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Use simple straightforward questions in lay terms. Avoid words with double meanings.
Use physical restraints for young children as needed. After restraining, let parents
comfort child.
Provide a pacifier
Speak softly
Use play
or unique characteris-
Praise cooperation
Maintain privacy
Use gown
3. Past Hx (Prenatal Hx, Labor & Delivery, Birth Hx, Feeding Hx)
4. Health Hx
5. Family Hx
6. Personal / Social Hx
PHYSICAL ASSESSMENT
1. General Measurements
2. Physiologic Measurements
3. Head-to-Toe Assessment
GENERAL MEASUREMENTS
HEIGHT (Length)
Positioning:
- fully extend the body, holding head midline, & pushing knees downward to extend legs
For 2 years
Technique: - remove shoes - stand straight w/ head midline & vision parallel bet.
ceiling & floor back, buttocks, & back of heels against the wall
WEIGHT
HEAD CIRCUMFERENCE
CHEST CIRCUMFERENCE
Normal Value
Chest circumference = HC 2 cm
ABDOMINAL GIRTH
MID-ARM CIRCUMFERENCE
ANTERIOR FONTANELLE
POSTERIOR FONTANELLE
PHYSIOLOGIC MEASUREMENTS
Temperature
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Axillary route
C Rectal route - lubricated thermometer inserted no more than 2 cm into rectum
Tympanic route
Oral route- - may be used in children > 4 yrs of age
Pulse
Respiration
Children under 7 years old are abdominal breathers; observe abdominal movements Use
same technique as
NORMAL VALUES
[Respiratory Rate]
3 to 10 yrs: 20 28 cpm
BLOOD PRESSURE
Systolic:
Diastolic:
1-5 years = 56
Normal Variation:
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1. Acrocyanosis- Cyanosis of the extremities only; normal within 12H after birth
- When the newborns body temperature drops, the hands and/or feet may
appear blue
(acrocyanosis)
2. VERNIX CASEOSA- Cheesy, white substance found on the skin and skin folds of newborns
5..LANUGO - Fine, downy hair covering the body of newborns; abundant in pre-term infants
- The fine, downy hairs called lanugo, which appear on the newborns body, shoulders,
and/or back at birth, develop in the fetus at 3 months gestation and disappear within the first
2 weeks of life.
6. MILIA Small, white papules on the nose, forehead or chin of newborns; resolve within a
few weeks
8. TELANGIECTATIC NEVI (Stork Bites)- Due to stretching of certain blood vessels; most often
temporary
9. MONGOLIAN SPOTS- Bluish pigmented areas noted on the sacral areas of Asian and black
infants; disappears over time
10. HARLEQUIN SIGN- One side of the body turns red; the other side is pale; cause unknown.
11. HEMANGIOMA - Caused by increased amount of blood vessels in the dermis. Fades with
time
12. PORT-WINE STAIN Dark-red or bluish birth mark; darkens with exertion or temperature;
doesnt fade with time
Abnormal Variation
3. CAF AU LAIT SPOTS - ABNORMAL if there are more than six, separate, large patches (may
have neurofibromas)
NORMA VARIATION
2. CAPUT SUCCEDANEUM - Swelling of the newborns scalp from vaginal birth; heals
spontaneously after a few days
3.
ABNORMAL VARIATION
3. MICROCEPHALY
4. DOWN SYNDROME- Third fontanelle between anterior & posterior fontanelles; unusual
facial proportions; short, webbed neck; wide, flat, philtrum
EYES
Used on children 4 to 6 yrs old; esp. those who are illiterate or preliterate
If child cant recognize the symbols, a response card is used (child points symbol on the card
based on what he sees on the chart)
HOTV CHART-
For those who dont know the alphabet, also use a response card
Can be used for illiterate children aged 4 to 6 years old; although not commonly used
anymore.
Uses a modified E that resembles a bird and a story to engage childrens attention.
The child "flies with Blackbird" showing with their arms which way it is flying.
1 year : 20/200
2 years : 20/70
5 years : 20/30
6 years : 20/20
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ABNORMAL
1. Down Syndrome- Wide-set position, upward slant, and thick epicanthal folds
2. BRUSHFIELDS SPOTS - Also often seen in children with Down syndrome; are small white
or grayish spots in the periphery of the iris
EARS
The ears and kidneys develop at the same time in utero; so malformed ears may be
accompanied by renal problems
NORMAL VARIATION
1. NATAL TEETH- Teeth present at the time of birth; usually removed by physician
2. EPSTEINS PEARLS Small yellow-white cysts on the hard palate & gums of newborns;
disappears after 1 week
ABNORMAL VARIATION
IMPORTANT POINTS
Deciduous Teeth:
Permanent Teeth:
6 years = permanent tooth eruption begins and progresses until all 32 have erupted
Tonsils:
CHEST
NORMAL VARIATION
1. WITCHS MILK- Enlarged, engorged breasts sometimes with a white liquid discharge in
newborns; results from the influence of maternal hormones; resolves within days
LUNGS
NORMAL
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Hyperresonance = normal percussion tone elicited in infants because of thinness of the chest
wall
5 to 6 years old = AP to transverse thoracic diameter (1:1 in young children) reaches adult 1:2
ratio
HEART
1 to 4 yrs old: left 4th ICS, to the left of midclavicular line (MCL)
ABDOMEN
4 years old & below: abdomen is prominent in standing & supine positions
ABNORMAL FINDING
1. UMBILICAL HERNIA- Common in African American children; usually disappear at the age of
1 year
GENITALIA
NORMAL VARIATION
ABNORMAL VARIATION
2. Paraphimosis is indicated when the foreskin is tightened around the glans penis in a
retracted position
3. Hypospadias (urinary meatus on the ventral surface of glans) and epispadias (urinary
meatus on dorsal surface of glans) are congenital disorders
5. Hydroceles are common in infants. They are a collection of fluid along the spermatic cord
within the scrotum that can be transilluminated
6. AMBIGUOUS GENITALIA - Enlarged clitoris with fusion of the posterior labia majora
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ANUS
The newborn should pass meconium, the first stool, within 24 to 48 H from birth
Imperforate anus (no anal opening) should be referred. Pustules may indicate secondary
infection of diaper rash. No passage of meconium stool could indicate no patency of anus or
cystic fibrosis.
NORMAL VARIAITON
ABNORMAL VARIATION
5. CONGENITAL HIP DYSPLASIA For infants < 1 year old, positive (+) Ortolanis & Barlows
sign [a click is heard]
- For infants there is limited hip abduction and difference in limb length (leg on affected hip
is longer)
Ortolanis maneuver - Flex knees, abduct thigh and move knees outward and down toward
table
Barlows maneuver - Flex knees, adduct thigh and legs until thumbs touch
6. SPINA BIFIDA- Outpouching of the spinal cavity due to incomplete closure of vertebrae;
the sac may rupture
NEUROLOGIC ASSESSMENT:
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