ALL INDIA INSTITUTE OF MEDICAL SCIENCES, PATNA

DEPARTMENT OF PAediatrics
Student’s Logbook

1
 The Department

Prof. (Dr.) Chandra Mohan Kumar

Professor and Head of the Department

Prof. (Dr.) Arun Prasad

Professor

Dr. Pratap Patra Kumar

Additional Professor

Dr.Siddhanath Sudhanshu
Additional Professor

Dr. Pradeep Kumar

Additional Professor

Dr. Swarnim
Associate Professor

Dr. Manoj Kumar

Associate Professor

Dr. Puneet Kumar Choudhary

Assistant Professor

In-charge of UG Teaching - Dr. Swarnim

In-charge of MBBS 2023- Dr. Manoj Kumar
Junior Administrative Officer- Mr. Ashraf Hussain
Department of Paediatric, IPD Building 2nd Floor
AIIMS Patna (Bihar) - 801507

Dear Students,

2
It gives me immense pleasure to welcome you all to the department of Paediatrics. You will be learning Paediatrics
during 4th to 9th semester. Paediatrics as a clinical subject in your curriculum is important for you since it is a part of your
Final MBBS (Part II) examination. But more importantly a comprehensive knowledge and competence to practice
Paediatrics empowers you to serve 40% of country’s population. Preventive, promotive and curative services for 0-18
years population is a major contribution towards building a healthy nation.
In order to achieve these learning objectives, we are beginning with your learning from 4 th semester with main focus on
clinics from 10:00 AM to 01:00 PM as well as theory lectures as per schedule. You will get an opportunity to see
paediatric cases in the clinics which will enable you to learn the principles of health care from neonatal period to
adolescence. Your regular attendance and participation in clinical rotations, small group discussions, seminars and skills
lab sessions will be monitored throughout your posting in the department.. Try to treat your pediatric patients with love,
compassion and courtesy and be gentle to gain their confidence. At the same time ensure that you don’t invade privacy of
any child in general and girls and adolescents in particular. You must take informed consent of patients and care givers
for all examinations and procedures. At the end of each posting you will be assessed for your competence achieved
during your clinical training. Therefore you must work towards achieving your course objectives and be proficient in the
basic principles of the subject. At the end of each posting there will a formative assessment.
You also need to remember that a minimum of 75% attendance is required to appear in the Final MBBS (Part II)
examination in Paediatrics. Therefore regular attendance and punctuality is a must. Your Teachers/Facilitators will
always be available to help you throughout the course and the teaching staff shall be delighted to be of any assistance to
you if you require it.
On behalf of all the staff members of the Department of Paediatrics, once again I welcome you all and wish you the best
of luck.

Prof. (Dr.) Chandra Mohan Kumar

Professor and Head,
Pediatrics Department

3
 ALL INDIA INSTITUTE OF MEDICAL SCIENCES, PATNA
UNDERGRADUATE LOGBOOK
DEPARTMENT OF PEDIATRICS

PHOTO OF STUDENT
Name :

Roll no :

Year of admission:

Mobile no :

Email ID :

Address (Permanent):

Address (Local) :

This document includes the minimum basic requirements as per extant

competencies/curriculum/regulations on Graduate Medical Education, 2018.

4
 LOGBOOK CERTIFICATE

This is to certified that the student Mr/Ms ..............................…………………….………………admitted

at AIIMS Patna in the year…............................................ Batch Roll No...................................................

Has satisfactorily completed / has not completed all assignments /requirements mentioned in this logbook

for final year MBBS course in the subject of Paediatrics. The student is/is not eligible to appear for the

summative assessment.

Dr. Chandra Mohan Kumar

Dr. Manoj Kumar Dr. Swarnim
Professor and Head,
In-charge of MBBS 2023 Batch In-charge of UG Academics Pediatrics Department

5
 GENERAL INSTRUCTIONS

1. This logbook is a record of academic and other activities of the student in the Department of
Pediatrics, AIIMS Patna.

2. Entries in the logbook reflect the activities undertaken by the student and certified by the
faculty.

3. Reflections by students should demonstrate the learning that has taken place.

CLINICAL POSTING

Rotation Phase Duration (Weeks) From To

Ist Phase II

IInd Phase III Part 1

IIIrd Phase III Part 2

6
 TABLE OF CONTENTS

S. No Content Page number

1 Competencies requiring certification 8-11

2 Competencies requiring documentation 12-13

3 Procedural skills requiring certification 14

4 Procedural skills requiring documentation 15

5 Affective competencies requiring documentation 16-17

7 Record of Clinical cases presented/attended Phase I 18

8 Record of Clinical cases presented/attended Phase II (Part 1) 19

9 Record of Clinical cases presented/attended Phase II (Part 2) 20

10 Case Records 21-38

11 Clinical Field visits 39

12 Participation in departmental activities 40

10 Self-directed learning 41-43

11 Reflections of the student for each clinical posting 44-46

12 Annexures 47 Onwards

7
 COMPETENCIES REQUIRING CERTIFICATION

No COMPETENCY Date Minimum Decision Initial of Feedbac

no for of Teacher k
certification Teacher: and date Received
Complete Initials
(C); of
Repeat Learner
(R)
PE1.4 Perform Anthropometric 3
measurements, document
in growth
charts and interpret

