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• Pediatric Assessment


  • Knowledge of Growth and Development
  • Development of a Therapeutic Relationship
  • Communication with children and their parents
  • Understanding of family dynamics and parent-child relationships: IDENTIFY KEY FAMILY MEMBERS
  • Knowledge of Health Promotion & Disease Prevention
  • Patient Education and Anticipatory Guidance
  • Practice of Therapeutic and Atraumatic Care
  • Patient and Family Advocacy
  • Caring, Supportive & Culturally Sensitive Interactions
  • Coordination and Collaboration
  • CRITICAL THINKING
• Introduction


  1. Key elements

  2. Times: Every month in the 1st year, Every 3 month of the 2nd and 3rd year, Each 6 month of 4th and 5th year, Yearly after the 6th year

  3. Avoid touching painful areas until confidence has been gained

  4. Begin exam without instruments

  5. Allow child to determine order of exam if practical

  6. Use the same format as adult physical exam
• Infant Exam


  1. Examine on parent lap

  2. Leave diaper on

  3. Comfort measures such as pacifier or bottle

  4. Talk softly

  5. Start with heart and lung sounds

  6. Ear and throat exam last
• Toddler Exam


  1. Examine on parent lap if uncooperative

  2. Use play therapy

  3. Distract with stories

  4. Let toddler play with equipment / BP

  5. Call by name

  6. Praise frequently

  7. Quickly do exam
• History


  • Bio-graphic Demographic: Name, Date of Birth, Age, Parents & siblings info, Cultural practices, Religious practices, Parents' occupations, Adolescent – work info
  • Past Medical History: Allergies, Past illness, Trauma / hospitalizations, Surgeries, Birth history, Developmental, Family Medical/Genetics
  • Current Health Status: Immunization Status, Chronic illnesses or conditions, What concerns do you have today?
• Equipment


  • Stethoscope & Sphygmomanometer
  • Pen Light
  • Otoscope / Opthalmoscope
  • Scale
• Review of Systems


  1. Ask questions about each system

  2. Measurements: weight, height, head circumference, growth chart, BMI

  3. Nutrition: breastfed, formula, favorite foods, beverages, eating habits

  4. Growth and Development: Milestones for each age group
• Physical Exam Technique


  • Inspection- eye only
  • Palpation- tip of finger
  • Percussion- use dullness (solid organ), resonance (over solid organ or filled air), tympanic (hollow organ)
  • Auscultation- stethoscope
• History: Review of Systems

  • Skin
  • HEENT
  • Neck
  • Chest & Lungs / Respiratory
  • Heart & Cardiovascular
  • GI
  • GU & GYN
  • Musculoskeletal & Extremities
  • Neuro
  • Endocrine
  • Sleep & Activity
  • Appetite
  • Bowel & Bladder
• In a time crunch, these three questions should give you enough insight into the child's general functioning
• Physical Assessment


  • Orderly
  • Systematic
  • Head-to-toe
  • Flexibility is essential
  • Kind and gentle
  • Firm, direct and honest
• General Appearance & Behavior

  • Facial expression
  • Posture / movement
  • Hygiene
  • Behavior
  • Developmental Status
• Vital Signs


  • Temperature: rectal only when absolutely necessary
  • Pulse: apical on all children under 1 year
  • Respirations: infant use abdominal muscles
  • Blood pressure: admission base line
  • And the "Fifth" Vital Sign is ____?
• Pediatric Vital Signs - Normal Ranges

  • Heart Rate: 80-150 (infant), 70-110 (toddler), 60-110 (school-age), 60-100 (adolescent)
  • Respiratory Rate: 24-38 (infant), 22-30 (toddler), 14-22 (school-age), 12-22 (adolescent)
  • Systolic blood pressure: 65-100 (infant), 90-105 (toddler), 90-120 (school-age), 110-125 (adolescent)
  • Diastolic blood pressure: 45-65 (infant), 55-70 (toddler), 60-75 (school-age), 65-85 (adolescent)
• Physical Assessment


  • General
  • Skin, hair, nails
  • Head, neck, lymph nodes
  • Eyes, ears, nose, throat
  • Chest, Tanner Scale
  • Heart
  • Abdomen
  • Genitalia, Tanner Scale, Rectal
  • Musculoskeletal: feet, legs, back, gait
• Palpation


  • Use of your fingers and palms to determine: Temperature, Hydration, Texture, Shape, Movement, Areas of Tenderness
  • Warm hands and short nails
  • Palpate areas of tenderness / pain last
  • Talk with the child during palpation to help him relax
  • Be observant of reactions to palpation
  • Move firmly without hesitation
• HEENT: Head & Neck, Eyes, Ears, Nose, Face, Mouth & Throat


