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4. Let client set the pace for conversations Allow toddler to sit on parent’s lap
Praise cooperation
- Feeding Hx
3. PRESCHOOLERS (3 to 6 years old) - History sa mother during pregnancy;
so that we can “link” the condition of
Use story telling the patient
- To gain cooperation and trust
NOT INCLUDED IF:
Use doll & puppet play - Mother cannot recall
- Old client na like 15 y.o
Give choices when able
Emphasize normality
3. Past Hx
- Prenatal Hx
- Labor & Delivery
- Birth Hx
PHYSICAL ASSESSMENT FOR PEDIATIC CLIENTS: GENERAL MEASUREMENTS
SUMMARY
1. General Measurements
2. Physiologic Measurements
3. Head-to-Toe Assessment
4. Current Development Assessment FOR MORE THAN 2 YEARS OLD
TECHNIQUE
GENERAL MEASUREMENTS
- Remove shoes
- Stand straight with head midline &
1. HEIGHT (LENGTH) vision parallel between ceiling and
floor
FOR LESS THAN 2 YEARS OLD - Back, buttocks, & back of heels
against the wall
POSITIONING MEASURE: CM
- Fully extent the body
- Holding head midline
CALCULATION OF HEIGHT
- Pushing knees downward to extent
legs
-
TECHNIQUE
- Measure from vertex of HEAD to
heel of FOOT
EX:
BL = 45
45 + 22.5
Expected in 1 year = 67.5 or 68
2. WEIGHT
NORMAL VALUES:
Chest Circumference: HC – 2 cm
CALCULATION ON WEIGHT
Normal Birth Weight (BW): 2.5 – 4 kg
3. HEAD CIRCUMFERENCE
LANDMARKS:
7. ANTERIOR FONTANELLE
4. CHEST CIRCUMFERENCE
Diamond-shape
Closes at 12 to 18 months
Only used for children BELOW 2
YEARS OLD
LANDMARK:
8. POSTERIOR FONTANELLE
Triangular
Closes at 2 to 3 months
NOTE:
Fontanelles normally bulge when child
is crying.
FROM BOOK:
NORMAL SIZE
Anterior Fontanelle: 4-5 cm at its
widest part
NEWBORN:
- Use RECTAL
D. ORAL ROUTE
- NOT ADVISABLE:
o Risk for injury sa mucosa
2. PULSE
4. BLOOD PRESSURE
2. VERNIX CASEOSA
3. DESQUAMATION
NORMAL: ABNORMAL:
- If occurring more than 24H after birth - If occurring within 24H after birth
5. LANUGO
6. MILIA
7. ERYTHEMA TOXICUM
- Cause is unknown
- Disappears within a week from birth
- Needs further confirmation
11. HEMANGIOMA
1. MOLDING 1. CEPHALHEMATOMA
- Oddly-shaped head due to overriding - Birth injury with bleeding into the
of sutures in newborns periosteal space
- Swelling of the newborn’s scalp from - Very large head due to excessive
vaginal birth accumulation of CSF.
- Heals spontaneously after a few days
3. MICROCEPHALY
- Small head
- Exposure of the mother to viral
infection (Zica virus, etc.) during
pregnancy
4. DOWN SYNDROME
1. HOTV chart
2. Lea Symbol chart
3. Snellen E chart
1. DOWN SYNDROME
2. BRUSHFIELD’S SPOTS
3. “SUN-SETTING” APPEARANCE
- Suggests hydrocephalus
HEAD-TO-TOE ASSESSMENT: EARS
ABNORMAL FINDINGS
1. LOW-SET EARS
2. EPSTEIN’S PEARLS
2. PERMANENT TEETH
TONSILS
6 YEARS: Reach adult size
10 to 12 YEARS: Twice the adult size
End of adolescence: Atrophy, same as adult
HEAD-TO-TOE ASSESSMENT: THORAX AND LUNGS
NOTE:
AUSCULTATION 5 TO 6 YEARS OLD
Use bell of the stethoscope or small - Anteroposterior (AP) to
diaphragm Transverse Thoracic diameter
Encourage deep breathing during ratio
auscultation
- 1:1 in young children
PERCUSSION - 1:2 when reaches adult
HYPERRESONANCE
- Normal percussion tone elicited in
infants because of thinness of the
chest wall
BREAST
NORMAL VARIATION
1. WITCH’S MILK
HEART
1 TO 4 YEARS OLD
- Left 4th ICS to the Left of Midclavicular Line
4 TO 6 YEARS OLD
- Left 4th ICS, Left MCL
NOTE
SINUS ARRYTHMIA (abnormal heart rhythm)
1. UMBILICAL HERNIA
1. PSEUDOMENSTRUATION 1. PHIMOSIS
- Dapat dry and frequent ang changing - Opening of the urethra is below the
sa diaper end of the penis to the scrotum
4. EPISPADIAS
5. HYDROCELE
7. PARAPHIMOSIS
8. IMPERFORATE ANUS
- No anal opening
NOTE:
MECONIUM
- First stool
- Newborns should pass meconium within 24 to 48 hrs. from birth
HEAD-TO-TOE ASSESSMENT: BACK AND EXTREMITIES
NORMAL VARIATIONS ABNORMAL FINDING
4. SYNDACTYLY
5. TALIPES EQUINOVARUS
- Clubfoot
- There is adduction of forefoot, inversion
of entire foot
- Entire foot points downward
6. CONGENITAL HIP DYSPLASIA
ORTOLANI’S MANEUVER
- Flex knees
- ABDUCT thigh
- Move knees outward and downward
table
BARLOW’S MANEUVER
- Flex knees
- ADDUCT thigh and legs until thumbs
touch
CONGENITAL HIP DYSPLASIA
- For infants there is limited abduction
and difference in limb length
- Leg on affected hip is longer
7. SCOLIOSIS
8. SPINA BIFIDA
AGE OF DISAPPEARANCE
- 3 to 4 months
2. SUCKING REFLEX
EXPECTED RESPONSE
AGE OF DISAPPEARANCE
- 10 to 12 months
AGE OF DISAPPEARANCE
- 3 to 4 months
AGE OF DISAPPEARANCE
- 8 to 10 months
AGE OF DISAPPEARANCE
- 4 to 6 months
6. MORO (or STARTLE) REFLEX EXPECTED RESPONSE
AGE OF DISAPPEARANCE
- 3 months
AGE OF DISAPPEARANCE
- 2 years
AGE OF DISAPPEARANCE
- 2 months
AGE OF DISAPPEARANCE
- 3 to 4 months
EXPECTED RESPONSE:
- Flexion, adduction,
- then extension of opposite leg
EXPECTED RESPONSE:
- Flexion of trunk
- Hip moving towards the stimulated side
EXPECTED RESPONSE:
- Raising of head
- Arching of back
NOTE:
- Absence of the newborn reflex at birth or persistence of a reflex past a certain age may
indicate a problem with CNS Function
CURRENT DEVELOPMENT ASSESSMENT
1. Gross motor skills
2. Fine Motor – Adaptive Skills
3. Language Skills
4. Personal – Social Skills