Synopsis
Take a developmentally appropriate history, examine a child with minimal distress, integrate parent and child accounts and identify illness, safeguarding and developmental concerns across age groups.
- Observe before touching: interaction, colour, posture, spontaneous movement, cry or speech and work of breathing provide high-value information before distress changes physiology.
- Use three sources deliberately: the child's account, the caregiver's longitudinal knowledge and the clinician's observations; record who supplied each important fact.
- Open with the child when development permits, then clarify with the caregiver without correcting or dismissing either account in front of them.
- For infants, define feeding by breast or formula pattern, volume or duration, wet nappies, stools, vomiting, weight trajectory, birth history and immunisation.
- For school-aged children and adolescents, offer part of the consultation alone, explain confidentiality and its safety limits and ask directly about mood, school, relationships, substances and sexual health when relevant.
- Use chronological age, corrected age for prematurity during early development, developmental level and communication needs rather than assuming ability from size.
- Examine least invasive areas first and leave throat, ears and painful sites until later; use play, caregiver positioning and warmed equipment.
- Count respiratory rate before auscultation while the child is quiet, count infant respirations for a full minute and record whether asleep, calm, febrile or distressed.
- Plot weight, length or height and head circumference on the correct sex- and age-appropriate UK growth chart when clinically relevant; a trend is more informative than one centile.
- Assess development across gross motor, fine motor and vision, language and hearing, and social domains; developmental regression is always abnormal.
- A complete examination includes hydration, skin, lymph nodes, abdomen, heart, lungs, neurology, joints and growth as directed by presentation, not just the symptomatic organ.
- Document positives and meaningful negatives, observations with units, growth centiles, chaperone, consent or assent, safeguarding findings and the safety-net plan.
Key red flags
Reduced interaction, weak cry, abnormal tone, persistent inconsolability, cyanosis, grunting, apnoea or poor perfusion overrides a reassuring verbal history.
A child younger than 3 months with a temperature of 38°C or higher is high risk under NICE fever guidance and needs urgent clinical assessment.
Non-blanching rash, neck stiffness, focal neurology, prolonged seizure, bilious vomiting, severe dehydration or testicular pain requires immediate targeted escalation.
An injury inconsistent with development, changing explanations, delay in presentation, patterned injury or concerning caregiver interaction requires safeguarding consideration and careful factual documentation.
Parental or caregiver concern that the child is behaving very differently from normal is clinically important even when a single observation lies within a reference range.
Investigation priorities
Assess appearance, interaction, breathing, colour and movement before distress alters findings.
Quantify temperature, pulse, respiratory rate, oxygen saturation, blood pressure and consciousness where indicated.
Management branches
Any child arrives for clinical assessment.
- Observe appearance, breathing and circulation before approaching and decide whether ABCDE is needed immediately.
- Introduce yourself to child and caregiver, establish relationship and parental responsibility and identify communication needs.
- Invite the child's account first when development permits, then integrate caregiver chronology and clinical observation.