  • Head: Symmetry of skull and face
  • Neck: Structure, movement, trachea, thyroid, vessels and lymph nodes
  • Eyes: Vision, placement, external and internal fundoscopic exam
  • Ears: Hearing, external, ear canal and otoscopic exam of tympanic membrane
  • Nose: Structure, exudate, sinuses
  • Mouth: Structures of mouth, teeth and pharynx
• Head


  • Shape: "NormoCephalic – ATraumatic"
  • Lesions
  • ? Edema
• Head: Key Points


  • Head Circumference (HC)
  • Fontannels/sutures: Anterior closes at 10-18 months, posterior by 2 months
  • Symmetry & shape: Face & skull
  • Bruits: Temporal bruits may be significant after 5 yrs
  • Hair: Patterns, loss, hygiene, pediculosis in school aged child
  • Sinuses: Palpate for tenderness in older children
  • Facial expression: Sadness, signs of abuse, allergy, fatigue
  • Abnormal facies: "Diagnostic facies" of common syndromes or illnesses
• Neuro Assessment


  • LOC / Glasgow coma scale
  • Pupil size
  • Vital Signs
  • Pain
  • Seizure Activity
  • Focal Deficits
• Bacterial Meningitis: Clinical Manifestations in an Older Child

  • High fever
  • Headache
  • LOC Changes / GCS
  • Nuchal rigidity / stiff neck
  • + Kernigs = inability to extend legs
  • + Brudzinski sign = flexion of hips when neck is flexed
  • Purple rash (check for blanching)
  • "Looks Sick"
• Eyes


  • PERRR
  • Red Reflex
  • Corneal Light Reflex
  • Strabismus: Alignment of eye important due to correlation with brain development, May need to corrected surgically, Preschoolers should have vision screening, Refer to ophthalmologist is there are concerns
• Eyes: Key Points


  • Vision: Red reflex & blink in neonate
  • Examine external structure of the: Conjunctiva, Sclera, Cornea, pupils, Iris
  • Snellen chart for older children
  • Irritations & infections
  • PERRL
  • Amblyopia (lazy eye): Corneal light reflex, binocular vision, cover-uncover test
• Ears: Key Points


  • Ask about hearing concerns
  • Inquire about infant's response to
  • Observe an older infant's/toddlers speech pattern
  • Inspect the ears: Assess the shape of the ears, Determine if both ears are well formed, Assess External shape and size, Pinna: line, low set ear (retardation), Internal structure
• Ear Exam


  • Pinna is pulled down and back to straighten ear canal in children under 3 years
• Common Ear Infections


  • Otitis Media: Most common reason children come to the pediatrician or emergency room, Fever or tugging at ear, Often increases at night when they are sleeping, History of cold or congestion, Infection can lead to rupture of ear drum, Chronic effusion can lead to hearing loss, OM is often a contributing factor in more serious infections: mastoiditis, cellulitis, meningitis, bacteremia, Chronic ear effusion in the early years may lead to decreased hearing and speech problems
• Nose & Throat / Mouth

  • Exudate
  • Pharynx
  • Tonsils
  • Signs & Symptoms of Allergic Rhinitis
  • Palate
  • Gums
  • Swallow
  • Oral Hygiene
  • Condition of teeth
  • Missing teeth
  • Orthodontic Appliances
• Nose: Key Points


  • Exam nose & mouth after ears
  • Observe shape & structural deviations
  • Nares: (check patency, mucous membranes, discharge, turbinates, bleeding)
  • Septum: (check for deviation)
  • Infants are obligate nose breathers
  • Nasal flaring is associated with respiratory distress
• Nose and Throat


  • Sinusitis: Fever, Purulent rhinorrhea, Facial Pain – cheeks, forehead, Breath odor, Chronic cough – could be day and night, (+) Post-nasal drip
• Mouth & Pharynx: Key Points

  • Lips: color, symmetry, moisture, swelling, sores, fissures
  • Buccal mucosa, gingivae, tongue & palate for moisture, color, intactness, bleeding, lesions
  • Tongue & frenulum - movement, size & texture
  • Teeth
• Exudate


  Fluid that oozes out of tissues
• Pharynx


  Part of the throat behind the mouth
• Tonsils


  Lymphoid tissue at the back of the throat
• Allergic Rhinitis


  Inflammation of the nasal passages due to an allergic reaction
• Assess for symmetry, deformity, skin lesion

  1. Observe

  2. Palpate
• Septal deviation


  Abnormal curvature of the nasal septum
• Mouth


  • Smooth and moist, with pinkish color
• Palate


  Roof of the mouth
• Gums


  Tissue surrounding the teeth
• Swallow


  Pass food or liquid from the mouth to the stomach