Pediatric physical assessment

History

Physical
Examination
Learning Outcomes
By the end of this session student will be able to:

1. .Identify the importance of assessment of growth

2. Apply communication strategies to improve the quality
of data collected.
3. Demonstrate how measure child weight, height, Hc and
CC
4. Identify infants reflexes and expected time to disappears.
EQUIPMENT
 Growth Monitoring in Childhood

.Definition of growth
Growth –an increase in number and size of cells as
they divide and synthesize new proteins ;results in
.increased size and weight of the whole or parts
Growth is measurable in Kg, pounds, meters,
inches, cm….. Etc
:Types of growth
 Physical growth (Ht, Wt, head & chest
circumference)
 Physiological growth (vital signs …)
Importance of assessing growth and
development

 Help the nurse to acquire knowledge about

normal criteria of growth and development and
then can differentiate abnormal growth and
development in different age groups.
 Help in teaching caregiver and family about
the condition of their children and formulate a
plan of care according to child condition.
Approach to examining children
Make friends with the child .
Be confident .
Explain what you are about to do and what you want the child
to do ,in language he can understand .
Questions should be directed at both the child and parent.
Not ask his permission ,as it may be refused .
Leave unpleasant procedure until last .
 Infants babies are best examined on an examination couch
with a parent next to them.
 Toddlers is best initially examined on their mother’s lap or
parent’s shoulders.
Older children and teenagers are often concerned about privacy
 Growth Assessment of Child

Weight
 length & Height
Head circumference
Chest circumference
 1-Weight:

Weight is measured with appropriately sized beam balance

scale .
Most newborn infants weight 2.700 to 4 kg at birth.
the average weight about 3400g.
Which measures weights to the nearest 10g for infants or
100g for toddlers.
The infant will double his birth weight by
 5-6 months and triple it by 9– 12 months of age.
If infant’s birth weight is not available, calculate the
weight for infant age 3 – 12 months using the
following formula:
  Age in months + 9
Weight = ------------------------
2
For example, the weight of 5 months old infant =
14 9 +5
kg 7 = ------ = ---------
2 2
Formula to calculate normal weight of children from 1
-6 year of age = Age in years X 2 + 8 = ? kg
For example, the weight of a child aging 4 years
 = 4 X 2 + 8 = 16 Kg.
 2-Length

Length (recumbent
supine length) is
taken for infants as
well as children less
than 2 years old.
Average boy’s length
is 50 cm and 49 cm
for girls (normal
range for both sexes
47.5 to 53.75 cm).
.…Length cont
Infant’s length increases about:
 3 cm / month during the first 3 months of age.

 2 cm / month at the age of 4 – 6 months.

 1.5 cm / month at the age of 7 to 12 months.

 For example:

 Calculate the length of 9 months old infant, whose birth

length was 52 cm
Height = (3 x 3) + (3 x 2) + (3 x 1.5) + 52 = 9 + 6 + 4.5 + 52 =
71.5 cm
 Height:

Height (standing) is
measured for children
more than 2 years old.
 Formula to calculate
normal height of
children over 1 year of
age
Age in years X 5 + 80 =
? = cm
Formula to calculate normal height of children
over 1 year of age
Age in years X 5 + 80 = ? = cm
 For example, the length of 2 years old child
= 2 x 5 + 80 = 90 cm.
 3. Head circumference (HC):

Measure the infants HC at birth and at each well

child visit up to age 2 years ,then yearly up to age 6
years .
HC at birth about( 33-35 cm )and is about 2 cm
larger than the chest circumference .
It increases about:
2 cm / month during the first 3 months.
½ cm / month during the second 9 months of age

 
H C example:
The HC of 9 months old infant, whose HC at birth
was 35 cm.
Head circumference = (3 x 2) + (6 x ½) + 35 = 6 + 3 +
35 = 42 cm
 
 The skull has two
fontanels: The anterior and
posterior fontanels.
The anterior fontanel is
diamond in shape.
It is 3 – 4 cm in length and
2 – 3 cm widths.
 It closes at 12 – 18 months

of age. The posterior

fontanel is triangular in
shape .
 It usually closes between 2
and 3 months
4. Chest circumference:

 Normal range is from 30.5 cm to 33cm.

 Chest-measured at nipple line.
 4. Physiological growth (vital signs)

Temperature:
 use electronic thermometer ( axillary or orally )

Pulse rate:
 Apical for infants and small children .

 Radial, temporal or carotid may be measured on older children.

 The pulse increases in response to exercise,anxiety, and fever.

Respirations:
 Count respiration on infant for one full minute.

 In older may be counted for 30 second and multiplied by tow.

Blood pressure:
 Auscultatory method more accurate rather than electronic
Chest assessment cont….
Looking for retractions sites
Auscultation
First heart sound (S1) is heard best with
stethoscope diaphragm over the mitral and tricuspid
areas.
Second heart sound (S2) is heard best with
stethoscope diaphragm over pulmonic and aortic
areas.
Third heart sound (S3) is heard best with
stethoscope bell over the mitral area ,This sound is
considered normal in some children and young
adults but is abnormal when heard in older adults.
S4, if present, indicates the need for further cardiac
evaluation because it’s rarely heard as a normal
heart sound.
murmurs or abnormal heart sounds
produced by blood passing through
a defective valve, great vessel, or other heart
structure.
Qualities of normal breath sounds
:Nervous System
Primitive reflexes : Involuntary movement responses to a
particular stimuli of newborn , can determine level of
neurological maturation as:
 Palmar Grasp
Plantar Grasp
Rotting
Sucking
Moro
Tonic Neck
Babinski
Infant reflexes
Palmar Grasp
Plantar Grasp
Rotting reflex
Sucking
Babinski


Babinski
TONIC-NECK REFLEX
Thank you

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