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The three major areas at arriving at a diagnosis are: Clinical History, Physical Examination, and Laboratory testing.

The Clinical history provides about 85% of the diagnostic clue. The Physical examination about 10% and the Laboratory testing about 5%.

The importance of the Physical Examination is to make sure that there is no serious illness that could be missed by looking, touching, and listening to the patient. Some of the more urgent cause of serious illness are: meningitis, serious infections of the skin, appendicitis, pneumonia, complicated asthma, heart failure, brain tumor, abdominal cancer, etc.

In children, ear infection is a common condition that needs physical examination. It cannot be properly diagnosed without a clinician looking at the ear drums. Pneumonia is another illness that needs either Physical Examination or a Chest X ray for more definitive diagnosis. Occasionally a classical history can point to a diagnosis of pneumonia. Chicken pox and almost all skin conditions need a visit to a physician’s office for diagnosis. However, with recent advances in technology, many skin problems could be diagnosed through the use of digital camera and the Internet.

Physical examination is crucial in the diagnosis of acute appendicitis. When you call your doctor because your child has belly pain, one reason why they would recommend that your child needs an office visit is to make sure your child do not have appendicitis.

If your child has high fever, vomiting, and headache a visit to your doctor is also necessary. Your doctor will do physical examination to make sure meningitis is not the likely cause.

This section of brilliantbaby.com will be updated regularly to show you what type of Physical examination should be done for certain condition or illness.

If the illness of is more of a chronic problem, the Clinical history has more weight in the diagnostic process. In acute or emergency situations, the Physical findings become as important as the clincial history or about the same weight in the decision making.

There are certain Physical findings that by it self will provide the diagnosis. These are very few and they are called phatognomonic signs. Some of these are:

A newborn baby with a hip click found during the newborn physical examination is a Classic sign of  Congenital Hip Dysplasia (the old term was Congenital Hips dislocation). This examination should be done routinely by all Primary Care Physicians. It is easy to do and if positive, early treatment of the Hips can reduce the chance of abnormality in walking later on in life.

The other important simple physical examination in newborn is the palpation of the Femoral Pulses. Again this should be done routinely in all Newborns and Infants. It should be documented in the medical record tha the Femoral pulses was palpable or positive. If the Femoral pulses are absent, Coarctation of the Aorta should be considered. A referral to a Pediatric Cardiologist is a must.

The third important physical examination in infants is the Red Refex of the eyes. Both eyes should be examined for Red Reflex. If there is a “white reflex” two serious eye conditions should be entertained: retinoblastoma and congenital cataract. An eye specialist should confirm the diagnosis.

Next:  Abdominal examination and soft spot (anterior fontanel)

Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine

Please send my your suggestions and comments to improve this site:

lleonidas@pcpediatrics.org

I wrote and desinged this website for parents of our practice. Before you use ideas from this website, please discuss it first with your clinician if you are not with our practice.

copyright Leo Leonidas 2002

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