PHYSICAL ASSESSMENT

OF CHILD
PARTICIPANTS
LUCY KALINGA(2020-04-14526)
KATISHO L JOHN (2020-04-14483)
YONAH D MAJAMAN (2018-04-11638)
Objectives
By the end of this presentation, you will be able to:
• Describe growth measurement in pediatric patients
• Understand the growth Charts and interpretation
• Highlight the physiological measurement
• Highlight general appearance of pediatric patients
• Assess Head to Toe
• Assess Nervous System in pediatric patient
Clinical Assessment of Pediatric
Patient(Infant,
Physical assessment of Pediatric Patient will base on the following
• Growth measurement
• Physiologic Appearance
• General Appearance
• Head to Toes Assessment
• Neurologic Assessment
• Developmental Assessment
Growth Measurement
• Height or Length
0-36 months recumbent length
2-18 years stature (standing height)
• Weight
• Head circumference
• Skinfold thickness
• Arm circumference
Values for these growth parameters are plotted on percentile charts, and the
child’s measurements in percentiles are compared with those of the general
population.
 Growth Measurement cont……
General Trends in Height and Weight gain during Childhood
AGE GROUP WEIGHT HEIGHT
Birth -6 months Weekly gain: 140-200 g Monthly gain: 2.5cm
Birth eight doubles by end of first 4-7 months
6-12 months Weight gain: 85-140 g Monthly gain: 1.25 cm
Birth weight triples by end of first year Birth length increases by approximately
50% by end of first year
Toddlers Birth weight quadruples by age 2.5 Height at age 2 is approximately 50% of
eventual adult height
Gain during second year: about 12cm
Gain during third year: about 6-8 cm
Preschoolers Yearly gain: 2-3 kg Birth length doubles by age 4
Yearly gain: 5-7.5 cm
School-age Yearly gain: 2-3 kg Yearly gain after age 7:5 cm
children Birth length triples by about age 13
General Trends in Height and Weight Gain
During Childhood cont’d
AGE GROUP WEIGHT HEIGTH
PUBERTAL GROWTH SPURT Weight gain: 7-25 kg Height gain: 5-25cm approximately
Females- 10-14 years Mean: 17.5 kg 95% of mature height achieved by
onset of menarche or skeletal age
of 13 years
Males- 11-16 years Weight gain: 7-30 kg Height gain: 10-30 cm
Mean: 23.7 kg approximately 95% of mature
height achieved by skeletal age of
15 years
Mean: 27.5 cm
WHO Growth Charts
for Infants and Children Birth to 24 Months
Child growth is monitored to:
Assess adequacy of nutrition
Identify weight status and potential for obesity
Screen for disease related to abnormal growth
Growth charts are
the standard tool
for interpreting growth
WHO Growth Standards
Birth to 24 Months
• Growth Parameters
– Weight-for-age
– Length-for-age
– Weight-for-length
– Head circumference-for-age

