Pediatric review of systems template: 13-section checklist

Key takeaways

A pediatric review of systems is a symptom inventory organized by body system, used to find problems the visit did not start with.

This template runs to 13 sections: general, weight, skin and lymph, HEENT, cardiac, respiratory, GI, GU, musculoskeletal, neuro, pubertal, allergy, and psychiatric.

There is no separate endocrine or hematology section. Polyuria sits under GU, and bruising and adenopathy sit under skin and lymph.

Answers are caregiver-reported and the wording changes with age. The pubertal and psychiatric sections usually need a confidential conversation with an adolescent.

Practice management software like Pabau stores intake answers straight in the clinical record, so nobody retypes a paper form.

A pediatric review of systems (ROS) is a symptom screen you work through one body system at a time. It exists to catch what nobody thought to mention. Think of the new limp, the poor feeding, or the snoring that turns out to be sleep apnea.

The template on this page runs to 13 sections, from general and weight through pubertal, allergy, and psychiatric. That framework matters. A note that reads only “ROS reviewed” tells the next clinician nothing about what you actually asked.

Below you will find every section, how the wording shifts with age, and where the ROS sits in the note.

What a pediatric review of systems screens for

A pediatric review of systems screens every body system for symptoms the visit did not start with. For each prompt on the form you record one of three answers: present, absent, or unable to assess.

It does two jobs at once:

• Symptom screening. It surfaces problems the chief complaint never raised. A child brought in for ear pain who also snores and mouth-breathes may have adenotonsillar obstruction rather than a one-off infection.
• Documentation. A recorded ROS shows what you asked and what the caregiver reported. That record supports medical necessity, and it is what compliant clinical documentation rests on in an audit.

Both jobs make the ROS one leg of a wider pediatric assessment, alongside the exam, the vitals, and the growth history.

Almost all of it is caregiver-reported. Young children cannot reliably self-report, and adolescents may hold back on the pubertal and psychiatric prompts while a parent is in the room. Those two sections usually need a separate, confidential conversation.

Three things change when your patient is a child

The body-system structure is the same in both. Pediatric use changes who answers, how the question is worded, and which sections earn their own heading.

On top of that, a pediatric ROS carries growth and development. Weight change, pubertal timing, and behavior at school matter here in a way an adult form rarely reflects.

Why the ROS and the HPI are not interchangeable

The history of present illness (HPI) goes deep on one problem. The ROS goes wide across every system. Both gather symptoms, so it is easy to blur them, and the note suffers when you do.

In practice the ROS often adds detail the HPI missed. So document them in order, and the note then reads from presenting problem, to detailed HPI, to full ROS.

All 13 sections on the checklist, and what each one asks

The template covers 13 sections: general, weight, skin and lymph, HEENT, cardiac, respiratory, GI, GU, musculoskeletal, neuro, pubertal, allergy, and psychiatric. Mark every prompt present or absent. Adapt the wording to the child’s age and to the caregiver’s own language.

The form opens with the patient’s name, date of birth, gender, relevant medical history, and the referring physician. It closes with a free-text box for a summary or additional notes.

General: The whole-child questions that come first

This section records how the child is doing overall, before you narrow down to any one system.

• Fever or chills?
• Fatigue or generalized weakness?
• Fussiness the caregiver has not seen before?
• Poor feeding, or any change in appetite?
• Sleep disturbance, or sleeping more than usual?

Weight: Growth is a vital sign in children

Weight earns its own heading because growth is a vital sign. The form asks one question. Has anything changed recently?

Answer it against the child’s own growth chart rather than a single reading, and note whether the trend crosses percentiles. Weight is the only growth measure here, so keep the rest of the pediatric vital signs to hand.

Skin and lymph: Rashes, bruising, and nodes in one pass

This section merges skin and lymphatic findings, which is why the form carries no separate hematology heading.

• Rashes?
• Adenopathy or swollen lymph nodes?
• Lumps anywhere on the body?
• Bruising or bleeding out of proportion to the injury?
• Pigmentation changes?

So easy bruising and persistent adenopathy sit alongside rashes. A possible bleeding or hematologic problem gets caught in the same pass as a skin complaint.

