PEDIATRIC ASESSMENT

PEDIATRIC ASSESSMENT:
⁃ Growth and development considerations
⁃ HEALTH HISTORY: COLLECTING SUBJECTIVE AND OBJECTIVE DATA
⁃ Pediatric physical assessment

Collecting subjective data

⁃ Are collected through interviewing the family caregiver and the child
⁃ Listen and communicate. Introduce and explain your purpose.
⁃ Establish rapport.

Interviewing family caregivers

: a family caregiver provides most of the information needed in caring for the child,
especially the infant or toddler.
⁃ Ask questions and note them
⁃ Avoid being judgmental

Interviewing the child

: important that the preschool child and the older child be included in the interview
⁃ Be age-appropriate
⁃ Establish rapport
⁃ Listen

Interviewing the adolescent

: adolescents can provide information about themselves.
⁃ Interview in private

Obtaining a client history

: when a child is brought to any healthcare setting, it is important to gather information
regarding the child's current condition, as well as medical history.
⁃ Biographical data
⁃ Chief complaint
⁃ History of present health concern
⁃ Health history
⁃ Family health history

⁃ Review of systems for current health problem

⁃ Allergies, medications, and substance abuse
⁃ Lifestyle
⁃ Developmental level

Collecting objective data

⁃ Collection of information through observations
⁃ Includes the nurse doing a baseline measurement

General status
⁃ Observing general appearance
⁃ noting psychological status and behavior

Developmental stages
: Infancy - a period of rapid growth in which the head, especially the brain grows faster than
other tissues.
: toddler – preschool age - a period of slow growth in which the trunk grows faster.
: school-age - a period of slow growth in which the limbs grow faster.
: Adolescent - a period of rapid growth for the trunk, including the gonads and other tissues.

Checks in infant assessment

⁃ Head and chest circumference in neonates are relatively equal
⁃ Neonates behavior is controlled by reflexes
⁃ At age 1 to 4 months posterior fontanelle closes
⁃ At age 5 to 6 months birth weight doubles and infant voluntarily grasps and releases
objects and exhibits signs of attachment to parent.
⁃ At 7 to 9 months infants are just objects outside his perceptual field
⁃ At 10 to 12 months, birth with triples and birth length increases about 50%

What to expect in a toddler

⁃ Gains 4 to 6 pounds per year
⁃ Exhibit egocentric behavior
⁃ Demonstrate separation in anxiety
⁃ Climbs stairs at age 21 months, runs and jumps by age 2 and rides a tricycle by age 3
⁃ Has first molars
⁃ Says 4 to 5 word sentences and is 75% intelligible by three
⁃ Begins toilet training

Normal findings in a preschooler

⁃ Pulse rate ranges from 90 to 100 bpm
⁃ Respiratory rate 25 breaths per minute
⁃ Blood pressure ranges from 85/60 to 70/90 MMHG
Motor skill milestones for preschoolers
⁃ Dresses without help
⁃ Build towers or blocks
⁃ Copies circles and lines
⁃ Uses scissors
⁃ Strings large beads
⁃ Throws a ball overhead
⁃ Alternate feet on steps
⁃ Hops on 1 foot
⁃ Skips at age 5
⁃ Develops hand dominance
⁃ Enjoys the sandbox, water play, blocks, crayons, play and finger paint.

Cognitive development in the adolescent

⁃ ABSTRACT THINKING
⁃ Increased ability to analyze, synthesize and use logic

Secondary sex characteristics in male adolescent

⁃ Testicular enlargement
⁃ Increase in muscle mass
⁃ Broadening of the chest
⁃ Increase in facial and body hair
⁃ Voice deepens
⁃ Pubic hair growth
⁃ Increase in sweat glands and sebaceous gland activity
⁃ Increase in body odor
⁃ Increase in Acne
⁃ Nocturnal emissions
⁃ Masturbation with ejaculation

Secondary characteristics in female adolescent

⁃ Breast development
⁃ Increased fatty tissues in the thighs, hips and breast
⁃ Broadening of the hips
⁃ Onset of menses
⁃ Pubic hair growth
⁃ Increased in sweat glands and sebaceous gland activity
⁃ Increase in body odor
⁃ Increase in acne

Measuring height and weight

: when to measure. Height and weight should be measured and recorded each time the child
has a routine physical examination, as well as the other health care visits.

