PEDIATRIC HISTORY

TAKING
1. Introduction
‘Hello, good day. My name is Astra Bachan and I am a year 5 medical student. I have just
been asked to have a short chat with you today concerning your child. Would that be okay?’

2. Demographics
 Parent’s name
 Child’s name
 Child’s age
 DOB
 Informant i.e Relationship to child. ‘Just confirming you are xyz’s mother?’
 General location/Address

3. Presenting Complaint
 Record the oldest symptom first
 Symptom x Onset (patient’s own words)

4. History of Presenting Complaint

‘I’m sorry to hear that. This may be very challenging for you. Allow me to ask, is this the first
time this has happened?’
 Any pre-morbid conditions i.e known medical conditions?

Explore the symptom eg Pain:

 S – Site
 O – Onset
 C – Characteristics
 R – Radiation
 A – Associated factors
 T – Timing
 E – Exacerbating/ Relieving factors. Any treatment?

 How has the current complaint affected the child’s appetite, activity levels, stool,
urine?

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5. Review of Systems
GENERAL:
 Any fever?
 Behavior
 Activity levels
 Weight

CVS:
 Any known heart conditions?
 Were you ever told your child has a heart murmur when they listened to the heart?
 Any sweating while feeding? (Sweating while feeding + breathlessness + poor
feeding = Cardiac failure in babies/infants)
 Any shortness of breath or gasping?
 Any recent changes in activity tolerance?
 Have you noticed the baby/child turning blue or pale anywhere? Fingers and toes or
the face? (Peripheral vs Central)
 Did you notice any swelling anywhere? Back for babies (sacral edema) or legs for
children (pedal edema)
 Has the child ever stopped breathing at any point even if it was just for a few
seconds? (Apnea)

RESP:
 Any Cough? Is it wet (what color? White, yellow, green, red), dry, barking, whooping?
 Any associated factors? Runny nose, stuffy nose, sneezing, watery eyes, sore throat,
ear pain, fever?
 Sick contacts – Is anyone at school or home sick with similar symptoms?
 When does the cough occur? Throughout the day or night alone? (Asthma – during
the night)
 Do you think there are any particular triggers? The cold, dust, animals,
pollen/outdoors, Sahara dust, smoke, changes in temperature?
 Do you hear any noises when the child breathes? Such as stridor (a harsh musical
sound from upper airway when child breaths in), snoring, wheezing (whistling in chest
when child breathes out)
 Has the child ever stopped breathing at any point even if it was just for a few
seconds? (Apnea)

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GIT
DIARRHEA:
 Does the child have any diarrhea? What’s the consistency?
(watery, any solids?)
Is there any blood or mucus in the stool?
 Have you noticed any changes in consistency, color or smell?
 How often do they pass stool normally?
 Any sick contacts at home or at school?
 Any travel history? Child travel or relative came from abroad?

VOMITTING:
 Any vomiting?
 How many times?
 How much would you say? 1 cup? (Volume)
 What color was the vomit? (Green, any blood)
 What were the contents? (Food stuff)
 Did the vomiting occur after coughing?
 How has this affected their appetite?
 Have you noticed any weight loss?
 Did the vomiting occur at any point in the day? (Early morning vomiting (SOL)
 Any travel history? Child travel or relative came from abroad?
 *Assess hydration status – Have they been drinking despite all this? Has their urine
decreased, have you noticed any sunken eyes or less tears when crying?

JAUNDICE:
 Have you noticed the baby/child turning yellow? Maybe the skin/ eyes?
(NB: Stool – pale stool, dark urine – obstruction!)

NEUROLOGICAL
SEIZURES
 Is this the first time this has happened?
 Can you describe what happened? Were they stiff? Were they shaking all over?
(Generalized seizure). Did it start one place and then move? (Jacksonian March) Did
it start one place and stay there? (Focal)
 How long did it last?
 What was the child doing at the time?
 What did you do? (Turn to the side, attempt to stop it in any way, recorded it?)
 Any associations? – Any fever at the time of seizure? Any frothing from mouth? Any
eye rolling? Any lip smacking? (infantile seizures) Any blood from their mouth to
suggest they bit their tongue? Did you notice if they wet their pants or soiled they
clothes? (Incontinence)

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  Post Ictal drowsiness - <30 mins. Were they sleepy after? For how long?
Did they have any weakness in their arms or legs after? (Todd’s Paresis - SOL)
 Prodromal symptoms – only in older children.
Did you see any flashing lights or smell anything before?
 Is there any paternal history of seizures associated with fevers?
 Is there a family history of epilepsy?