PE1.7 Perform Developmental 3

assessment
and interpret

PE7.5 Observe the correct 3

technique of breast feeding
and distinguish right from
wrong techniques

PE11.5 Calculate BMI, document 3

in BMI chart and interpret

8
No COMPETENCY Date Minimum Decision Initial of Feedback
no for of Teacher Received
certificatio Teacher: and date Initials of
n Complete Learner
(C);
Repeat
(R)
PE 19.6 Assess patient for fitness 5
for
immunization and
prescribe an age-
appropriate immunization
schedule

PE27.15 Assess airway and 3

breathing: recognise signs
of severe respiratory
distress.
Check for cyanosis, severe
chest in
drawing, grunting

PE27.17 Assess airway and 3

breathing:
administer oxygen using
correct technique and
appropriate flow rate

9
No COMPETENCY Date Minimum Decision Initial Feedbac
no for of of k
certificatio Teacher: Teache Received
n Complete r and Initials
(C); date of
Repeat Learner
(R)

Check for signs of shock 3

PE27.19 i.e. pulse,
Blood pressure, CRT

Choose the type of fluid 3

PF27.21 and calculate
the fluid requirement in
shock

Assess level of 3
consciousness & observe
emergency treatment of a
child with
PE27.22 convulsions/coma;
Position an unconscious
child; Position a child
with
suspected trauma;

PE27.23 Assess for signs of severe 3

dehydration

10
No COMPETENCY Date Minimum Decision Initial of Feedback
no for of Teacher Received
certificatio Teacher: and date Initials of
n Complete Learner
(C);
Repeat
(R)

Perform and interpret 3

PE33.6 Urine Dipstick
for Sugar

Identify deviations in 2
PE33.11 growth and plan
appropriate referral

PE34.6 Identify a BCG scar 3

PE34.7 Interpret a Mantoux test 3

11
 COMPETENCIES REQUIRING DOCUMENTATION*
These can be integrated with the case presentations/ demonstrations/ seminars or may be
undertaken as standalone activities.

Number COMPETENCY Initial of Number COMPETENCY Initial of

Teacher Teach
and date er and
date
PE 9.7 Plan an appropriate diet in health PE12.17 Identify the clinical features of
and Vitamin
disease B complex deficiency
PE 10.4 Identify children with under PE 12.18 Diagnose patients with Vitamin B
nutrition as per IMNCI criteria complex deficiency and plan
and plan management
PE 11.3 Assessment of a child with PE 12.21 Identify the clinical features of
obesity with regard to eliciting Vitamin C deficiency
history including physical
activity, charting
and dietary recall.
PE 12.3 Identify the clinical features of PE 13.3 Identify the clinical features of
dietary deficiency / excess of dietary deficiency of Iron and
Vitamin make a diagnosis
A
PE 12.4 Diagnose patients with Vitamin PE 16.2 Assess children < 2 months using
A deficiency, classify and plan IMNCI guidelines
management.
PE 12.8 Identify the clinical features of PE 16.3 Assess children > 2 to 5 years
dietary deficiency of Vitamin D using
IMNCI guidelines and Stratify
Risk.
PE 12.9 Assess patients with Vitamin D PE 21.14 Recognize common surgical
deficiency, diagnose, classify conditions
and plan management of the abdomen including acute
abdomen
PE 20.6 Explain the follow up care for PE23.12 Interpret a chest X ray and
neonates including breast recognize cardiomegaly
feeding, temperature
maintenance, immunization,
importance of growth

12
 monitoring and red flags
PE20.18 Identify and stratify risk in a sick PE21.9 Identify external markers for
neonate using IMNCI guidelines kidney disease, like failing to
thrive, hypertension,
Number COMPETENCY Initial of Number COMPETENCY Initial of
Teacher Teach
and date er and
date
PE21.12 Interpret report of Plain X Ray of PE 30.20 Interpret and explain the findings
KUB in a
CSF analysis.
PE 24.11 Apply the IMNCI guidelines in PE 31.11 Observe administration of
risk stratification of children nebulization
with diarrheal dehydration and
refer.
PE 24.13 Interpret RFT and electrolyte PE 32.2 Identify the clinical features of
report Down’s
Syndrome
PE 27.10 Observe the various methods of PE 29.15 Preparation and interpretation of
administering oxygen peripheral smear

PE 28.15 Stratify risk in children with PE 33.10 Recognize precocious and delayed
stridor puberty and refer
using IMNCI guidelines

13
 PROCEDURAL SKILLS REQUIRING CERTIFICATION (To be done in
mannequins/simulated models)

No COMPETENCY Date Min Decision of Initial Initials

no to Teacher: Complete of of
certify (C); Teache Learne
Repeat (R) r r
and date
PE24.15 Perform NG tube insertion in a 2
manikin
PE24.16 Perform IV cannulation in a model 3

PE24.17 Perform Interosseous insertion 2

model
PE27.28 Provide BLS for children in manikin 3

Neonatal resuscitation 3

Demonstrate the method of 3

positioning of an infant & child to
PE27.16 open airway in a simulated
environment

