TAKEN FROM FUNDAMENTALS OF PEDIATRICS BY NAVARRO

Physical Examination

1. General survey
a. Mental state or sensorium, level of activity, shrieking cry, grunting, affect (cheerful,
irritable)
b. Cardiopulmonary distress, color, chest retractions
c. Gait if ambulatory, position if bedridden
d. Nutritional state (well, under, or overnourished)
e. State of hydration (dry skin, sunken eyeballs)
f. Well, mildly ill, or severely ill-looking
2. Vital signs
a. Temperature (T °C) – can measured through oral, rectal, aural, or auxillary examination
(choice is made based on the child’s age, development, and medical condition
b. Cardiac rate (CR), pulse rate (PR), and respiratory rate (RR)
c. Blood pressure (BP) – taken routinely beginning at 3 years old or at any age when
relevant to illness
d. Anthropometric data
i. Weight (Wt) in kg
ii. Length (Lt) for children <3 years old, height in cm for children ≥3 years old
1. Supine length in <3 y.o.
iii. Head circumference (HC) in cm for <3 years old; measured over the maximum
point of occipital protuberance and a point just above the supraorbital ridge
iv. Other measurements
1. Chest circumference (CC) in cm
2. Abdominal circumference (AC) in cm, arm span, U (upper segment)/L
(lower segment) ratio for children with growth disorders;
v. Nutritional status: BMI
3. Physical Exam Proper
a. Skin – color, turgor, loss of subcutaneous tissue, rash or eruptions, hemorrhages, scars,
edema, jaundice
b. Head – shape or contour of the head, sutures, and hair; scalp: hematoma, abscess, or
edema; check fontanels for infants; note quantity and color of the hair
c. Face – look for any asymmetry, unusual facies, and deformities
d. Eyes – check the lids, conjunctivae, sclerae, pupils, extraocular movements, vision,
strabismus, opacities, discharge, red orange reflex (ROR), corneal light reflex; note any
lid edema, pallor or hyperemia of the conjunctivae, pterygium, subconjunctival
hemorrhage, or opacities (plaques) such as in Bitot’s spots; note ictericiae or unusual
coloration on the sclerae
e. Ears – note size, shape, location, and position of the ears relative to the rest of the head;
inspect ear canal for any watery, purulent, or bloody discharge; check postauricular and
mastoid areas
f. Nose – check for patency of nares, alar flaring, presence and character of discharge,
position of septum, and sinus tenderness
g. Mouth and throat – inspect the lips, gums, tongue, mucous membrane, dentition,
palate, posterior pharyngeal wall, and tonsils