HEADACHES:
 Any headaches? Do they hold their head and cry?
 Any early morning vomiting?
 Any vision changes?
 Any sensitivity to light? Does the child not want to go outdoors?
 Any loss of consciousness or fainting?
 Any problems sleeping? Or changes in the quantity of sleep?
 Any changes in their gait? (SOL)
 Any clumsiness or falling down? (SOL)
 Any abnormal movements?
 Associations (Any trauma, running nose, fevers?)
 Changes in activity levels?

GU:
 Any increased frequency of urination?
 Do they complain of any pain or burning when urinating?
 Do they ever hold their pee up?
 Do they urinate more in the night? (Nocturia)
 Are there any changes to the color of their urine? (Tea colored, cola colored, brown,
orange?
 Any changes to urine itself? Is it foamy? Cloudy?
 Any changes to the odor of the urine?
NB: foamy urine + tea colored urine + history of rash/sore throat = Post Strep
Glomerular Nephritis)
 Any associations? Fever, body swelling?

DERMATOLOGY:
 Any rashes anywhere? – Is this the first time you noticed a rash? When did it begin?
Did it spread? Did it always look that way? (Consider cellulitis if red and pus filled)
 Can you describe it? Is it dry or scaly? Does it have pus in it? What color?
 Does it itch? How troublesome is the itching?

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  Any triggers? Food/allergy/irritants/stress/pets/carpets?
 Does it irritate the child? Does the child tug at it?
 Does it interfere with sleep?
 Anyone else in the family with a similar issue?
(Scabies, fam history of atopy – asthma)
 Any associated symptoms? Fever?
(Fever and rash in any child is Meningococcal Septicemia until proven otherwise!)
Any body pains? – (tender nodules on legs, fever and arthralgia = Erythema
nodosum)
Any swelling of body parts (Edema) (Leaky capillaries cause edema in meningococcal
septicemia)

MUSCULOSKELETAL
 Any swelling of joints?
 Any tenderness?
 Any warmth of joints?
 Any deformities?
 Any Lumps?

6. Past Medical History

CHRONIC ILLNESS SCREEN:
 Sickle Cell Disease How were they diagnosed?
 Thalassemia When were they diagnosed?
 Asthma Who diagnosed them?
 Epilepsy Are they being followed up by a specialist/clinic?
 Congenital Heart Diseases

Are they currently seeing a doctor or attending a clinic for anything?

SURGERIES:
Has your child ever had any surgeries for anything? What was the reason?
Were they followed up?
HOSPITALIZATIONS: Complications?
Has your child ever been hospitalized before? Treatment?

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7. Drug History
Is your child taking any medication for anything?
 Name of medication
 Dose
 Frequency
 Reason for use
 Duration of use
 Last dose
 Compliance
 Adverse drug reactions

Inquire about
 Vitamins
 Herbal supplements
 Over the counter
 Allergies – Penicillin, eggs, peanuts Reactions?
Treatment

8. Birth History
ANTENATAL:
 Did you have any challenges conceiving?
 Planned or unplanned pregnancy?
 How was the pregnancy discovered?
 How soon after did you follow up in a clinic or see a doctor?
 How many USS did you do? Were they all normal? (Was the anomaly scan normal?)
 Did you have all your booking bloods done? – HIV, VDRL, Sickle Cell Screen, Blood
group? Were they all negative?
 Did you take your supplements such as Iron and Folate as instructed by your doctor?
 Were you on any medications during your pregnancy? What was the reason?
 Did you have any illnesses during your pregnancy? DM, HTN, Eclampsia, Fevers,
Rashes, TORCH infections (toxoplasmosis, rubella cytomegalovirus, herpes simplex,
and HIV), GBS, Vaginal discharges.
 Were you ever hospitalized for anything during your pregnancy?
 Did you smoke, drink alcohol or use any recreational drugs while you were pregnant?

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INTRAPARTUM:
 Did the baby come on time? i.e full term, pre-term
(how many weeks pre-term)
 Were they delivered vaginally or via C-Section?
Was it spontaneous/induced or elective or emergency
 How long did the labor process last for? Was it a prolonged delivery?
 Were there any complications during the delivery? Eg Breeched position, cord around
the neck, meconium aspiration?
 Did the doctors have to use any instruments to get the baby our safely? Eg Forceps or
vacuum?