Assess airway and breathing: 3

perform assisted ventilation by Bag
PE27.18 and mask in a simulated
environment

Administer IV/per rectal Diazepam 3

PE27.22 for a convulsing child in a simulated
environment

14
PROCEDURAL SKILLS REQUIRING DOCUMENTATION (To be done in mannequins/
simulated models)

No COMPETENCY Date Initial of Feedback

Teacher Received
and date Initials of
Learner
PE 19.13 Demonstrate correct administration of
different vaccines in a
mannequin

PE 29.17 Demonstrate bone marrow aspiration in a

mannequin

Demonstrate lumbar puncture in a mannequin

15
 AFFECTIVE COMPETENCIES REQUIRING DOCUMENTATION
Number Initial of Faculty and date Initial of Number Initial of faculty and Initial
Teacher date of
and date Teach
er and
date
PE 2.3 Counselling a parent PE 8.5 Counsel and educate
with failing to thrive mothers on
child the best practices in
complementary feeding.
PE 3.4 Counsel a parent of a PE 10.5 Counsel parents of
child with children with
developmental delay SAM and MAM.
PE 6.8 Respecting patient PE 19.7 Educate and counsel a
privacy and maintaining patient for
confidentiality while immunization.
dealing with adolescents.
PE 7.8 Educate mothers on PE 19.8 Demonstrate
antenatal breast care and willingness to
prepare mothers for participate in the
lactation. national and
subnational
immunization days
PE 7.9 Educate and counsel PE 20.5 Counsel /educate
mothers for best mothers on the care of
practices in breast neonates.
feeding.
PE Respects patient privacy PE 21.16 Counsel / educate a
7.10 patient for referral
appropriately
PE 7.11 Participate in Breast PE 22.2 Counsel a patient with
Feeding Week chronic illness
celebration

16
Number Competency Initial of
teacher and
date
PE 23.18 Demonstrate empathy while dealing with children with cardiac diseases in every
patient Encounter.
PE 26.13 Counsel and educate patients and their family appropriately on liver diseases
PE 27.32 Counsel parents of dangerously ill / terminally ill child to break bad news
PE 27.33 Obtain informed consent
PE 27.34 Willing to be a part of the ER team
PE 27.35 Attends to emergency calls promptly
PE 29.19 Counsel and educate patients about prevention and treatment of anemia.
PE 32.5 Counsel parents regarding
1. Present child
2. Risk in next pregnancy (Down’s Syndrome)
PE 32.10 Counsel parents regarding
1. Present child
2. Risk in next pregnancy (Turner Syndrome)

17
RECORD OF CLINICAL CASES PRESENTED/ ATTENDED PHASE I

Case Presented/
S. Teacher’s
Date Patient Name & ID Diagnosis Attended
No. Signature
Write P/A

18
RECORD OF CLINICAL CASES PRESENTED/ ATTENDED PHASE II (Part I)

Case
S. Patient Name & Teacher’s
Date Diagnosis Presented/
No. ID Signature
Attended

19
RECORD OF CLINICAL CASES PRESENTED/ ATTENDED PHASE II (Part 2)

Case
Teacher’s
S.No. Date Patient Name & ID Diagnosis Presented/
Signature
Attended

 At least three Pediatric and two neonatology cases must be presented during the
entire duration of Pediatrics posting

20
 Paediatric Model Case Sheet
Case 1
Name: Son/Daughter of

Age Sex Religion

Address

Date of Admission
Date of Examination
Source of History- Reliability
Chief Complaints

History of Present/Presenting Illness-

History of Past Illness-

History of Similar Illness

History of Illness requiring hospitalization/Surgical Intervention

21
Antenatal History

Birth History

Neonatal History

Feeding/Nutritional History

Immunization History
NIS Vaccines
Additional Vaccines
Developmental History
Gross Motor

Fine Motor

Language

Social
Developmental Age DQ-

Family History-
Consanguinity
Siblings

Socio-economic History-
Family Size/ Housing
Access to drinking water and Sanitation
Family Income/Per capita income
Socio-economic Status of Parents

Personal, Educational and Social History

Hygiene
Schooling
School Performance and Achievements
Peer Group Interactions
Behavioral Issues
Treatment History

22
General Examination
Anthropometry/Auxiology- Height/Length- (Z Score/%le) Wt-
(Z Score/%le)
Wt for Height/Length- (Z Score/%le)
Head Circumference- (Z Score) Chest Circumference- MAC
US/LS

Vitals- Pulse/HR,RR,Temp,BP, SpO2

Pallor/Icterus/Cyanosis/Clubbing/Edema/ Lymhnodes

Head to Toe

Systemic Examination
CNS

CVS

Respiratory System

G I System

Musculo-Skeletal System

Summary

Differential Diagnosis

Investigations Needed
23
Provisional Diagnosis

Advise-
General Supportive Advices

Specific Treatment

24
 Paediatric Model Case Sheet
Case 2
Name: Son/Daughter of

Age Sex Religion

Address

Date of Admission
Date of Examination
Source of History- Reliability
Chief Complaints

History of Present/Presenting Illness-

History of Past Illness-

History of Similar Illness

25
 History of Illness requiring hospitalization/Surgical Intervention

Antenatal History

Birth History

Neonatal History

Feeding/Nutritional History

Immunization History
NIS Vaccines
Additional Vaccines
Developmental History
Gross Motor

