Physical Assessment / Review -Child

Physical Assessment / Review -Child

Physical Assessment / Review

Summary of Recommendation and Evidence

Population

Recommendation

Grade
(What's This?)

Screening of both Genders

This screening is recommended for children.

B

Review of Systems

  • Ask questions about each system.
  • Measurements: weight, height, head circumference, growth chart, BMI.
  • Nutrition: breastfed, formula, favorite foods, beverages, eating habits.
  • Growth and Development: Milestones for each age group.

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

Pediatric Vital Signs – Normal Ranges

  Infant Toddler School-Age Adolescent
Heart Rate 80-150 70-110 60-110 60-100
Respiratory Rate 24-38 22-30 14-22 12-22
Systolic blood pressure 65-100 90-105 90-120 110-125
Diastolic blood pressure 45 - 65 55-70 60-75 65-85

Objectives  

  1. To understand how the general approach to the physical examination of the child will be different compared to that of an adult patient, and will vary according to the age of the patient.
  2. To observe and demonstrate physical findings unique to the pediatric population, and to understand how these findings may change depending upon the age of the child.

Competencies

  1. To obtain accurate vital signs (Temperature, HR, RR, BP) in a pediatric patient in different age groups and to be able to evaluate these vital signs compared to age-adjusted normals. To understand the normal variation in temperature depending on the route of measurement.
  2. To complete a thorough physical examination on a pediatric patients in different age groups.

Physical Assessment

Body Systems Problems to Identify
General General growth pattern, overall health status, ability to keep up with other children or tires easily with feeding or activity, fever, sleep patterns.
Allergies, type of reaction (hives, rash, respiratory difficulty, swelling, nausea), seasonal or with each exposure 
Skin and lymph Rashes, dry skin, itching, changes in skin color or texture, tendency for bruising, swollen or tender lymph glands
Hair and nails Hair loss, changes in color or texture, use of dye or chemicals on hair
Abnormalities of nail growth or color
Head Headaches
Eyes Vision problems, squinting, crossed eyes, lazy eye, wears glasses, eye infections, redness, tearing, burning, rubbing, swelling eyelids
Ears Ear infections, frequent discharge from ears, or tubes in ears
Hearing loss (no response to loud noises or questions, inattentiveness, was hearing test ever done?), hearing aids or cochlear implant
Nose and sinuses Nosebleeds, nasal congestion, colds with runny nose, sinus pain or infections
Nasal obstruction, difficulty breathing, snoring at night
Mouth and throat Mouth breathing, difficulty swallowing, sore throats, strep infections, mouth odor Tooth eruption, cavities, braces
Voice change, hoarseness, speech problems
Cardiac and hematologic Heart murmur, anemia, hypertension, cyanosis, edema, rheumatic fever, chest pain
Chest and respiratory Trouble breathing, choking episodes, cough, wheezing, cyanosis, exposure to tuberculosis, other infections
Gastrointestinal Bowel movements, frequency, color, regularity, consistency, discomfort, constipation or diarrhea, abdominal pain, bleeding from rectum, flatulence
Nausea or vomiting, appetite
Urinary Frequency, urgency, dysuria, dribbling, strength of urinary stream
Toilet trained—age when day and night dryness attained, enuresis
Reproductive
Female
Male
Both
For pubescent children
Menses onset, amount, duration, frequency, discomfort, problems; vaginal discharge, breast development
Puberty onset, emissions, erections, pain or discharge from penis, swelling or pain in testicles
Sexual activity, use of contraception, sexually transmitted diseases
Musculoskeletal Weakness, clumsiness, poor coordination, balance, tremors, abnormal gait, painful muscles or joints, swelling or redness of joints, fractures
Neurologic Brain or head injuries
Seizures, fainting spells, dizziness, numbness
Learning problems, attention span, hyperactivity, memory problems