How to Measure height

⁃ The child who can't stand usually is measured for height at the same time
⁃ To measure the height of a child who is not able to stand alone steadily, usually under
the age of about two, please the child flat, with knees held flat, what are examining table;
measure the child's height by straightening the child's body and measuring from the top of
the head to the bottom of the foot.

How to measure weight

: if a child is young enough to have his length measured while he's lying down, you most
likely weigh him with an infant scale.
⁃ To prevent injury, never turn away from a child in the scaler never leave him
unattended
⁃ You can usually use in huddle scale to weigh children older than age 2 or three

Measuring head circumference

: the head circumference routinely measured in children to DH2 or three years are in any
children with a neurologic concern.
⁃ You should measure a child's head circumference until he is 36 month old.

Vital signs
⁃ Including temperature cools respirations and blood pressure, are taken at each visit
and compared with the normal values for children at the same age.

Pulse
: the pools the apical pulse should be counted before the child is disturbed disturbed for
other presidios. Does that to school the stethoscope is placed between the child left knee pool
and sternum. I radical pools may be taken on an older child. Pools rates vary with age: from
100 to 1 80 bpm for a neon 8 to 52 95 bpm for the 14 to 18 years old adolescent

Respirations
: the child can be observed why lying or sitting quietly; infants are abdominal breathers;
therefore the movement of the infants abdomen is observed to count respirations.
⁃ Older child: same with adults
⁃ The infants respirations must be counted for a full minute because of normal
irregularity.
⁃ Retractions are noted as substernal, subcoastal, intercoastal, suprasternal, or
supraclavicular

Blood pressure

: four children three years of age and older, blood pressure monitoring is part of routine and
ongoing data collection; the most common sites used to obtain a blood pressure reading in
children are the upper arm lower arm or four arm thigh and calf of ancle; the blood pressure
is taken by also auscultation palpitation or doppler or electronic method

Pediatric Physical examination

⁃ Data are also collected by examining the body systems of the child

Pediatric skin

Neonates and infants - bacterial and candida infection may occur with diaper rash.

Pre-school and school-age children

⁃ Younger children are susceptible to common disorders. They typically have bruises
on their lower extremities resulting from active play.
Adolescents — at puberty hormonal changes affect the child's skin and hair

Pediatric head and neck

Symmetry or a balance is noted in the features of the face and in the head.
⁃ Assess the range of motion
⁃ Assess the fontanelles in infants
⁃ Assess the eyes
⁃ Assess the ears
⁃ Assess the nose mouth and throat
⁃ Check for head and facial symmetry
⁃ Note shape and symmetry of his head; note for craniosynostosis.

Pediatric neck examination

⁃ Assess the child's head and neck muscles
⁃ Neck mobility is an important indicator of neurologic disorders
⁃ Cerebral function is to assess level of consciousness in a young child, it uses motor
cues1. Observe for lethargy drowsiness and stupor2. Observe for hyperactivity
Pediatric eyes and vision

⁃ Behavior problems or Poor performance in school may be related to difficulty seeing

the chalkboard.
History queStions : look for clues the familial I disorders such as refractive error's and
retronobasltoma. As the parents of the child hold reading materials close to his face to read, a
sign of myopia, or nearsightedness.
Physical examination - includes tests for visual acuity an inspection for strabismus.

Pediatric visual acuity examination.

: because visual acuity and that perception develop fully by age 7, you can test vision in the
school aged children as you would in adult:
Just a child age 4 with the E chart
⁃ This chart is made up entirely of capital e’s legs pointing up down right or left.
⁃ The child identifies what he sees with his hands or fingers the position of each e.
⁃ No method accurately measures visual acuity in children younger than age four.
⁃ But testing with Allan cards may provide useful data
⁃ Each card contains an illustration of a familiar objects such as a Christmas tree
birthday cake or horse

Pediatric ears and hearing

An infant younger than six months should respond to a spoken voice,

⁃ By six months an infant can localize the direction of sound; I'm by age 5 a child's
hearing is fully developed.

: investigate a child's speech development by listening to him carefully, speech development

reflects hearing acuity during childhood. Observe behaviors for possible signs of ear
disorders.