Fine Motor

Language

Social
Developmental Age DQ-

Family History-
Consanguinity
Siblings

Socio-economic History-
Family Size/ Housing
Access to drinking water and Sanitation
Family Income/Per capita income
Socio-economic Status of Parents

Personal, Educational and Social History

Hygiene
Schooling
School Performance and Achievements
Peer Group Interactions
Behavioral Issues
Treatment History
26
General Examination
Anthropometry/Auxiology- Height/Length- (Z Score/%le) Wt-
(Z Score/%le)
Wt for Height/Length- (Z Score/%le)
Head Circumference- (Z Score) Chest Circumference- MAC
US/LS

Vitals- Pulse/HR,RR,Temp,BP, SpO2

Pallor/Icterus/Cyanosis/Clubbing/Edema/ Lymhnodes

Head to Toe

Systemic Examination
CNS

CVS

Respiratory System

G I System

Musculo-Skeletal System

Summary

Differential Diagnosis

27
Investigations Needed

Provisional Diagnosis

Advise-
General Supportive Advices

Specific Treatment

28
 Pediatric Model Case Sheet
Case 3
Name: Son/Daughter of

Age Sex Religion

Address

Date of Admission
Date of Examination
Source of History- Reliability
Chief Complaints

History of Present/Presenting Illness-

29
History of Past Illness-

History of Similar Illness

History of Illness requiring hospitalization/Surgical Intervention

Antenatal History

Birth History

Neonatal History

Feeding/Nutritional History

Immunization History
NIS Vaccines
Additional Vaccines
Developmental History
Gross Motor

Fine Motor

Language

Social
Developmental Age DQ-

Family History-
Consanguinity
Siblings

Socio-economic History-
Family Size/ Housing
Access to drinking water and Sanitation
Family Income/Per capita income
Socio-economic Status of Parents

Personal, Educational and Social History

Hygiene
Schooling
School Performance and Achievements
30
 Peer Group Interactions
Behavioral Issues
Treatment History

General Examination
Anthropometry/Auxiology- Height/Length- (Z Score/%le) Wt-
(Z Score/%le)
Wt for Height/Length- (Z Score/%le)
Head Circumference- (Z Score) Chest Circumference- MAC
US/LS

Vitals- Pulse/HR,RR,Temp,BP, SpO2

Pallor/Icterus/Cyanosis/Clubbing/Edema/ Lymhnodes

Head to Toe

Systemic Examination
CNS

CVS

Respiratory System

G I System

Musculo-Skeletal System

Summary

Differential Diagnosis
31
Investigations Needed

Provisional Diagnosis

Advise-
General Supportive Advices

Specific Treatment

32
 Neonatal Unit Model Case Sheet
Case 1
Name B/O Date and Time of Birth-
Sex- Male/Female/Ambiguous
Father’s Name-
Address-
Contact No-
Occupation Income
Maternal Diagnosis
Mode of Delivery- Indication for C S (If done)
Baby’s Diagnosis-
Gestational Score-
Maternal History-
Name-
Age- Parity- Education- Occupation
LMP- EDD Gestational Age
Trimester Event
Trimester 1

Trimester 2

Trimester 3

Diet

Immunization

Maternal Illness (if any)

Anemia/ Diabetes/ Hypertension/ Tuberculosis/ CRF/ Hypothyroidism/ Heart Disease/ Any other

Labour
Leaking PV
Bleeding PV
Perinatal Maternal Fever
Progress of Labour Liquor
Anaesthesia
Maternal Medications

Delivery Notes-
33
Term/Preterm
Crying/Breathing Y/N
Tone- Normal/ Flaccid/ Hypertonia
APGAR Score 1 min 5 min 15 Min

Physical Examination-
1.Vitals
Colour
HR
RR
CRT
SPO2
Temp

2. Anthropometry
Birth Weight
Length
Head Circumference (HC)- AC CC

3. General Examination
Pallor
Icterus Central
Cyanosis
Acrocyanosis

None

Tone and Posture-

Head-
Caput Cephalhematoma Craniotabes Fontanale

Face- Dysmorphism
Ears Eyes Nose Lips Tongue Palate
Neck-
Tumor Cyst Fistula Goitre Others
Respiratory System
Air Entry Bilateral Equal Y/N Added Sounds Grunt

CVS

Apex Beat (L/R) Space Heart Sounds Murmur

Abdomen
Umbilical Cord Stump- Arteries Vein
34
Liver Spleen Kidneys Others

Spine and Extremities

Spine Hand and Feet Femoral Pulsations

Congenital Dysplasia of Hip

Genito-Urinary & Anal Region-

Skin

Reflexes
Moro’s
Grasp
Rooting
Suckling
Others

35
 Neonatal Unit Model Case Sheet
Case 2
Name B/O Date and Time of Birth-
Sex- Male/Female/Ambiguous
Father’s Name-
Address-
Contact No-
Occupation Income
Maternal Diagnosis
Mode of Delivery- Indication for C S (If done)
Baby’s Diagnosis-
Gestational Score-
Maternal History-
Name-
Age- Parity- Education- Occupation
LMP- EDD Gestational Age
Trimester Event
Trimester 1

Trimester 2

Trimester 3

Diet

Immunization

Maternal Illness (if any)

Anemia/ Diabetes/ Hypertension/ Tuberculosis/ CRF/ Hypothyroidism/ Heart Disease/ Any other

