Version June 2024
| History of presenting illness |
| Nutrition history |
| Dietary history – Including changes in appetite and recent oral intake (quantity and quality of diet) |
| Recent change in weight |
| Recent swelling of feet |
| Associated symptoms |
| Stool pattern, especially diarrhea (increased volume and watery, frequency, presence of blood) |
| Fever |
| Cough (acute or chronic) |
| Decrease in urine output |
| Past medical history |
| Neonatal history |
| Prematurity |
| Low birth weight |
| Twin birth |
| Birth asphyxia |
| Infant feeding history |
| Duration of breastfeeding |
| Use of breast milk substitutes |
| Age and diet at weaning |
| Other |
| Recurrent diarrhea or pneumonia |
| Recurrent or recent thrush (suggests possible immunosuppression) |
| Other chronic disease, such as cancer |
| Recent history of or contact with infectious disease, such as tuberculosis or measles |
| Preventive health care |
| Immunizations received |
| Vitamin A supplementation |
| Family history |
| History of tuberculosis or HIV |
| Social history |
| Family structure |
| Number of living parents or other caregivers |
| Number of siblings |
| Birth order of this patient |
| Economics |
| Parents' occupation |
| Household income |
| Availability of food |
| Accommodation |
| Crowding |
| Water source |
| Sanitary facilities |
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