activity/apathy/alertness, hypogonadism (e.g. IBD, CF,
(boys >15y, Penis enlargement general health anorexia)
girls >14y) Pubic hair Symptoms of other systemic Hypothyroidism Delayed growth
Height spurt diseases (CF, thyroid, anorexia, Fatigue, cold intolerance
Crohns Dry skin, coarse hair
Girls order: Hypergonadotrophic Klinefelters/ Turners: short stature, amenorrhoea
Breast development Neurological hypogonadism Turners Klinefelters: small testes, gynaecomastia,
Height spurt General: fits/LOC, headache, tall & thin
Pubic hair dizziness, vision/hearing PCOS Oligo/amenorrhoea
Axillary hair Motor: weakness/wasting Hirsutism, acne
Other differentials Hypogonadotrophic
Kallmann syndrome
Other development
Intracranial tumour
Previous growth and
Weight and nutrition
Steroid hormone enzyme deficiency
Behavioural changes
Acquired gonadal damage
Family history
Parents pubertal age (inc
mother menarche) and height
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Behavioural Expand on behaviour problems Psychiatric ADHD Hyperactivity, inattentiveness
problems ADHD symptoms: poor concentration, hyperactivity
Conduct disorder symptoms: hostile, aggressive, cruel
Conduct disorder Bullies/threatens/intimidates
OCD symptoms: intrusive thoughts, repetitive behaviours
Starts fights
Autism symptoms: poor social interaction, emotionless, routines
Cruel to people/animals
Oppositional Losses temper
defiant disorder Argues with adults and defies requests
Deliberately annoys others
OCD Intrusive thoughts (obsessions)
Repetitive behaviours (compulsions)
Excessive washing/cleaning/checking
Autism Speech/language delay
Imposition of routines
Doesnt seek friendships, prefers own
Limited gestures and expressions
Other Anxiety disorders
differentials Attachment disorder
Bipolar disorder

Childhood Bruising General Injury related Non-accidental Bruises on soft tissues

bruising Onset and progression Fever, behaviour, injury (ears/neck/chest/abdomen/buttocks/calves/
Pattern activity/apathy/alertness thighs)
Mechanism of injury Story inconsistent with injury
(detailed if possible NAI) Neurological Accidental injury Bruises on sticking out bits (forehead, shins,
Associated symptoms General: fits/LOC, headache, nose, bony prominences)
dizziness, vision/hearing, neck Consistent story of injury
stiffness/photophobia Non-injury HSP Symmetrical rash on back of legs, buttocks
Motor: weakness/wasting related Purpura slightly raised
May be abdominal/joint pain
ITP Spontaneous purpura and petechiae
Usually post-infection
Meningococcal Non-blanching rash
septicaemia Neck pain/stiffness
Other Acute lymphoblastic leukaemia
differentials Traumatic petechiae (e.g. due to forceful coughing)

Faint/fit/ Attack General Neurological Febrile convulsion 1-2min generalised seizure

funny turn Before: warning, Fever, behaviour, Early in infection when fever is rising
circumstance activity/apathy/alertness Seizure Absence seizure
During: duration, LOC, Focal seizure
movements Neurological Generalised seizure (suggested by loss of
(floppy/stiff/jerking), General: fits/falls/LOC, bladder/bowel control, tongue biting)
incontinence/bite tongue, headache, dizziness, Paediatric epileptic Characteristic features of syndromes
complexion vision/hearing, memory loss, syndromes
After: amnesia, muscle pain, neck stiffness/photophobia Reflex anoxic Pale and fall to floor
confusion/sleepiness, injuries Motor: weakness/wasting, seizure In response to bump to head, emotion (e.g.
from fall incontinence fear, surprise), crying or fever
Sensory: pain, numbness, Non-neurological Vasovagal syncope Faint after prolonged
Background to attacks tingling standing/emotion/pain
e.g. had before, frequency,
impact on life Cardiorespiratory Pseudoseizure Atypical seizures
Dyspnoea, cyanosis, chest Breath holding spell Child holds breath and goes blue
pain/palpitations Usually when upset
Other Narcolepsy
differentials Arrhythmia
Hypertrophic cardiomyopathy

2015 Dr Christopher Mansbridge at, a source of free OSCE exam notes for medical students finals OSCE revision