Labour
Leaking PV
Bleeding PV
Perinatal Maternal Fever
Progress of Labour Liquor
Anaesthesia
Maternal Medications

Delivery Notes-
36
Term/Preterm
Crying/Breathing Y/N
Tone- Normal/ Flaccid/ Hypertonia
APGAR Score 1 min 5 min 15 Min

Physical Examination-
1.Vitals
Colour
HR
RR
CRT
SPO2
Temp

2. Anthropometry
Birth Weight
Length
Head Circumference (HC)- AC CC

3. General Examination
Pallor
Icterus Central
Cyanosis
Acrocyanosis

None

Tone and Posture-

Head-
Caput Cephalhematoma Craniotabes Fontanale

Face- Dysmorphism
Ears Eyes Nose Lips Tongue Palate
Neck-
Tumor Cyst Fistula Goitre Others
Respiratory System
Air Entry Bilateral Equal Y/N Added Sounds Grunt

CVS

Apex Beat (L/R) Space Heart Sounds Murmur

Abdomen
Umbilical Cord Stump- Arteries Vein
37
Liver Spleen Kidneys Others

Spine and Extremities

Spine Hand and Feet Femoral Pulsations

Congenital Dysplasia of Hip

Genito-Urinary & Anal Region-

Skin

Reflexes
Moro’s
Grasp
Rooting
Suckling
Others

38
 CLINIC/FIELD VISITS

Visits Number Competency Date completed

Immunization Clinic PE 19.10

PE 19.11

PE 19.12

PE 19.14

Other Clinics (Desirable)

39
40
PARTICIPATION IN DEPARTMENTAL ACTIVITIES

Self-documentation by
Activity Date
student

Participation in celebration and IEC activities like

Breastfeeding Week, National Newborn Week, World
Immunization Week, World Tuberculosis Day, World
Health Day, World Asthma Day, World Thalassemia Day

Participation in IAP/ Other Quiz

Participation in ICMR STS/ Other Research

Projects

Research paper presented/ submitted/ published

Participation in Seminars/Conferences &

Role

Other Activities

41
SELF-DIRECTED LEARNING - Phase II

Topic Methodology Reflections

SELF-DIRECTED LEARNING - Phase III (Part 1)

42
 Topic Methodology Reflections

SELF-DIRECTED LEARNING- Phase III (Part 2)

43
 Topic Methodology Reflections

REFELCTIONS FOR CLINICAL POSTING PHASE II

44
Sr. Patient Name: Age/Sex: CR No.
No. Diagnosis:

Student Presenter : Date:

What Happened?

So What?

What Next?

Faculty Signature: Date:

REFELCTIONS FOR CLINICAL POSTING PHASE III (Part 1)

45
Sr. Patient Name: Age/Sex: CR No.
No. Diagnosis:

Student Presenter : Date:

What Happened?

So What?

What Next?

Faculty Signature: Date:

REFELCTIONS FOR CLINICAL POSTING PHASE III (Part 2)

46
Sr. Patient Name: Age/Sex: CR No.
No. Diagnosis:

Student Presenter : Date:

What Happened?

So What?

What Next?

Faculty Signature: Date:

Annexure

47
48
49
50
51
52
53
54
55
 11 50th 99 100 102 104 105 107 107 59 59 60 61 62 63 63
90th 113 114 115 117 119 120 121 74 74 75 76 77 78 78