HEENT: The longest section, and the airway cluster inside it

HEENT is the longest section on the form, with 17 prompts across the head, eyes, ears, nose, mouth, and throat.

• Headaches, concussions, or an unusual head shape?
• Strabismus, conjunctivitis, or other visual problems?
• Hearing concerns, ear infections, or draining ears?
• Colds, sore throats, or tonsillitis?
• Mouth breathing, snoring, or apnea?
• Oral thrush, dental caries, or epistaxis?

Mouth breathing, snoring, and apnea are grouped on purpose. Together they screen for adenotonsillar obstruction and sleep-disordered breathing, which a single question about snoring would miss.

The visual prompts work the same way, and a positive answer usually leads to a fuller eye examination.

Cardiac: The one prompt that never appears on an adult form

These prompts screen for congenital and acquired heart disease. One of them, squatting during play, has no adult equivalent.

• Cyanosis?
• Dyspnea or exercise intolerance?
• Heart murmurs noted at any earlier visit?
• Squatting during play?
• Chest pain or palpitations?

Squatting is on the list because a child with an unrepaired cyanotic lesion may squat to settle a hypoxic spell. Tetralogy of Fallot is the classic example. A parent usually describes the child crouching down and going quiet.

Respiratory: Infection history matters more than a single symptom

These prompts lean on infection history and airway reactivity rather than one-off symptoms.

• Previous pneumonia or bronchiolitis?
• Wheezing?
• Chronic cough, with or without sputum?
• Hemoptysis?
• Any known tuberculosis exposure?

Note how often pneumonia has recurred and how it was treated. Repeated lower respiratory infection in one child is worth a second look rather than a second course of antibiotics.

Gastrointestinal (GI): Two entries that jump the queue

The GI section covers intake, output, and the entries that need same-day attention.

• Change in stool color or character?
• Diarrhea or constipation?
• Vomiting, and any blood in the vomit?
• Jaundice?
• Abdominal pain or colic?
• Change in appetite?

Vomiting blood and jaundice are the two that move a child up the queue. Both belong in your summary note even when everything else on the form is absent.

Genitourinary (GU): Where polyuria and facial edema live

The GU section carries nine prompts, including two that other forms file under endocrine or renal.

• Frequency, dysuria, or hematuria?
• Discharge?
• Abdominal pain?
• Quality of the urinary stream?
• Polyuria?
• Previous urinary infections?
• Facial edema?

Polyuria appears here rather than under a separate endocrine heading, so new-onset diabetes gets caught during the urinary review. Facial edema points toward nephrotic syndrome or glomerulonephritis. It is easy to overlook in a well-looking child.

Musculoskeletal: Joint pain, gait, and why fever repeats here

These prompts screen for joint disease, injury, and any change in how the child moves.

• Joint pain or swelling?
• Fevers alongside the joint symptoms?
• Scoliosis?
• Muscle aches or weakness?
• Injuries?
• Gait changes?

Fever repeats here on purpose. Joint pain with fever raises septic arthritis or juvenile idiopathic arthritis, so the form asks again in that specific context.

Neuro: Four prompts, all of them worth chasing

The neuro section is short, and every prompt on it carries weight.

• Seizures?
• Weakness?
• Headaches?
• Numbness?

Headaches appear in both HEENT and neuro. Record them where the associated findings point, and describe the pattern rather than reaching for a label.

Pubertal: The section adult forms have no equivalent for

This is where the form records development and sexual health.

• Secondary sexual characteristics, and whether they are early, on time, or delayed?
• Menses, and any menstrual problems?
• Pregnancies?
• Sexual activity?

Ask an adolescent these questions confidentially, without the caregiver in the room. Consent and confidentiality rules differ by state, so follow the ones that apply where you practice.

Allergy: The atopic conditions gathered in one place

The allergy section groups the atopic conditions together instead of splitting them between respiratory and skin.

• Urticaria?
• Hay fever or allergic rhinitis?
• Asthma?
• Eczema?
• Drug reactions?

So asthma and eczema sit here rather than under respiratory or skin. That mirrors how atopic conditions cluster in the same child. Record any drug reaction with the drug, the reaction, and the date.

