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Clinical Guide
PAEDIATRIC HISTORY MANUAL
A Comprehensive Guide for Medical Students & OSCEs
About This Manual
Taking a paediatric history can feel daunting because you are often communicating with two people at once: the parent (or caregiver) and the child. This manual provides a structured, realistic approach, focusing on what you actually need to ask in an OSCE or on the ward.
Includes:
- Age-adapted Communication Strategies
- BIRDS & HEEADSSS Frameworks
- Exact Dialogue Scripts for Parents & Teens
Edition: 2026 Clinical Format Version
Prepared by: Dr. Raheel Azhar
The Golden Rule: Never dismiss what parents or carers say – they know their child better than anyone. A parent's report of "he's just not himself" is clinical data, not noise.
Comprehensive Paediatric History
1
Preparation, Intro & Rapport
What to say
"Hello, my name is Dr Raheel. I am a medical student with the paediatric team. Could I confirm your names and how you are related to [Child's Name]?""I would like to ask some questions about what has been happening today. Is that okay?"
- Rapport: Keep a comfortable distance at first. Young children usually feel safer in a parent's lap or arms.
- Address both: Speak directly to the child whenever their age allows it, using simple language (e.g., "tummy" instead of "abdomen").
2
Consent & Speaking Alone (GARC)
What to say (Normalising)
"It is my usual practice to speak with parents and then with [child's name] on their own for a few minutes — is that alright?"(To the adolescent): "What we discuss will normally stay private. However, if you tell me that you or someone else is at serious risk of harm, I may need to involve someone who can help — I'd try to talk that through with you first."
3
Presenting Complaint (PC)
What to ask
"What has brought [Child's Name] in today?"To the child: "Can you tell me how you've been feeling?"
Let the parent or child speak without interruption first (the "golden minute") to identify the main symptom and why help was sought today specifically.
4
History of Presenting Complaint (HPC)
What to ask
"When exactly did this start? Has it stayed the same, gotten better, or gotten worse? Do you happen to have any photos or videos of the rash / breathing / seizure on your phone?"
If Pain, use age-adapted SOCRATES:
- Site: Where exactly does it hurt? Ask the child to point with one finger.
- Onset: When did it start? Was it sudden or gradual?
- Character: What does it feel like? (e.g., sharp, dull, crampy). Use child-friendly terms.
- Radiation: Does the pain move anywhere else?
- Associated symptoms: Any fever, vomiting, rash, or changes in behaviour?
- Timing: How long does it last? Does it wake them up at night?
- Exacerbating/Relieving factors: What makes it better or worse? Does paracetamol/ibuprofen help?
- Severity (Older child): Numerical 0–10 scale.
- Severity (Younger child): Faces pain scale (Wong-Baker).
- Severity (Preverbal): Assess via behaviour, crying, and physiological signs.
5
Acute Red Flags
Critical Rule-outs
"Are they playing normally or excessively sleepy? Any fast breathing, grunting, or sucking in around the ribs? Have they looked very pale, mottled, or had blue lips? Any new rash that doesn't fade when pressed with a glass?"
6
Ideas, Concerns, and Expectations (ICE)
What to ask
"What do you think might be causing this? Is there anything in particular you're worried about? How is this problem affecting [Child] and the rest of the family?"
7
Systemic Review & Signposting
Signpost: "Okay, we’ve talked about John’s symptoms. Next, I’d like to run through a quick checklist of his general body systems and his past medical history."
Crucial in all paediatric histories:
- Feeding: "What does he usually eat/drink, and has that changed?"
- Toileting: "How many wet nappies a day? How often do they open their bowels?"
8
Past Medical & Surgical History (BIRDS)
Students can use the acronym BIRDS as a memory aid:
- Birth history
- Immunisations
- Recurrent illnesses and admissions
- Drugs and allergies
- Surgery
9
Pregnancy, Birth & Neonatal History
What to ask (especially for infants/young children)
"Were there any problems during the pregnancy? Was [Child] born early or on time? Did they need any help breathing or spend time in the special care baby unit (SCBU/NICU)?"
10
Medications & Allergies
What to ask
"Are they currently prescribed any medications or taking over-the-counter remedies? Are there any problems getting them to take the medicine? Do they have any allergies, and if so, what exactly happens?"
11
Immunisations, Feeding & Growth
- Immunisations: "Are they up to date with their routine immunisations? (Check the Red Book)."
- Infant Feeding: Breast/formula/mixed? Frequency, duration, latching issues?
