Has childs or familys life been affected? Introduce yourself. Gain consent. Childs name Date of birth.

Determine relationship of adults to the child Presenting complaint What has the family done about it?

What prompted referral to a doctor?

What do the parents Think or fear is the matter? history of presenting complaint onset of symptoms Past medical history Duration past hospital admissions Previous episodes past operations Past illnesses

Relieving or aggravating factors

past accidents

Time course of problem

past injuries

If getting worse or better

Maternal Obstetric Problems

Any associated symptoms

Delivery problems

Birth weight

Gestational week at birth

Any problems after birth

Admission to NICU ?

economic status, housing , relationships, parental smoking, marital stress Is the child happy at home? Is the child happy at nursery/school?Taking Development: If premature correct milestones for up to 2yr.

Immunisations

Parental worries about vision, hearing, development

Medication History:

Past and present medications summary Generally, motor problems in first year, talking and coordination in second year and behavioural and social in 3rd year. Key Milestones

Drug Allergies

Know Allergies

Family History:

Have any members of the family or friends had similar problems or any serious disorder?

Draw a family tree. If there is a positive family history, extend family pedigree over several generations

Gross Motor: Sit 6 months [T [T Roll 7 months Stand 12 months [T Walk 15 months [T

Is there consanguinity? Social History: Relevant information about the family and its community parental occupation,

Fine Motor: Transfers 7 months Pincer grip 9 months 2 Block Tower 14 months 3 Block Tower 18 months Language : Vocalises 8 weeks Laughs 4 months First words 12 months Two words 24 months

Warning signs of developmental delay 8 weeks Not smiling in response Poor eye contact Head lag Silent baby 8 months Poor interaction Not sitting alone or weight bearing Not babbling Persisting primitive reflexes Hand preference

Social : Smiles 6 weeks Waves 12 months Plays 15 months Toilet Awareness 24 months Previous child health surveillance developmental checks Bladder and bowel control Sleeping problems

18 months Not recognising name Not walking Not using first words 24 months Not giving affection Cant build 3 block tower Not linking 2 words Childs temper , behaviour

Concerns and progress at nursery/school

Systemic review: (select as appropriate) General: rashes, fever ENT: throat infections, snoring, Cardiovascular: heart murmur, cyanosis, exercise noisy breathing (stridor). tolerance Normal health how active and lively? Gastrointestinal: vomiting, diarrhoea/constipation, abdominal pain Normal Growth? Genitourinary: dysuria, frequency, wetting, toilet-trained. . Respiratory: cough, wheeze, breathing problems General enquiry: Any recent change in behaviour or personality Feeding/ drinking/ appetite?

Pubertal development (if appropriate)?