Paeds · clinical-assessment-and-reasoning

Structured physical examination from newborn to adolescent

Also known as Paediatric physical examination · Age-adapted physical examination · Newborn examination · Short case examination · NIPE style newborn screen

Fellowship guide to planning and performing an age-adapted structured physical examination from newborn through adolescence: preparation, opportunistic sequencing, growth and vital-sign technique, newborn screening manoeuvres, system exams, dignity and safeguarding, interpretation thresholds, and short-case performance.

high18 referencesUpdated 11 July 202619 min readVerification in progress

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Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

Airway threat, severe work of breathing, fatigue or poor air entry during examinationShock signs: mottling, weak pulses, prolonged CRT with altered interactionAbsent or white red reflex, or new unequal red reflexesPositive Ortolani, limited abduction, or unstable hip findings needing timely pathwayPathological murmur features, weak femoral pulses, or cyanosis at restUnexplained bruising in non-mobile infants or concerning bruise patternsForced examination, missed confidential adolescent needs, or incomplete safeguarding exam

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescentyoung-adult-transition

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acutedelivery-roomnicurural-remotetelehealth

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-short-clinicalmrcpch-developmentmrcpch-history-managementmrcpch-communicationrcpsc-structured-oral

Board mappings

General and Community PaediatricsCurrent 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own cultureCurrent 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young personRenewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatricsRenewed curriculum for first-year trainees from 2027 — Learning goal 9: Clinical assessment and management – child safety and maltreatmentRenewed curriculum for first-year trainees from 2027 — Learning goal 10: Clinical assessment and management – developmental and behavioural paediatricsRenewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionalsRenewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatricsClinical ApplicationsLong CasesShort Cases2. Professional skills and knowledge: Communication3. Professional skills and knowledge: Clinical procedures4. Professional skills and knowledge: Patient management9. Safeguarding vulnerable childrenGeneral Paediatrics: Recognises, investigates and manages safeguarding issues, including providing advice to general practitioners, other healthcare professionals and social care providersFoundation of Practice (FOP)Theory and Science (TAS)Applied Knowledge in Practice (AKP)ClinicalDevelopmentHistoryCommunicationGeneral Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child CareGeneral Pediatrics Content Outline — Domain 8: Child Abuse and NeglectGeneral Pediatrics Content Outline — Universal Task 3: DiagnosisGeneral Pediatrics Content Outline — Universal Task 4: Management and TreatmentPatient Care 3: Organize and Prioritize Patient CarePatient Care 4: Clinical ReasoningInterpersonal and Communication Skills 1: Patient- and Family-Centered CommunicationMedical ExpertPediatrics: Transition to Discipline EPA #1 — Performing and presenting a basic history and physical examinationPediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and/or familiesPediatrics: Core EPA #8 — Recognizing and managing suspected child maltreatment and/or neglect

Your progress

Saved locally on this device.

Practise this topic

Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescentyoung-adult-transition

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acutedelivery-roomnicurural-remotetelehealth

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-short-clinicalmrcpch-developmentmrcpch-history-managementmrcpch-communicationrcpsc-structured-oral

Board mappings

Overview & Definition

A structured paediatric physical examination is not a fixed head-to-toe script recited the same way for every child. It is a deliberate, age-adapted sequence that answers clinical questions while protecting dignity and trust. You start with what you can learn without touching. You choose an order that fits the child’s age, illness and tolerance. You leave the most upsetting steps until last when it is safe to do so. [15] [13]

Think of four related activities that people sometimes mix up. Doorway observation (including tools such as the Paediatric Assessment Triangle) tells you whether the child looks immediately threatened. Opportunistic examination means you use calm moments to listen to the chest or feel the abdomen before the child becomes distressed. Structured systems examination is the organised short-case style survey of a region or system. Screening manoeuvres (red reflex, hips, femoral pulses, spine, genitalia in newborns) deliberately seek silent conditions. Each has a job. None replaces the others. [15] [10] [7]

The examination pathway you can actually run

Prepare

Light, privacy, warm hands, equipment, growth chart, correct BP cuff, interpreter, chaperone when needed, infection control, and a plan for who stays in the room.

Observe first

Interaction, colour, work of breathing, posture, play, devices, and caregiver handling before you touch.

Measure with care

Growth, heart rate, respiratory rate, temperature, oxygen saturation and blood pressure using age-correct technique and local reference charts.

Examine by age strategy

Newborn screening manoeuvres; toddler opportunistic order; school-age systems order; adolescent confidentiality and consent.

Synthesise and act

Localise findings, state urgency, convert to ABCDE if needed, document gaps, and plan re-examination or referral.