- Growth: Are they tracking normally on their centile chart? Any parental concerns about weight gain?
12
Child Development
Assess the four domains: Gross motor, Fine motor & vision, Speech/language/hearing, Social & personal.
Red Flag: Developmental Regression
"Have they lost any skills they used to have, like walking or speaking certain words?"
| Age | Gross Motor | Speech & Language |
|---|---|---|
| 6 months | Sits with support | Babbles |
| 12 months | Cruises / walks with one hand | 1-2 words with meaning |
| 2 years | Runs, kicks a ball | 2-word phrases |
13
Family History
What to ask
"Are there any conditions which appear to run in the family? Has anyone else in the household had a fever/illness recently?"(If a close relative died young): "I'm really sorry to hear that. Do you mind me asking how old they were when they died?"
Tip: Draw a simple family tree (genogram) in the OSCE if dealing with inherited conditions.
14
Social History & Safeguarding
What to ask
"Who lives at home? Are they happy at school? Are parents or household members smoking/vaping?"(Routine safeguarding check): "Do you have a social worker or any current input from social services?"
- Stay alert to unexplained injuries, delay in seeking help, or stories that don't match the injury.
15
Adolescent Psychosocial (HEEADSSS)
HEEADSSS Framework (Speak to them alone):
- Home (Relationships, arguments)
- Education (School performance, bullying)
- Eating (Body image, diet)
- Activities (Hobbies, screen time)
- Drugs, alcohol, smoking, vaping
- Sexuality and relationships
- Suicide, mood and self-harm
- Safety (Gangs, violence, online safety)
16
Summary & Safety Netting
What to say
"To summarize, [Child's Age]-year-old presenting with [Main Complaint] for [Duration]. Does that sound correct, or is there anything you would like to add?"(Safety Netting): "If his breathing gets faster, or he becomes difficult to wake up, please seek immediate medical attention. Thank you both for your time."
OSCE Pacing Challenge: Paediatric Red Flags
Read the clinical vignette, verbalize your "must-not-miss" red flag questions out loud, and then click to reveal the examiner's checklist.
Scenario 1: "An 8-month-old infant presents with a fever of 39.2°C for the last 24 hours. The parents say he has been crying more than usual."
- Non-blanching rash: (Checking for meningococcal septicaemia)
- Reduced wet nappies / Poor feeding: (Checking for severe dehydration)
- Difficulty breathing / Grunting: (Checking for respiratory distress / pneumonia)
- Inconsolable crying / Difficult to wake: (Checking for meningitis / sepsis)
Scenario 2: "A 7-year-old child presents with abdominal pain that started near his belly button yesterday and has now moved to the lower right side."
- Pain moving to the right iliac fossa / Worse on jumping: (Checking for acute appendicitis)
- Bilious (green) vomiting: (Checking for bowel obstruction)
- Blood in stool (redcurrant jelly): (Checking for intussusception / IBD)
- Pain waking them at night: (Organic pathology rather than functional pain)
Scenario 3: "A 15-year-old adolescent presents with a 2-month history of low mood, poor sleep, and dropping grades at school."
- Active suicidal thoughts or plans: (Must ask directly; it does not increase risk)
- Self-harming behaviours: (Cutting, burning, reckless drug use)
- Bullying (in-person or cyber): (Major trigger in this age group)
- Safeguarding issues at home: (Abuse, violence, or neglect)
References
- National Institute for Health and Care Excellence (NICE). Fever in under 5s: assessment and initial management (NG143).
- NICE Quality Standard QS64: Fever in under 5s.
- Royal College of Paediatrics and Child Health (RCPCH) — developmental assessment resources.
- Royal Children's Hospital Melbourne — clinical practice guidelines and developmental milestone resources.
- American Academy of Pediatrics — Bright Futures and CDC "Learn the Signs. Act Early."
- Canadian Paediatric Society — adolescent health and psychosocial assessment resources.
- World Health Organization — The Second Decade: Improving Adolescent Health and Development.
- Goldenring JM, Rosen DS. "HEEADSSS 3.0: The Psychosocial Interview for Adolescents."
- General Medical Council (GMC) — guidance on consent and confidentiality for children and young people.
Live Session Score
0 / 16
History-Taking Flow
01 Prep & Intro
02 Consent/GARC
03 PC
04 HPC
05 Acute Flags
06 ICE
07 Systemic/Feed
08 PMH & PSH
09 Birth Hx
10 Meds/Allergies
11 Immunisations
12 Development
13 Family Hx
14 Social/Safe
15 HEEADSSS
16 Summary/Net