POSTNATAL:
 Where was the baby born?
 Do you remember the birth weight?
 Was the baby pink and crying?
 Was the baby handed to mom right away?
 Were there any infections?
 Did the baby have a jaundice? Did the doctors have to put the baby under any light?
 Did the baby have to be admitted to the NICU for anything?
 How long did you stay at the hospital?
 How long did baby stay in the hospital?
 Were you and baby discharged at the same time?
 Were there any congenital abnormalities discovered at birth?

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9. Developmental History:

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OLDER CHILDREN:
 What school do they attend?
 What class are they in?
 What are their grades like?
 Do they interact with other children?
 Do they have friends?
 Do they like school?
 Compared to other siblings, how are they performing?

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PRETEENS – TEENS:
 H – Home and relationships
 E – Education and employment
 E – Eating habits
 A – Activites and hobbies
 D – Drugs and alcohol
 S – Sex and relationships
 S – Self harm, depression, self imaGe
 S – Safety and abuse

10. Immunizations
 Have they had all their vaccines on time?
 What was their last vaccine?
 Can I see the immunization card?

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11. Nutritional History
 Were they breast fed or bottled fed?
 What formula did they use? How often do they feed?
How do you mix the formula?
 At what age did they start weaning?
 Do they eat from the family pot?
 Do they eat from all food groups?
 Do they give trouble to eat?
 What’s their typical meal plan? Breakfast, snack, lunch, dinner

12. Family History

 Mom and dad’s ages
 Mom and dad’s occupations
 Mom and dad’s educational levels
 How many members of the family?
 Family tree?
 How many siblings?

CHRONIC ILLNESS SCREEN – SIBLINGS:

 Sickle Cell Disease
 Thalassemia
 Asthma
 Epilepsy
 Congenital Heart Diseases

CHRONIC ILLNESS SCREEN – FAMILY

 H - Hypertension
 I - Ischemic Heart Disease
 D - Diabetes
 E - Epilepsy
 A - Asthma
 B - Blood disorders
 C – Cancers

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13. Social History
 Living conditions – How many people live in the house? Who lives in the house?
 Amenities – running water, proper garbage disposal, indoor bathrooms.
 House infrastructure – how many rooms? Who sleeps with the child?
 *Asthma cases: Any carpets, pets, drapes, smokers in the house, stuffed animals
 *Atopy history: Eczema, Allergic Rhinitis

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Common History Cases
1. Fever:
HPC:
 Onset - When did it start?
 Did you measure with a thermometer? Where? (axilla, under tongue)
(Fever - >37.5)
 Characteristics of fever? Intermittent, constant?
 Did you do anything to alleviate the fever? Tepid sponging, fan therapy, sponge
baths, Panadol? How much Panadol, how often, when was the last dose?
 Associated factors: Chills, rigors, excessive sweating, seizures.
 Effects on daily activities? Is the child still feeding well? How has their activity been?
Are they interested in playing? Are they irritable or crying more?

FINDING A CAUSE OF THE FEVER - ROS

RESP – URTI/LRTI?
 Any Cough? Is it wet (what color? White, yellow, green, red), dry, barking, whooping?
 Any associated factors? Runny nose, stuffy nose, sneezing, watery eyes, sore throat,
ear pain, fever?
 Sick contacts – Is anyone at school or home sick with similar symptoms?
 When does the cough occur? Throughout the day or night alone? (Asthma – during
the night)
 Do you think there are any particular triggers? The cold, dust, animals,
pollen/outdoors, Sahara dust, smoke, changes in temperature?
 Do you hear any noises when the child breathes? Such as stridor (a harsh musical
sound from upper airway when child breaths in), snoring, wheezing (whistling in chest
when child breathes out)
 Has the child ever stopped breathing at any point even if it was just for a few
seconds? (Apnea)

GI: GASTROENTERITIS?
DIARRHEA:
 Does the child have any diarrhea? What’s the consistency?
(watery, any solids?)
Is there any blood or mucus in the stool?
 Have you noticed any changes in consistency, color or smell?
 How often do they pass stool normally?
 Any sick contacts at home or at school?
 Any travel history? Child travel or relative came from abroad?

