Pediatric Physical Assessment Kids are not small adults

Pediatric Physical Assessment Kids are not small adults

Facilitating Examination of Infants • • • Parental presence Physical comfort and relaxation Distraction Auscultate when quiet Procedures that provoke crying at end of exam

Facilitating Examination of Toddlers • • • Parent’s lap Play Security object Instruments Control and choice

Facilitating Examination of Preschoolers • Games and activities • Demonstrate and touch instruments • Distraction

Facilitating Examination of Older Children and Adolescents • • Modesty and privacy Choices Explanations of body parts and functions Parental presence or absence/need for chaperones • Reassurance of normalcy (adolescents)

DIFFERENCES VITAL SIGNS DIFFER WITH AGE THEIR BODIES ARE DIFFERENT GROWTH AND DEVELOPMENT MEASUREMENTS PSYCHOSOCIAL ASSESSMENT VARIES WITH AGE CONSIDER BEHAVIOR DIFFERENCES ORDER OF ASSESSMENT MAKES A DIFFERENCE! EXPLAIN!!

FIGURE 8– 4 Measuring infant length. Have an assistant hold the infant’s head in the midline while you gently push down on the knees until the legs are straight. Position the heels of the feet on the footboard and record the length to the nearest 0. 5 cm or 1/4 inch.

FIGURE 8– 7 Standing height measurements are taken routinely at each well child visit to assess the child’s rate of growth. Position the head in an erect and midline position while the shoulders, buttocks, and heels touch the wall. Move the head piece down to touch the crown. Measure the height reading to the nearest 0. 5 cm or 1/4 inch.

ASSESSMENT DIFFERENCES (GENERAL, SKIN, LYMPHATICS) LOC / ACTIVITY / NUTRITION AGE RELATED SKIN (ACROCYANOSIS) LYMPH NODES ARE NOT USUALLY PALPABLE IN AN INFANT, BUT ARE IN A CHILD UNTIL PUBERTY. THEY SHOULD BE UNDER 1 CM, NONTENDER, AND MOBILE.

HEENT • • Shape of head and face Symmetry Skull sutures Fontanels

HEENT (con’t) HEAD CIRCUMFERENCE, LICE EYES: RED RELEX, BLINK REFLEX, CORNEAL LIGHT REFLEX, VISION SCREENING EARS: INFECTION, HEARING, PLACEMENT, DRAINAGE NOSE / MOUTH: SPEECH, FOREIGN BODIES, SHAPE, TEETH, INFANTS BREATHE THROUGH NOSE UNTIL 2 MONTHS OLD

FIGURE 8– 15 Draw an imaginary line down the middle of the face over the nose and compare the features on each side. Significant asymmetry may be caused by paralysis of cranial nerve V or VII, in utero positioning, or swelling from infection, allergy, or trauma.

FIGURE 8– 18 When the line crosses the lateral canthi, the palpebral fissures are horizontal and no slant is present. When the lateral canthi fall above the imaginary line, the eyes have an upward or Mongolian slant. A downward or anti-Mongolian slant is present when the lateral canthi fall below the imaginary line. Epicanthal folds are present when an extra fold of skin partially or completely covers the caruncles in the medial canthi.

FIGURE 8– 23 This line normally passes through the upper portion of the pinna. The pinna is considered “low set” when the top lies completely below the imaginary line. Low-set ears are often associated with renal disorders.

LUNGS AND HEART TRANSMISSION OF SOUNDS ARE ENHANCED CHEST WALL- Retractions MURMURS – CONGENITAL HEART DISEASE YOU NEED YOUR OWN VITAL SIGN SHEET TO KNOW WHAT IS NORMAL HR AND RR BASED ON AGE!!!

ABDOMEN AND MUSCULOSKELETAL DIFFERENCES ABDOMEN POTBELLY AS TODDLER SCOLIOSIS TODDLER GAIT MOTOR SKILLS VARY WITH DEVELOPMENTAL STAGES, BUT STRENGTH EQUAL BILAT

NEURO DIFFERENCES NORMAL INFANT MUSCLE TONE / PRIMATIVE REFLEXES SCHOOL PERFORMANCE / SOCIAL INTERACTIONS

Developmental Periods • Newborn (0 to 1 month old) – Prenatal influences on growth and development • • • Infant (1 to 12 months of age) Toddler (1 to 3 years of age) Preschooler (3 to 6 years of age) School-age child (6 to 12 years of age) Adolescence (12 to 18 years of age)

Developmental screening • Several different evaluation tools • Distinguishes between chronological age and developmental age • Why important? ? • What effects developmental screenings?

Developmental screening 1. 2. 3. 4. Based on 4 areas: Social skills Fine motor skills Language skills Gross motor skills