Pediatric chest and lungs.

⁃ Chest measurements are done on infants and children to determine normal growth
rate.
⁃ How to measure the chest
⁃ Adolescent in the older school-age child or adolescent note evidence of breast
development
⁃ Assessed respiratory characteristics. Evaluate respiratory rate rhythm and depth;
report any noisy or granting respirations.
⁃ How to assist breath sounds.

Pediatric heart assessment

⁃ in some infants and children, a pulsation can be seen in the chest that indicates the
heartbeat, which is called the point of maximum impulse.
⁃ Assessing heart rate and rhythm
⁃ Assessing for a heart abnormalities
⁃ Assess the heart functions effectiveness
Pediatric abdomen
Auscultation significant findings:
⁃ Abdominal murmur - may indicate coarctation of the aorta.
⁃ High-pitched abdomen sounds — may indicate abdominal obstruction or
gastroenteritis
⁃ Venous hum - may indicate portal hypertension
⁃ Splenic or hepaatic friction rub - may indicate inflammation
⁃ Double sounds in the femoral artery- may indicate aorctic insufficiency
⁃ Absence of bowel sounds - may indicate paralytic ileum or peritonitis
⁃ CLUE TO PEDIARIC ABDOMINAL PAIN : 1. Guarding 2. Grimacing 2. Change in
pitch of cry

Pediatric genitalia and rectum

⁃ It is important to respect the child's privacy and take into account the child's age and
stage of growth and development.

Pediatric urinary system

: inspect the skin for anemic pallor

Palpate for bladder distention and kidney enlargement.

Cause of bed wetting:

⁃ Bladder irritation
⁃ Urethral irritation
⁃ Emotional difficulties

Pediatric back and extremities

: the back and extremities should be assessed Wagner manatees. Assess the back.
⁃ Observe : symmetry and for curvature of the spine:
⁃ Infants: spine is rounded and flexible; as the child grows and develops motor skills,
the spine further develops
⁃ Asses gait and posture.
⁃ Assess gait and posture when the child enters or is walking in the room
⁃ Assess the extremities . The extremities should be warm, have a good color, and be
symmetrical

Pediatric neurologic status

⁃ Assessing the neurologic status of the infant and child is the most complex aspect of
the physical exam.
⁃ Includes:
⁃ Neurologic exam (reflex, cranial nerve function)
⁃ Neurologic assessment tools (Glasgow coma scale)

2. FUNTIONAL ASSESSMENT TEST

2.1 Newborn
Newborn assessment includes:
⁃ Initial and ongoing assessment
⁃ A head to toe physical examination
⁃ Neurologic and behavioral assessment.

APGAR SCORING SYSTEM

⁃ The Apgar score is a test given two newborns soon after birth.
⁃ This test checks the baby’s heart rate muscle tone and other signs to see if extra
medical care or emergency care is needed.
⁃ Apgar stands for appearance pulse grimace activity and respiration.
⁃ In the test, five things are used to check for a baby’s health. Each is scored on a scale
of 2 to 0, with two being the best score
⁃ Appearance skin color
⁃ Pulse ( heart rate)
⁃ Grimace response or reflexes
⁃ Activity muscle tone
⁃ Respiration breathing rate and effort
⁃ A baby who score a 7 or above on the test is considered good health.
⁃ A lower score means that your baby may need some immediate medical care, such as
suctioning of the airways or oxygen to help him or her breathe better.
⁃ A slightly low score especially at one minute is common, especially in babies born:
⁃ After high risk pregnancy
⁃ Through a C-section
⁃ After a complicated labor and delivery
⁃ Prematurely

2.2 infants and children - MMDST

⁃ The Metro Manila developmental screening test or MMDST is a screening test to note
for normalcy of the child's development and to determine any delays as well in children 6
1/2 years old and below.
⁃ Recommendations for measurement intervals include:
⁃ Infants (0 - 12 months) - every two months
⁃ Young children at 15, 18, 24 and 30 months
⁃ Age 3+ calling every year

KATZ and decks of independence in activities of daily living scale ( Katz ADL) - is a widely
used tool to assess the level of independence in older adults.
Barthel index- assesses functional independence, generally stroke patient.