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 VOMITTING:
 Any vomiting?
 How many times?
 How much would you say? 1 cup? (Volume)
 What color was the vomit? (Green, any blood)
 What were the contents? (Food stuff)
 Did the vomiting occur after coughing?
 How has this affected their appetite?
 Have you noticed any weight loss?
 Did the vomiting occur at any point in the day? (Early morning vomiting (SOL)
 Any travel history? Child travel or relative came from abroad?
 *Assess hydration status – Have they been drinking despite all this? Has their urine
decreased, have you noticed any sunken eyes or less tears when crying?

GU: URINARY TRACT INFECTION?

 Any increased frequency of urination?
 Do they complain of any pain or burning when urinating?
 Do they ever hold their pee up?
 Are there any changes to the color of their urine? (Tea colored, cola colored, brown,
orange?
 Any changes to urine itself? Is it foamy? Cloudy?
 Any changes to the odor of the urine?
NB: foamy urine + tea colored urine + history of rash/sore throat = Post Strep
Glomerular Nephritis)
 Any associations? body swelling, pain in tummy/loin area?
 Uncircumcised males? Most common cause of UTI in male babies

NEUROLOGICAL: MENINGITIS?
 Has the child had any seizures? If yes, see below. *Must ask items in bold to rule ou
rmeningitis*

 How many seizures?

 Can you describe what happened? Were they stiff? Were they shaking all over?
(Generalized seizure). Did it start one place and then move? (Jacksonian March) Did
it start one place and stay there? (Focal)
 How long did it last?
 What was the child doing at the time?
 What did you do? (Turn to the side, attempt to stop it in any way, recorded it?)
 Did the child have a fever at the time of seizure?

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  Associations - Any frothing from mouth? Any eye rolling? Any lip smacking? (infantile
seizures) Any blood from their mouth to suggest they bit their tongue? Did you notice
if they wet their pants or soiled they clothes? (Incontinence)
 Post Ictal drowsiness - <30 mins. Were they sleepy after? For how long?
Did they have any weakness in their arms or legs after? (Todd’s Paresis - SOL)
 Prodromal symptoms – only in older children.
Did you see any flashing lights or smell anything before?
 Has the child’s activity been reduced?
 Are they more irritable?
 Are they sleeping more often?
 Do they hold their head or neck?
 Do they cry or not want to go outside in the light?
 Does the child have a rash? – Meningococcal Septicemia
 Is there any paternal history of seizures associated with fevers?
 Is there a family history of epilepsy?

MSS/DERM: OSTEOMYELITIS? SEPTIC ATHRITIS? CELLULITIS?

 Does the child have a limp or refuse to weight bear on a limb?
 Any redness on the body?
 Any swelling?
 Any tenderness?
 Any rashes? Cellulitis/Impetigo
(*Children with SCD are more susceptible to Osteomyelitis)

NB: Children less than 6 months of age are more likely to get infections especially if pre-
term. Ask about gestational age, PROM, GBS, Abx at birth, Maternal infections

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2. Acute Otitis Media:
 Is the child more irritable?
 Do they tug at their ears?
 Is there any discharge from the ears? What color? How much?
Consistency? Odor?
 Any changes in hearing? – Oitis media with effusion – conductive hearing loss. Can affect
speech and development. Common between 2-7 years of age

NB: Acute Otitis Media is more common in children 6-12 months of age because their
Eustachian tubes are short and horizontal. Classical symptoms are ear pain and fever. There
may be perforation of the eardrum and pus can be seen externally.

3. Nephritic Syndrome: Post Strep Glomerulonephritis

 What color is the urine? Brown/tea/cola/red-tinged
 Was the child sick recently? – Sore throat, cough, URTI, tonsillitis? Or Rash? –PSGN Occurs
2-3 weeks after viral illness

4. Nephrotic Syndrome
 Any swellings? – Eyes? Both eyes or one eye? Any discharge? Any associated visual
problems? Genital area swelling? Legs swollen?
 Breathlessness or abdominal distension?
 How is your urine? Foamy urine? Frothy urine?

5. Seizures:
 Is this the first time this has happened?
 Can you describe what happened? Were they stiff? Were they shaking all over?
(Generalized seizure). Did it start one place and then move? (Jacksonian March) Did
it start one place and stay there? (Focal)
 How long did it last?
 What was the child doing at the time?
 What did you do? (Turn to the side, attempt to stop it in any way, recorded it?)
 Any associations? – Any fever at the time of seizure? Any frothing from mouth? Any
eye rolling? Any lip smacking? (infantile seizures) Any blood from their mouth to
suggest they bit their tongue? Did you notice if they wet their pants or soiled they
clothes? (Incontinence)

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  Post Ictal drowsiness - <30 mins. Were they sleepy after? For how long?
Did they have any weakness in their arms or legs after? (Todd’s Paresis - SOL)
 Prodromal symptoms – only in older children.
Did you see any flashing lights or smell anything before?
 Is there any paternal history of seizures associated with fevers?
 Is there a family history of epilepsy?