95th 117 118 119 121 123 124 125 78 78 79 80 81 82 82

99th 124 125 127 129 130 132 132 86 86 87 88 89 90 90

12 50th 101 102 104 106 108 109 110 59 60 61 62 63 63 64

90th 115 116 118 120 121 123 123 74 75 75 76 77 78 79

95th 119 120 122 123 125 127 127 78 79 80 81 82 82 83

99th 126 127 129 131 133 134 135 86 87 88 89 90 90 91

13 50th 104 105 106 108 110 111 112 60 60 61 62 63 64 64

90th 117 118 120 122 124 125 126 75 75 76 77 78 79 79

95th 121 122 124 126 128 129 130 79 79 80 81 82 83 83

99th 128 130 131 133 135 136 137 87 87 88 89 90 91 91

14 50th 106 107 109 111 113 114 115 60 61 62 63 64 65 65

90th 120 121 123 125 126 128 128 75 76 77 78 79 79 80

95th 124 125 127 128 130 132 132 80 80 81 82 83 84 84

99th 131 132 134 136 138 139 140 87 88 89 90 91 92 92

15 50th 109 110 112 113 115 117 117 61 62 63 64 65 66 66

90th 122 124 125 127 129 130 131 76 77 78 79 80 80 81

95th 126 127 129 131 133 134 135 81 81 82 83 84 85 85

99th 134 135 136 138 140 142 142 88 89 90 91 92 93 93

16 50th 111 112 114 116 118 119 120 63 63 64 65 66 67 67

90th 125 126 128 130 131 133 134 78 78 79 80 81 82 82

95th 129 130 132 134 135 137 137 82 83 83 84 85 86 87

99th 136 137 139 141 143 144 145 90 90 91 92 93 94 94

17 50th 114 115 116 118 120 121 122 65 66 66 67 68 69 70

90th 127 128 130 132 134 135 136 80 80 81 82 83 84 84

95th 131 132 134 136 138 139 140 84 85 86 87 87 88 89

99th 139 140 141 143 145 146 147 92 93 93 94 95 96 97

BP, blood pressure
* The 90th percentile is 1.28 SD, 95th percentile is 1.645 SD, and the 99th percentile is 2.326 SD over the mean. For research
purposes, the standard deviations in appendix table B–1 allow one to compute BP Z-scores and percentiles for boys with height
percentiles given in table 3 (i.e., the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles). These height percentiles must be
converted to height Z-scores given by (5% = -1.645; 10% = -1.28; 25% = -0.68; 50% = 0; 75% = 0.68; 90% = 1.28; 95% = 1.645)
and then computed according to the methodology in steps 2–4 described in appendix B. For children with height percentiles other
than these, follow steps 1–4 as described in appendix B.
11 50th 100 101 102 103 105 106 107 60 60 60 61 62 63 63
90th 114 114 116 117 118 119 120 74 74 74 75 76 77 77

95th 118 118 119 121 122 123 124 78 78 78 79 80 81 81

99th 125 125 126 128 129 130 131 85 85 86 87 87 88 89

12 50th 102 103 104 105 107 108 109 61 61 61 62 63 64 64

90th 116 116 117 119 120 121 122 75 75 75 76 77 78 78

95th 119 120 121 123 124 125 126 79 79 79 80 81 82 82

99th 127 127 128 130 131 132 133 86 86 87 88 88 89 90

13 50th 104 105 106 107 109 110 110 62 62 62 63 64 65 65

90th 117 118 119 121 122 123 124 76 76 76 77 78 79 79

95th 121 122 123 124 126 127 128 80 80 80 81 82 83 83

99th 128 129 130 132 133 134 135 87 87 88 89 89 90 91

14 50th 106 106 107 109 110 111 112 63 63 63 64 65 66 66

90th 119 120 121 122 124 125 125 77 77 77 78 79 80 80

95th 123 123 125 126 127 129 129 81 81 81 82 83 84 84

99th 130 131 132 133 135 136 136 88 88 89 90 90 91 92

15 50th 107 108 109 110 111 113 113 64 64 64 65 66 67 67

90th 120 121 122 123 125 126 127 78 78 78 79 80 81 81

95th 124 125 126 127 129 130 131 82 82 82 83 84 85 85

99th 131 132 133 134 136 137 138 89 89 90 91 91 92 93

16 50th 108 108 110 111 112 114 114 64 64 65 66 66 67 68

90th 121 122 123 124 126 127 128 78 78 79 80 81 81 82

95th 125 126 127 128 130 131 132 82 82 83 84 85 85 86

99th 132 133 134 135 137 138 139 90 90 90 91 92 93 93

17 50th 108 109 110 111 113 114 115 64 65 65 66 67 67 68

90th 122 122 123 125 126 127 128 78 79 79 80 81 81 82

95th 125 126 127 129 130 131 132 82 83 83 84 85 85 86

99th 133 133 134 136 137 138 139 90 90 91 91 92 93 93

BP, blood pressure
* The 90th percentile is 1.28 SD, 95th percentile is 1.645 SD, and the 99th percentile is 2.326 SD over the mean. For research
purposes, the standard deviations in appendix table B–1 allow one to compute BP Z-scores and percentiles for girls with height
percentiles given in table 4 (i.e., the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles). These height percentiles must be
converted to height Z-scores given by (5% = -1.645; 10% = -1.28; 25% = -0.68; 50% = 0; 75% = 0.68; 90% = 1.28; 95% = 1.645)
and then computed according to the methodology in steps 2–4 described in appendix B. For children with height percentiles other
than these, follow steps 1–4 as described in appendix B.
The Tanner Stages
Because the onset and progression of puberty are so variable,
Tanner has proposed a scale, now uniformly accepted, to I
Preadolescent
describe the onset and progression of pubertal changes (Fig. no sexual hair

924). Boys and girls are rated on a 5 point scale. Boys are rated
for genital development and pubic hair growth, and girls are
rated for breast development and pubic hair growth. II
Sparse, pigmented,
long, straight,
Pubic hair growth in females is staged as follows (Fig 9-24, B): mainly along labia
and at
base of penis
• Stage I (Preadolescent) - Vellos hair develops over the pubes in a
manner not greater than that over the anterior wall. There is no
sexual hair.
III
Darker, coarser,
• Stage II - Sparse, long, pigmented, downy hair, which is straight or curlier
only slightly curled, appears. These hairs are seen mainly along the
labia. This stage is difficult to quantitate on black and white
photographs, particularly when pictures are of fair-haired subjects.
• Stage III - Considerably darker, coarser, and curlier sexual hair IV
Adult, but
appears. The hair has now spread sparsely over the junction of the decreased
pubes. distribution

• Stage IV - The hair distribution is adult in type but decreased in total

quantity. There is no spread to the medial surface of the thighs.
V
• Stage V - Hair is adult in quantity and type and appears to have an Adult in quantity
inverse triangle of the classically feminine type. There is spread to the and type with
spread to medial
medial surface of the thighs but not above the base of the inverse thighs
triangle.

