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Guideline for performing physical exam
- Perform assessment in appropriate, monthreatening area
- Provide time to play and get acquainted
- Observe behaviors that signal childs readiness to cooperate
- Begin with nonthreatening manner for youn child and fearful child
- Begin with most cooperative child to model behavior
- Involve child in the process
- Examine in a comfortable and secure position
- Organized sequence
- Reassure the child throughout, especially about bodily concerns during puberty
- Discuss findings with family at the end
- Praise child for cooperation, give reward
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Measurements
- Ht
- Wt
- Length
- Head circumference
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General survey
- Nutrition
- Personality
- Interaction
- Posture
- Development
- Speech
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Skin
- Color
- Texture
- Temp
- Moisture
- Turgor
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Lymph nodes
- Note size
- Mobility
- Temp
- Tenderness
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Head and neck
- General shape and symmetry
- Range of motion
- Palpate skull
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Eyes
- Compare size of pupils, shape, movement
- PERRLA
- Inspect structures
- Fundus
- Vision testing- ocular alignment, visual acuity, peripheral vision, color vision
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Ears
- Symmetry
- Location
- External structures
- Tympanic membrane
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Nose
- Symmetry
- Mucus memrbanes
- Septum
- Patency
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Mouth and throat
- Move tongue around
- Uvula
- Gums
- Lips
- Teeth
- Tonsils
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Chest
- Size
- Shape
- Symmetry
- Movement
- Breast development
- Bony landmarks
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Lungs
- Observe respirations for rate, rhythm, depth, quality
- Auscultate
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Heart
- PMI
- Capillary refill
- Peripheral pulses
- Auscultate
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Abdomen
- Order of assessment
- Contour & movement
- Quadrants
- Femoral pulses
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Genitalia
- Matter of fact approach, respect privacy
- Males- penis, urethral opening, scrotum & testes, hair distribution
- Females- labia minora & majora, urethral opening, vaginal opening
- Anus- presence
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Back
- Spine for curvature
- Tufts of hair, dimples, or discoloration
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Extremities
- Length
- Size
- Temp
- Color
- Bowleg or knock-knee
- Muscle strength
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Neurological
- Balance and coordination
- Gait
- Body movements
- Fine & gross motor per development
- Reflexes & cranial nerves
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Growth charts
- Standing heights replace length once children can stand
- Head circumference measured until age 5
- BMI calculated based on childs wt and ht (or length) and is calculated as kg or wt/m2 of ht
- Bmi is useful for determining if childs ht and wt are in proportion
- Children below 10th% indicate undernutrition
- Children over 90% indicate overnutrition
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Newborn and infant <6months exam
- Rocking or clicking noises may help when infant begins to get distressed
- Keep exam sequence flexible
- Promote parent-infant bonding and face-to-face interaction
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Infants>6months exam
- Keep in parents lap and hold against parents chest for some steps
- Observe level of activity, mood, and responsiveness
- Use toys to distract
- Use feet to hands approach
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Toddlers exam
- Stranger anxiety
- Tell child what you will do each step and the expectation of cooperation instead of asking
- Demonstrate equipment
- Feet to head approach
- Parents control and set limits on movement, play, behavior, or social interaction
- Parents may be overprotective, which can cause child to be demanding, dependent
- Offer child choices when possible
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Preschoolers exam
- Parents lap or exam table
- Lap underpants on
- Give positive feedback
- Play with equipment
- Do head, eyes, ears, mouth, last
- Recognize association b/w body parts &problems with chronic conditions
- May believe thoughts and behaviors cuased condition
- Emphasize treatment is not a punishment for wrongdoing
- Use play for child to learn self-care, perform activities, feel sense of accomplishment
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School-age child exam
- Exam table
- Gown to cover underpants
- Head to toe suquence
- Understands more about management of conditions
- Try to interact with child of same age and condition
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Adolescent exam
- Protect modesty
- Provide reassurance about normal growth progression
- Head to toe sequence
- Ongoing development of identity, body image, self-concept
- Become more aware of difference from peers
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Standardized vision charts
- Cannot be used to test vission until understands directions and can cooperate
- About 3-4y/o
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Hearing loss result of
- Birth trauma
- Frequent ear infections
- Meningitis
- Antibiotics
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Hearing assessment
- Infants and toddler- widen eyes, breifly stop activity, or turn head toward sound
- Preschool and older children - use whispered words to evaluate hearing of children over 3y/o
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Normative blood pressures
- Newborn (1-3days) - 65/41
- 1mo-2yr - 95/58
- 2-5yr - 101/57
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