IF IT’S A FEBRILE CONVULSION: Full fever history as above to find a cause!

6. Broncholitis – Children 1-9 months. Dry cough, irritability, increasing

breathlessness, apnea, wheezing, poor feeding. Sick contact?
 Irritability
 Difficulty feeding
 Cough - Any Cough? Is it wet (what color? White, yellow, green, red), dry, barking, whooping?
 Any associated factors? Runny nose, stuffy nose, sneezing, watery eyes, sore throat, ear
pain, fever?
 When does the cough occur? Throughout the day or night alone? (Asthma – during the night)
 Do you think there are any particular triggers? The cold, dust, animals, pollen/outdoors,
Sahara dust, smoke, changes in temperature?
 Do you hear any noises when the child breathes? Such as stridor (a harsh musical sound
from upper airway when child breaths in), snoring, wheezing (whistling in chest when child
breathes out)
 Has the child ever stopped breathing at any point even if it was just for a few seconds?
(Apnea)
 Has the child ever looked blue or pale or grey?
 Do you ever find the child struggling to breathe? Rapid breathing?
 Sick contacts – Is anyone at school or home sick with similar symptoms?

 Prematurity?

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7. Cardiac Failure
HPC:
 Sweating while feeding. When was the first time you noticed this? Is it only while
feeding? Are they able to finish their feeds?
 Shortness of breath while feeding or playing
 Extreme irritability
 Have you ever noticed the baby turning blue or grey at any point? Was it the fingers
and toes or lips and tongue?
 Do you find the baby breathing rapidly?
 Were there any time when the baby stopped breathing altogether?
 Have you ever noticed any weird sounds when the baby breaths? Like a wheeze? A
high pitched musical noise?
 Do you ever find that the baby’s fingers and toes are sometimes cool?
 Do you remember the baby’s birth weight? Do you think the baby has put on weight
since they were born?
 Did any doctor ever tell you that the baby has a ‘heart murmur?’
 Do you know of any heart problems the baby may have?

 Maternal infections? Rubella? - PDA

 Prematurity? – PDA
 Alcohol abuse?
 VSD? – Most common CHD. Large ones lead to heart failure. Can be complicated by
endocarditis
 ASD – not symptomatic really in kids
 Ebstein anomaly – Maternal use of lithium – thyroid

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Overlap:
 Sweating while feeding. When was the first time you noticed this? Is it only while
feeding? Are they able to finish their feeds?
 Shortness of breath while feeding or playing
 Extreme irritability
 Have you ever noticed the baby turning blue or grey at any point? Was it the fingers
and toes or lips and tongue?
 Do you find the baby breathing rapidly?
Were there any time when the baby stopped breathing altogether?
Specific to Bronchiolitis:
 Any sick contacts at home?
 Any associations? Cough - Any Cough? Is it wet (what color? White, yellow, green, red), dry,
barking, whooping?
 When does the cough occur? Throughout the day or night alone? (Asthma – during the night)
 Do you think there are any particular triggers? The cold, dust, animals, pollen/outdoors,
Sahara dust, smoke, changes in temperature
 Any associated factors? Runny nose, stuffy nose, sneezing, watery eyes, sore throat, ear
pain, fever?
 Have you ever noticed any weird sounds when the baby breaths? Like a wheeze? A
high pitched musical noise?
Specific to Heart Failure:
 Do you ever find that the baby’s fingers and toes are sometimes cool?
 Do you remember the baby’s birth weight? Do you think the baby has put on weight
since they were born?
 Did any doctor ever tell you that the baby has a ‘heart murmur?’
 Were you ever told your baby has any heart conditions?
 Any associations? - Fever

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8. Hematuria
PC: dark urine, weird color to urine.