The stages in male pubic hair development are as follows (Fig. 9-24, B):

• Stage I (Preadolescent) - Vellos hair appears over the pubes with a degree of development
similar to that over the abdominal wall. There is no androgen-sensitive pubic hair. • Stage
II - There is sparse development of long pigmented downy hair, which is only slightly curled
or
F
straight. The hair is seen chiefly at the base of penis. This stage may be difficult to
ig. 9-24, B
evaluate on a photograph, especially if the subject has fair hair.
• Stage III - The pubic hair is considerably darker, coarser, and curlier. The distribution is
now spread over the junction of the pubes, and at this point that hair may be recognized
easily on black and white photographs.
• Stage IV - The hair distribution is now adult in type but still is considerably less that seen in
adults. There is no spread to the medial surface of the thighs.
• Stage V - Hair distribution is adult in quantity and type and is described in the inverse
triangle. There can be spread to the medial surface of the thighs.
In young women, the Tanner
stages for breast
development are as follows
I I
(Fig. 9-24, C): Preadolescent Preadolescent

• Stage I (Preadolescent) - Only

the papilla is elevated above
the level of the chest wall.
II
• Stage II - (Breast Budding) - II Enlargement,
change in texture
Elevation of the breasts and Breast budding

papillae may occur as small

mounds along with some
increased diameter of the
areolae. III
III Growth in length and
• Stage III - The breasts and Continued Enlargement circumference
areolae continue to enlarge,
although they show no
separation of contour.
IV
• Stage IV - The areolae and Further development of
papillae elevate above the IV glans penis, darkening
Areola and papilla of scrotal skin
level of the breasts and form form secondary mound
secondary mounds with
further development of the
overall breast tissue.
• Stage V - Mature female
V
breasts have developed. The V
Adult genitalia
Mature female breasts
papillae may extend slightly
Fig. 9-24, C Fig. 9-24, A
above the contour of the
breasts as the result of the recession of the aerolae.

The stages for male genitalia development are as follows: (Fig. 9-24, A):

• Stage I (Preadolescent)- The testes, scrotal sac, and penis have a size and proportion
similar to those seen in early childhood.
• Stage II - There is enlargement of the scrotum and testes and a change in the texture of
the scrotal skin. The scrotal skin may also be reddened, a finding not obvious when viewed
on a black and white photograph.
• Stage III - Further growth of the penis has occurred, initially in length, although with some
increase in circumference. There also is increased growth of the testes and scrotum.
• Stage IV - The penis is significantly enlarged in length and circumference, with further
development of the glans penis. The testes and scrotum continue to enlarge, and there is
distinct darkening of the scrotal skin. This is difficult to evaluate on a black-and-white
photograph.
• Stage V - The genitalia are adult with regard to size and shape.
 Approximate Calorific Value of Some Cooked Preparations
Preparation Calories
Quantity for one serving
( Kcal )
Preparation Quantity for one serving Calories
5. Savoury snacks ( Kcal )
1. Cereal Bajji or pakora 8 Nos. 280
Besan ka pura 1 No. 220
Rice 1 cup 170
Phulka Chat (Dahi-pakori) 1 No. 5 pieces 80 220
Paratha Cheese balls 1 No. 2 Nos. 150 250
Puri Dahi vada 1 No. 2 Nos. 80 180
Bread Vada 2 slices2 Nos. 170 140
Poha Masala vada 1 cup 2 Nos. 270 150
Upma Masala dosa 1 cup 1 No. 270 200
Idli Pea-kachori 2 Nos. 2 Nos. 150 380
Dosa Potato bonda 1 No. 2 Nos. 125 200
Kichidi Sago vada 1 cup 2 Nos. 200 210
Wheat porridge 1 cup 220
Samosa 1 No. 200
Semolina porridge 1 cup 220
Sandwiches (butter - 2tbsp) 2 Nos. 200
Cereal flakes with milk
Vegetable puff 1 cup 1 No. 220 200
( corn/wheat/rice )
Pizza (Cheese and tomato) 1 slice 200
2. Pulse
6. Chutneys
Plain dhal ½ cup 100
Coconut/groundnuts/til 2 tbsp 120
Sambar 1 cup 110
Tomato 1 tbsp 10
3. Vegetable
Tamarind ( with jaggery ) 1 tbsp 60
With gravy 1 cup 170
7. Sweets and Desserts
Dry 1 cup 150
Besan barfi 2 small pieces 400
4. Non-Vegetarian
Chikki 2 pieces 290
Boiled egg 1 No. 90
OmmeletteFruit cake 1 No. 1 piece 160 270
Fried eggRice puttu 1 No. ½ cup 160 280
Sandesh
Mutton curry ¾ cup 2 Nos. 260 140
Chicken Double
curry ka meetha ¾ cup ½ cup 240 280
Fish friedHalwa (kesari) 2 big pieces
½ cup 190 320
Fish cutlet
Jelly/Jam 2 Nos. 1 tbsp 190 20
Prawn curry
Custard (caramel) ¾ cup ½ cup 220 160
Keema kofta curry
Srikhand ¾ cup ½(6cup
small koftas ) 240 380
Milk chocolate 25 g 140
Ice-cream ½ cup 200
 Preparation Quantity for one serving Calories
( Kcal )
8. Beverages
Tea (2 tsp sugar +
1 cup 75
50 ml toned milk )
Coffee (2 tsp sugar + 1 cup 110
100 ml )
Cow's milk (2 tsp sugar) 1 cup 180
Buffalo's milk (2 tsp sugar) 1 cup 320
Lassi (2 tsp sugar) 1 cup/glass (200 ml ) 110
Squash 1 cup/glass 75
Syrups (Sharabats) 1 cup/glass 200
Cold drinks 1 bottle (200 ml ) 150
Fresh lime juice 1 glass 60
 Portion Sizes and Menu Plan

