Review of Systems and Examination of the Older Child

School-aged children may have chronic somatic complaints such as headaches, stomach pain, or leg pains which often have a partly emotional basis. A good history of the circumstances in which these complaints occur can help you tease out the triggers. Other items to add to the review of systems for children aged 6 to 12 years include persistent sneezing and nasal itching, itchy eyes, snoring, disturbed sleep, daytime somnolence, chest pain, exercise-induced cough or wheezing, nocturnal cough, palpitations, polyuria, polydipsia, syncope, persistent sadness or worry, sports injuries, and concussion.

It is usually easy to examine children 6 to 12 years of age. They understand the purpose of the examination and rarely present any problems. It is often helpful to engage the child in conversation regarding school, friends, or hobbies. Conversation helps relax the child even if he or she does not appear apprehensive. Allow the child to wear a gown or drape.

The order of the examination is essentially the same as in adults. If the child is complaining of pain in a certain area, that area should be examined last.

As with younger children, brief explanations about each part of the examination should be given to older children.

Wash your hands with soap and warm water before beginning the examination.

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