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Pediatric Physical Assessment

Pediatric Physical Assessment

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Published by: Dennis Nabor Muñoz, RN,RM on May 24, 2010
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11/02/2014

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PEDIATRIC ASSESSMENT: FOCUS ON PHYSICAL ASSESSMENTCLASS 8Pediatric Assessment: The Major Focus
Major differences between children and adults
Specific approaches and techniques to physical exam
 Normal findings, variations and common pathological conditions
Interpretation of exam results
Major Concepts in Pediatric Physical Assessment
Children are not little adults
Understanding differences from adults is important
Differences relate to both growth and development patterns
Differences exist in motor skills and coordination, and in physiologic, psychosocial, behavioral,temperamental, language, and cognition areas
Skills Utilized in Working with Children
Knowledge of growth and development
Communication skills with children and their parents
Understanding of family dynamics and parent-child relationships
Knowledge of health promotion and anticipatory guidance
Major Concepts for Assessment and Health Promotion
Development
Medical history
 Nutritional status
Growth and vital sign measurements
Physical assessment
Guidelines for well child supervision
Anticipatory guidance
Immunizations
Exam Settings
Outpatient (office, clinic emergency room)
Well child check 1
 
Illness visit
Inpatient
Moderate to severe illness
Anxiety and stress
School setting or health office
Children usually healthy
Illness visits primarily common acute problems and some chronic illness issues
Health screenings
Environmental Setting
Safety is primary
Pleasant, comfortable settings are helpful
Accessible toys for young children are distracters and may reduce anxiety
Age appropriate literature or items for teens and older children provide diversion in waiting areas
Standard Measurements
Weight
Height
Head Circumference
Chest Circumference
Vital Signs
Temperature
Pulse, Heart Rate
Respiration
Blood Pressure
Gestational Age Assessment and Intrauterine Growth Charts
Sensory Issues
Smell: usually not tested; observe for unusual odors from child
Taste: usually not tested; infants often prefer sweet tasting foods
Touch: well developed in infant; if stimulated can invalidate other sensory tests
Vision: right eye (OD), left eye (OS), both eyes (OU)
Hearing: correlates with language development; localization requires both ears
Specific Evaluations
Development
Vision
Hearing
Language
Key Points to Assessment Procedure
Head to foot exam is most orderly
Vary sequence according to child’s response
Examine young children in parent’s lap
Do intrusive examinations last2
 
Approach to Physical Exam
Consider age and developmental level; observe for “readiness” clues
Take time to get “acquainted”
Use play techniques for infants and young children
Determine best exam place ( table, parent’s lap, examiner’s lap)
Use systematic approach; but be flexible to accommodate child’s behavior 
Examine least intrusive areas first (i.e., hands, arms)
Examine sensitive, painful or intrusive areas last (i.e. ears, nose, mouth)
Determine what exam you want to complete before possible crying (i.e. heart, abdomen)
Age Groups
 Neonate/NewbornBirth to 28 days
Pre-termGestational age <37 weeks
TermGestational age 37-42 weeks
Post-termGestational age > 42 weeks
InfantBirth to 1 yea
Young, ImmobileBirth to 6 months
Older, Mobile6 to 12 months
Young Child1-5 years
Toddler1-3 years
Pre Schooler3-6 years
School Age or Older Child6-12 years
Adolescent13 to 18/21 years
Pre-Adolescent10-12 years
Approach to InfantsBirth to 6 months
: If baby is comfortable and stress free, exam can be conducted on table. Sensorymethods, such as voice, noise makers, toys to see or touch, or skin touch attract babies. They like asmiling human face. Do quiet things first, then head to toe.
6 to 12 months:
Consider exam in parent’s lap due to separation or stranger anxiety (up to 4 years).“Warm up” more slowly with play techniques. Object permanence and ability to anticipate develops,so provide comfort measures after unpleasant procedures. Increased mobility leads to additional safetymeasures and limit-setting concepts, which continue with each age group.
Approach to Toddlers
Exam in parent’s lap, due to need for parent security. Play games. Do least intrusive things first.Save ears, nose, throat for last. Avoid “no” responses or choices they can not make. Offer simpleacceptable choices. Let them touch equipment.Approach to Pre-SchoolersKeep parent close. Some will cooperate with exam on table. Protect modesty. Use dolls, animalsor parents to “examine” first. Magical thinking may cause fearfulness or thinking equipment isalive. Let them play with equipment. Use familiar, safe, non-frightening words and approaches.3

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