Portion Size of Foods (raw) and Nutrients

Energy Protein Carbohydrate Fat

g/Portion
( Kcal ) ( g) (g ) (g )

Cereals & millets 30 100 3.0 20 0.8

Pulses 30 100 6.0 15 0.7

Egg 50 85 7.0 - 7.0

Meat/chicken/ 50 100 9.0 - 7.0

fish

Milk (ml) &

100 70 3.0 5 3.0
milk products

Roots & Tubers 100 80 1.3 18 -

Green leafy
100 46 3.6 - 0.4
vegetables

Other vegetables 100 28 1.7 - 0.2

Fruits 100 40 - 10 -

Sugar 5 20 - 5 -

Fat & Oils

5 45 - - 5.0
( visible )

The balanced diets are given as multiples of these portion sizes

@
Toned milk.
 Some Nutrient-rich Foods

Nutrient
Nutrients Food Groups Foods content for 100 g
edible portion

Energy Cereals and Tubers Rice, wheat and tapioca 340 Kcal

Nuts and Oilseeds Almond, cashewnut, dry

coconut and groundnut 600 Kcal

Vegetable oil, ghee

and Vanaspati 900 Kcal

Protein Pulses and Legumes Bengalgram, blackgram,

greengram, lentil and
redgram 22 g

Nuts and Oilseeds Groundnuts, cashewnuts

and almond 23 g

Fish 20 g

Meat and Poultry Meat 22 g

Egg white 11 g

Milk products Cheese, khoa , skimmed milk

powder (cow) and whole
milk powder (cow) 30 g

Beta- Leafy vegetables Ambat chukka , coriander

Carotene leaves, ponnaganti, spinach,
leaves, mint,
radish leaves 2-6 mg
Some other leafy vegeta-
bles like agathi, ama-
ranth, curry leaves,
fenugreek leaves and
gogu 7-15 mg.

Other vegetables Pumpkin and green chillies 1 mg

Carrot 6.5 mg

Fruits Ripe mango 2.0 mg

Papaya 0.9 mg

Folic Acid Green leafy vegetables Amaranth, ambat chukka ,

mint and spinach 120 mg

Pulses Bengalgram, blackgram,

greengram and redgram 120 mg

Oilseeds Gingelly and soyabean 180 mg

 Nutrient
Nutrients Food Groups Foods content for 100 g
edible portion

Iron Green leafy vegetables Amaranth, bengalgram

leaves, cauliflower
greens and radish
leaves 18-40 mg

Calcium Cereals and Legumes Ragi, bengalgram

(whole), horsegram
( whole), rajmah and
soyabean 200-340 mg

Green leafy vegetables Amaranth, cauliflower

greens, curry leaves,
knol-khol leaves 500-800 mg

Agathi 1130 mg
Colocasia leaves 1540 mg

Nuts and Oilseeds Coconut dry, almond,

mustard seeds and
sunflower seeds 130-490 mg
Gingelly seeds 1450 mg
Cumin seeds 1080 mg

Fish Bacha, katla, mrigal,

pran and rohu 320-650 mg

Milk and Milk Products Buffalo’s milk, cow’s

milk, goat’s milk, curds
( cow’s ) 120-210 mg

Cheese, khoa , skimmed

milk powder and whole-
milk powder 790-1370 mg

Vitamin C Green leafy vegetables Agathi, cabbage, cori-

ander leaves, drumstic
leaves, knol-khol
greens 120-220 mg

Other vegetables Giant chillies ( capsicum ) 137 mg

Green chillies 117 mg

Fruits Amla 600 mg

Guava 212 mg

Fibre Cereals and Pulses Wheat, jowar, bajra,

ragi, maize, legumes,
dhals and fenugreek
seeds >10 g
 Nutrient
Nutrients Food Groups Foods content for 100 g
edible portion

Vitamin A Fats and edible oils Butter, ghee (cow milk)

and hydrogenated oil
( fortified ) 700 m g

Riboflavin Cereal grains and Bajra, barley, ragi,

products wheat germs and wheat
bread (brown) 0.2 m g

Pulses and legumes Bengalgram, blackgram,

greengram, lentil, red-
gram and soyabean 0.2 mg

Leafy vegetables Amaranthus, carrot

leaves, colacasia leaves,
curry leaves, fenugreek
leaves, gogu, mint,
radish leaves and spinach 0.25 mg

Nuts and Oilseeds Gingelly seeds, mustard

seeds, niger seeds,
sunflower seeds, almond
and walnut 0.3 mg
Condiments and spices Chillies dry, chillies
green, coriander and
cumin seeds 0.35 mg

Fruits Apricot dried and papaya 0.23 mg

Meat and poultry Egg (hen) 0.26 mg

Sheep’s liver 1.7 mg

Milk and milk products Skimmed milk powder and

whole milk powder
( cow’s milk ) 1.5 mg
NOTES
NOTES
NOTES
NOTES