• No BMI percentile because this is not a measure used for

children younger than 2
Practice Scenario - Birth
• Omar is a 3 month old breastfed male infant:
• Birth date: 15 APR 2012
• Birth weight: 3.41 kg
• Gestational age: 38 weeks
• Plot the point and describe his weight-for-age percentile
• Description: “weight-for-age is at the 50th percentile
Growth Charts Interpretation
• Children between 5th and 85th percentile likely to be growing normally
• Consider the size of parents, ethnic, racial, genetics, environmental
factors, nutrition, activity levels and health conditions.
Benefits of Using WHO Growth Charts
• Based on high quality population data
• Growth charts used as growth assessment tools and feeding
recommendations
• Supports breastfeeding as optimal nourishment
• Allows provider to address feeding practices and family environment
Physiological Measurements
• Temperature,
• Pulse
• Respiration
• Blood Pressure
Vital Sign How is it assessed Normal Abnormal Clinical Significance
Temperature
Physiological Measurement
Thermometer placed on sites such as
oral, axillary, rectal, tympanic
membrane, ear canal
36.5-37.5 Celcius <36.5 or
>37.5°C
Sign. for infection,
Anemia, Diarrhea,
Dehydration
Pulse
cont…..
Taken radially in children older than 2
years old, in infants and young
children, the apical impulse (AI)
Infants:100-160
bpm
Toddlers: 90-
Below or
Above
Heart conditions,
infections,
Dehydration, Anemia,
140bpm Thyroid disorders,
Children 6-12 Medication
years: 70-
120bpm
Respiration Observe abdominal movements, Newborn: 30-- Below or Respiratory infections,
because respirations are primarily 60b/min Above heart failure
diaphragmatic. Infants -pre
schoolers: 20-
30Schoolaged-
Adolescent: 12-
20
Blood Pressure Auscultation or use of automated
devices
General Appearance
• Observe the Child’s size, posture, body movement and level of alertness.
• Assess for Skin color and texture.
• Facial features
• Body habitus and Nutrition status
• Respiration Status
• Circulatory status
• Hydration status
• Overall cleanliness and hygiene
• Behaviour
Head to Toes Assessment
• Head and Neck
Note for a flattening of the head
Marked asymmetry is usually abnormal and may indicate premature
closure of the sutures (craniosynostosis).
Note head control in infants and head posture in older children.
Palpate the skull for patent sutures, fontanels, fractures, and swellings.
Head and Neck Assessment cont..
Normally, the posterior fontanel closes by 2 months old, and the
anterior fontanel fuses between 12 and 18 months old.
Early or late closure is noted, because either may be a sign of a
pathologic condition.
Palpate the lymph nodes for any enlargement or tenderness and
evaluate the range of motion of the neck.
Head to Toes Assessment Cont….
• Eyes
Assess the eyes to observe for symmetry and location in
relationship to the nose
Note for any redness, evidence of rubbing or drainage, ask the
older child to follow a light to observe her or his ability to focus
Observe pupils for equality, roundness, and reaction to light.
• Ears
Measure the height alignment of the pinna by drawing
an imaginary line from the outer orbit of the eye to the
occiput, or most prominent protuberance of the skull.
The top of the pinna should meet or cross this line.
Note the child’s ability to hear during normal conversion
Head to Toes Assessment Cont….
• Nose, Mouth, and Throat
The nose is in the middle of the face, if an imaginary line were drawn
down the middle.
Both sides of the nose should be symmetrical
Observe for swelling, drainage, or bleeding
Nose, Mouth and Throat cont..
Have the older child hold his or her mouth wide open and move the
tongue from side to side, with the infant or toddler use a tongue blade
to see the mouth and throat.
Observe the mucous membranes for color, moisture, and any patchy
areas that might indicate infection
Observe the number and condition of the child’s teeth.
Head to Toes Assessment Cont…
• Chest and Lung
Chest measurements are done on infants and children to determine
normal growth rate.
How to measure the chest. Take the measurement at the nipple level
with a tape measure; observe for chest size, shape, movement of the
chest with breathing, and any retractions.
Adolescents. In the older school-age child or adolescent, note evidence
of breast development.
Chest and Lung cont..
Assess respiratory characteristics. Evaluate respiratory rate, rhythm,
and depth; report any noisy or grunting respirations.
How to assess breath sounds. Using a stethoscope, the nurse listens to
breath sounds in each lobe of the lung, anterior and posterior, while
the child inhales and exhales; describe, document, and report absent or
diminished breath sounds, as well as unusual sounds such as crackling
or wheezing.
Head to Toes Assessment cont..
• Heart
In some infants and children, a pulsation can be seen in the chest that
indicates the heart beat, which is called the point of maximum impulse.
Assessing heart rate and rhythm. The nurse listens for the rhythm of the
heart sounds and counts the rate for 1 full minute.
Assessing for heart abnormalities. Abnormal or unusual heart sounds
might indicate the child has a heart murmur, heart condition, or other
abnormality that should be reported.
Assess the heart function’s effectiveness. To determine the heart function’s
effectiveness, the nurse assesses the pulses in various parts of the body.
Head to Toes Assessment cont..
• Abdomen
The abdomen may protrude slightly in infants and small children.
Dividing the abdomen. To describe the abdomen, divide the area into
four sections and label sections with the terms left upper quadrant
(LUQ), left lower quadrant (LLQ), right lower quadrant (RLQ), and right
upper quadrant (RUQ).
Assess bowel sounds. Using a stethoscope, the nurse listens for bowel
sounds or evidence of peristalsis in each section of the abdomen and
records what is heard.
Head to Toes Assessment cont..
• Genitalia and Rectum
When inspecting the 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.
Inspect the genitalia and rectum. While wearing gloves, the nurse
inspects the genitalia and rectum; observe the area for any sores or
lesions, swelling, or discharge.
Assess the testes. In male children the testes descend at varying times
during childhood; if the testes cannot be palpated, this information
should be reported.
Head to Toes Assessment cont…
• Back and Extremities
The back and extremities should also be assessed for abnormalities.
Assess the back. The back should be observed for symmetry and for curvature
of the spine; in infants the spine is rounded and flexible; as the child grows
and develops motor skills, the spine further develops.
Assess gait and posture. Note gait and posture when the child enters or is
walking in the room.
Assess the extremities. The extremities should be warm, have good color, and
be symmetrical; by observing the child’s movements during the exam, the
nurse notes range of motion, movement of the joints, and muscle strength.
Neurological Assessment
• Neurological Assessment
Assessing the neurologic status of the infant and child is the most
complex aspect of the physical exam.
Neurologic exam. The practitioner in the health care setting assesses
the neurologic status of the child by doing a complete neurologic exam;
this exam includes detailed examination of the reflex responses, as well
as the functioning of each of the cranial nerves.
Neurological Assessment cont..
• Neurologic assessment tools. The nurse uses a neurologic assessment
tool such as the Glasgow coma scale; the use of s standard scale for
monitoring permits the comparison of results from one time to
another and from one examiner to another; using this tool, the nurse
monitors various aspects of the child’s neurologic functioning.
Developmental Assessment of Pediatric
Gross Motor Fine motor and Hearing and Social
vision language
3 months Head control Reaches for Objects Cries, laughs, laughs
Fixes and follow vocalizes (4 months)
6 months Rolls over Coordination Localises sound Alert and interested
Pushes up Transfers Babbles Start solids
9 months Sits alone Pincer grip Inappropriate Stranger anxiety
Crawls sounds
12 months Stands alone Pincer grip Babbles, Socially responsive,
Understands simple wave bye
commands, says ‘
mamma/Dadda’
18 months Walk alone Uses spoon Uses words Stranger shyness,
Tantrums
2 years Runs, stairs( 2 feet Circular scribbles 2 words phrases Knows identity,
per step) and lines parallel play
Developmental Assessment cont..
Gross motors Fine motor and Hearing and Social
vision language
3-4 years Stand on one foot, Builds bridge with Short sentences, Interactive play
stairs ( Climbs with bricks knows colours
one foot per step at
3 years)
5 years Skips/ hops Full Drawings Fluent speech Dresses self
THANK YOU