Psychiatric: Where a positive answer starts a longer conversation

The psychiatric section closes the form with three prompts about sleep, behavior, and activity level.

• Difficulty sleeping?
• Behavioral changes?
• Hyperactivity?

A positive answer here is a starting point rather than a diagnosis. Follow it with a validated instrument instead of relying on the single ROS line.

The six prompts that appear twice, and why

Six prompts turn up in more than one section: fever, appetite change, sleep, abdominal pain, headache, and weakness.

That repetition is deliberate. Each one asks the same question in a different clinical context. That is how the form catches a pattern a single line would miss.

Why the same prompt changes meaning from newborn to teen

All 13 sections apply at every age. What changes is the wording, and which answers carry the visit. That is where a generic adult template stops being useful.

A positive psychiatric prompt needs a proper follow-up. Screening for autism, ADHD, anxiety, or depression takes a validated instrument.

Options include the M-CHAT, a Vanderbilt rating scale, or the PHQ-A questionnaire. Practices running those screens in a mental health EMR keep the scores alongside the ROS rather than inside it.

How to document the ROS so the note holds up

Documentation quality decides whether the note still makes sense months later. Five habits do most of the work:

1. Record present and absent, never just reviewed. Write what you asked and what came back. For example: fever and diarrhea present, chronic cough and rash absent.
2. Lead with the pertinent positives. If the complaint is abdominal pain, give the GI and GU answers in detail. Keep the negative lists short.
3. Show how the ROS changed your thinking. Joint pain with fever prompted same-day bloods, and the note should say so.
4. Know what the ROS does and does not drive. Since the 2021 office-visit revisions, the code level rests on medical decision making or total time. A medically appropriate ROS still evidences medical necessity.
5. Name your informant. Record who answered and anything you could not assess. Note when the pubertal and psychiatric sections were taken confidentially.

A structured clinical record template keeps the section order consistent, so nothing gets skipped when the visit runs late. The same goes for what comes after, which is why a reusable progress note template saves rework.

Before you finish documenting

Run a quick check before the note closes:

• Every section marked, including the ones that came back absent.
• Pertinent positives near the top rather than buried in a negative list.
• The informant named, plus anything you could not assess.
• A line noting that the pubertal or psychiatric questions were taken confidentially.
• Any red flag repeated in your summary, so the next reader cannot miss it.

How Pabau captures the pediatric ROS before the visit starts

A paper checklist has to be retyped into the record, which costs time and loses detail. In busy primary care practices that retyping is the first thing to get skipped.

Practice management software like Pabau sends the ROS out as a digital intake form before the appointment. Automated workflows attach the right form to each appointment type, so a well-child check and a sick visit collect different prompts.

Answers land in the child’s record as structured fields, organized by section. The ROS is already written up when you open the note. Pabau Scribe, our AI scribe, can draft the rest of the note from the consultation, and you review and sign it before it saves.

Ready to streamline pediatric intake and documentation?

Capture the full pediatric ROS on a digital intake form and keep the answers organized by section. Everything saves straight into the child’s record.

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Conclusion

The framework is the part worth protecting. Work all 13 sections, match the wording to the child’s age, and name who answered. Skip sections and you are back to guessing which questions were asked.

None of that survives a paper form that gets retyped at the end of the day. Download the template above and adapt it for your practice. Then book a demo to see how Pabau collects the same 13 sections digitally, straight into the child’s record.

Continue your research

Need the vital signs to go with the history? Our pediatric vital signs chart lists the normal ranges by age, so a reading in the room has something to sit against.

Need a fuller mental health assessment? Our psychiatric evaluation template sets out a step-by-step framework for the conversation a positive psychiatric prompt starts.

Treating a child with a burn? Our pediatric burn chart estimates burn size using pediatric body proportions rather than adult ones.

Writing the visit up afterwards? Our PIRP note template gives you a repeatable structure for problem, intervention, response, and plan.

Wondering where the ROS sits in a SOAP note? Our SOAP notes guide walks through each section, including what belongs in Subjective.

Frequently asked questions