The initial evaluation of a child with a congenital anomaly requires patience, empathy, knowledge, and a support staff. The conversation between doctor and family should be in lay terms with avoidance of medical jargon, except for important terminology concerning the named diagnosis. Misconceptions concerning the anomaly and its underlying pathogenesis are common and should be dispelled. Children with considerable anomalies or an underlying syndrome require medical, psychological, financial, and social assistance. This type of care is best provided at an institution familiar with the care of “challenged” children.

The history should be comprehensive and include questions concerning familial occurrence of limb anomalies, prenatal problems, birth history, and child development. The family history is particularly pertinent in congenital anomalies with known familial propagation, such as polydactyly and syndactyly. The prenatal history is important with regard to possible causes. Inquiry includes questions about previous pregnancies, stillbirths, or miscarriages. The birth history should include the duration of pregnancy, time and length of delivery, position at time of birth (e.g., breech presentation), and posture of the affected limb(s). Details about the achievement of developmental milestones (e.g., sitting, standing, walking, and talking) are important, because the presence of a congenital anomaly does not negate the possibility of additional problems, such as cerebral palsy.