HPC:
 Is this the first time this has happened?
 When did you first notice it? Did you or child notice it? Does it happen every time they
urinate?
 Can you tell me more about the color? Has the color changed from when you first
noticed it to now?
 Does the urine have an odor? Is it foamy?
 Do you know if it occurs at the start of the stream, mid-stream, end of the stream or
throughout the whole stream?
 Does the child have any associated symptoms? Fever? tummy pain? Irritability?
Increased frequency? Decreased frequency, Wetting himself more/can’t keep it up?
Crying or not wanting to use the bathroom (dysuria) (UTI)
 Is there any body swelling anywhere? Peri—orbital swelling? (Acute Nephritis)
 Are there any bruises or small purple spots? Kind of like they’re bleeding under the
skin? Maybe on the butt, or skin, or ankles?
(Fever + Rash + Joint pain + Tummy pain + Hematuria = Henoch Schonlein Purpura)
 Is the child bleeding from any other site? Mouth, lips, ears, eyes, nose?
 Do you think the child has any difficulty hearing of late? Perhaps talking louder,
turning up the volume on TV, Not responding when being spoken to?
(Male + Hearing issues + Fam Hx = Alport’s syndrome)
 Is there any history of trauma? Maybe while playing?
 Was the child sick over the last few weeks? Like did they have any fever, chills, any
sore throat? (PSGN)
 Any recent gastroenteritis? Diarrhea or vomiting? (IgA Nephropathy – Berger’s
disease)
 What about any skin rashes or skin infections in the last few weeks? (PSGN)
 Is the child taking any medication? (Rifampicin, phenytoin, ibuprofen)
 Is anyone else in the family on any medications such as antibiotics, pain killers and is
there a possibility the child could have ingested any?
 Has anyone else in the family experienced similar symptoms? Or blood in the urine?
 Has anyone in the family ever had kidney stones?


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ROS:
General:
 How has this affected the child’s behavior/activity levels?
 Do you notice any change in weight? i.e are their clothes fitting them more loose?
DDx:
 Post Strep GN –if recent viral infection
 Henoch-schonlein purpura – if rash!
 Alport’s Syn – If family hx/ deafness
 Urinary Tract Infection – if symptoms
 Meds, foods.

9. Asthma – TBC lol

Wheeze:
 When did you notice it?
 Can you describe the noise? Loud, high pitched musical sound. Is it when the child
breathes out or in?
 Is it the first time this has happened?
 Does it happen constantly?
 Is there a particular time this occurs?
 Is it associated with any cough? Dry?
 Triggers: Cold, dust, illness, animal dander, pollen, smoke, exercise, temp, aerosols
 History of atopy – tendency to develop immediate allergic reactions to pollen, food,
dander and insects bites? Hay fever, bronchial asthma,

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10. Swelling of both eyes
 How long? When did you notice it?
 Has it gotten worse since you first noticed it?
 Is he able to see? Can he open his eyes?
 Is this the first time it has happened?
 Where exactly is swollen? (site)
 How much exactly is swollen? (Extent)
 When you press it, does it leave a mark? (Pitting vs non pitting)
 Did you do anything to relieve the swelling? Any piriton or ice?
 Does anything make it worse?
 Is it both eyes or one eye? Any watering? Any discharge? – Mucopurulent = Bacterial
conjunctivits
 Any discoloration? Any itchiness, or burning? Does It hurt? Is it
warm/tender/erythematous?
 Any associated visual problems?
 Has he been rubbing his eyes before?
 Does he have any allergies to food or meds? Did he take any medication recently?
Eat anything out of ordinary recently? Did he get any insect bites?
 Does he have any trouble swallowing? Or breathing problems? – Allergic rxn
 Anywhere else swelling? Genital area swelling? Legs swollen? Does he problems
putting on shoes?
 Breathlessness or abdominal distension?
 How is your urine? Foamy urine? Frothy urine? Any color changes? Like orange?
Dark? blood? How long? Did you see it or did the child tell you?
 Does he have any allergies to food or meds? Did he take any medication recently?
Eat anything out of ordinary recently? Did he get any insect bites?
 Is It possible he may have had any trauma to the area while playing?
 Does he have any associated symptoms: fever, weight loss or weight gain? Does his
clothes fit differently? Any runny nose, cough, any rashes? Like little red itchy rashes?
(hives)
General:
 Is he more tired of late? Does he have a decreased appetite?

DDx for swelling of eyes:

1. Nephrotic Syndrome secondary to minimal change disease (R/O Nephritic – Hematuria +
Recent viral illness)
2. Allergic reaction?
3. Viral/bacterial conjunctivitis if discharge
4. Periorbitial cellulitis if red, warm, tender

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