chapter  13
22 Pages

Paediatric history and examination

ByPeter Kopelman, Dame Jane Dacre

This chapter explores the key aspects of history taking and examination in children and young people. It focuses on some of the similarities that will be familiar from adult medicine and details some of the key additional areas that need a specific focus. The apex beat is best felt with the pulp tip of the third finger of the right hand lightly resting on the left fourth or fifth intercostal space between the mid-clavicular and mid-axillary lines. Precordial pulsations of left ventricular hypertrophy and right ventricular hypertrophy, and cardiac thrills, are best appreciated with the palm of the hand. Vocal resonance may be diminished in pleural effusion and increased in consolidation. Whispering pectoriloquy may be heard with consolidation. Paediatric history taking and examination can be time-consuming. The emergence of Paediatric Early Warning Score charts has helped to develop a structured way to look at what is and is not normal, and to escalate intervention appropriately.