[15] [1] [1]

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References18Show ledger

[1]Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet (London, England), 2011.PMID 21411136
[2]O'Leary F, Hayen A, Lockie F, et al. Defining normal ranges and centiles for heart and respiratory rates in infants and children: a cross-sectional study of patients attending an Australian tertiary paediatric hospital. Archives of disease in childhood, 2015.PMID 25784747
[3]Fleming S, Gill P, Jones C, et al. Validity and reliability of measurement of capillary refill time in children: a systematic review. Archives of disease in childhood, 2015.PMID 25260515
[4]Fleming S, Gill P, Jones C, et al. The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis. PloS one, 2015.PMID 26375953
[5]Fleming S, Gill PJ, Van den Bruel A, et al. Capillary refill time in sick children: a clinical guide for general practice. The British journal of general practice : the journal of the Royal College of General Practitioners, 2016.PMID 27789509
[6]Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 2017.PMID 28827377
[7]Shaw BA, Segal LS Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics, 2016.PMID 27940740
[8]Singh A, Wade RG, Metcalfe D, et al. Does This Infant Have a Dislocated Hip?: The Rational Clinical Examination Systematic Review. JAMA, 2024.PMID 38619828
[9]Maikku M, Rantala T, Valkama M The Ortolani test has a high positive predictive value in clinical hip screening for developmental dysplasia of the hip. Acta paediatrica (Oslo, Norway : 1992), 2023.PMID 36928888
[10]Donahue SP, Nixon CN Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics, 2016.PMID 29756730
[11]Pierce MC, Kaczor K, Lorenz DJ, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA network open, 2021.PMID 33852003
[12]Advani N, Menahem S, Wilkinson JL The diagnosis of innocent murmurs in childhood. Cardiology in the young, 2000.PMID 10950330
[13]Kuo DZ, Houtrow AJ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[14]Sharma M, Brown AW, Powell NM, et al. Racial and skin color mediated disparities in pulse oximetry in infants and young children. Paediatric respiratory reviews, 2024.PMID 38233229
[15]Dieckmann RA, Brownstein D, Gausche-Hill M The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care, 2010.PMID 20386420
[16]Moon RJ, Davies JH Confidence, consent and chaperones for pubertal staging examinations: a national survey. Archives of disease in childhood, 2023.PMID 36328439
[17]Wilson M, Patel SM, Langhan ML The Use of Medical Chaperones During Physical Examinations: The Perceptions of Adolescents and Their Caregivers. Pediatric emergency care, 2024.PMID 38032984
[18]Trubey R, Huang C, Lugg-Widger FV, et al. Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review. BMJ open, 2019.PMID 31061010

Structured physical examination from newborn to adolescent

Also known as Paediatric physical examination · Age-adapted physical examination · Newborn examination · Short case examination · NIPE style newborn screen

high18 referencesUpdated 11 July 202619 min readVerification in progress

Practise this topic

Overview & Definition

The examination pathway you can actually run

Prepare

Light, privacy, warm hands, equipment, growth chart, correct BP cuff, interpreter, chaperone when needed, infection control, and a plan for who stays in the room.

Observe first

Interaction, colour, work of breathing, posture, play, devices, and caregiver handling before you touch.

Measure with care

Growth, heart rate, respiratory rate, temperature, oxygen saturation and blood pressure using age-correct technique and local reference charts.

Examine by age strategy

Newborn screening manoeuvres; toddler opportunistic order; school-age systems order; adolescent confidentiality and consent.

Synthesise and act

Localise findings, state urgency, convert to ABCDE if needed, document gaps, and plan re-examination or referral.

[15]

[1]

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References18Show ledger

[1]Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet (London, England), 2011.PMID 21411136
[2]O'Leary F, Hayen A, Lockie F, et al. Defining normal ranges and centiles for heart and respiratory rates in infants and children: a cross-sectional study of patients attending an Australian tertiary paediatric hospital. Archives of disease in childhood, 2015.PMID 25784747
[3]Fleming S, Gill P, Jones C, et al. Validity and reliability of measurement of capillary refill time in children: a systematic review. Archives of disease in childhood, 2015.PMID 25260515
[4]Fleming S, Gill P, Jones C, et al. The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis. PloS one, 2015.PMID 26375953
[5]Fleming S, Gill PJ, Van den Bruel A, et al. Capillary refill time in sick children: a clinical guide for general practice. The British journal of general practice : the journal of the Royal College of General Practitioners, 2016.PMID 27789509
[6]Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 2017.PMID 28827377
[7]Shaw BA, Segal LS Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics, 2016.PMID 27940740
[8]Singh A, Wade RG, Metcalfe D, et al. Does This Infant Have a Dislocated Hip?: The Rational Clinical Examination Systematic Review. JAMA, 2024.PMID 38619828
[9]Maikku M, Rantala T, Valkama M The Ortolani test has a high positive predictive value in clinical hip screening for developmental dysplasia of the hip. Acta paediatrica (Oslo, Norway : 1992), 2023.PMID 36928888
[10]Donahue SP, Nixon CN Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics, 2016.PMID 29756730
[11]Pierce MC, Kaczor K, Lorenz DJ, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA network open, 2021.PMID 33852003
[12]Advani N, Menahem S, Wilkinson JL The diagnosis of innocent murmurs in childhood. Cardiology in the young, 2000.PMID 10950330
[13]Kuo DZ, Houtrow AJ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
[14]Sharma M, Brown AW, Powell NM, et al. Racial and skin color mediated disparities in pulse oximetry in infants and young children. Paediatric respiratory reviews, 2024.PMID 38233229
[15]Dieckmann RA, Brownstein D, Gausche-Hill M The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care, 2010.PMID 20386420
[16]Moon RJ, Davies JH Confidence, consent and chaperones for pubertal staging examinations: a national survey. Archives of disease in childhood, 2023.PMID 36328439
[17]Wilson M, Patel SM, Langhan ML The Use of Medical Chaperones During Physical Examinations: The Perceptions of Adolescents and Their Caregivers. Pediatric emergency care, 2024.PMID 38032984
[18]Trubey R, Huang C, Lugg-Widger FV, et al. Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review. BMJ open, 2019.PMID 31061010