Pediatric Health Assessment
Age Range: Infant
1-12 months
Age Range: Toddler
1-3 years
Is abdomen pain abnormal?
ALWAYS
Tonic Neck Reflex
Arm & leg extend on side to which head turns
Age Range: Neonate/Newborn
Birth-28 days
Cephalhematoma
Bleeding between the periosteum and skull from pressure during birth; does not cross suture lines.
How do you measure Head Circumference?
By placing a paper tape measure around the widest circumference of the head (occipital prominance to just above the eyebrows)
Caput succedaneum
edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma
Common skin variences in pediatrics
•Bruising on toddlers' legs is common •Very little body or facial hair for young child •Increased perspiration, oiliness and acne in adolescence
Lungs and Respiratory System Inspection
•Chest circumference is not routine measurement •Irregular breath sounds with brief pauses
Menarche
the first menstrual period
Head, Eyes, Ears, Nose & Throat
•Fontanels ("soft spot) •Head circumference •Inspect eyes for position •Two individuals to inspect internal ear for infant •Nose breathers
APGAR
•Generalized skin color (Appearance) •Heart rate (Pulse) •Reflex irritability (Grimace) •Muscle tone (Activity •Respiratory effort (Respiration)
Female Breast Development
•Girls as young as 8 will show prepubertal budding •Full development of breasts takes 3 years •Menarche often begins just after the peak of adolescent growth spurt, at approximately age 12
Pediatric Physical Exam
•Perform least invasive assessments first •Show equipment to toddlers and young children •As child enters teen years, it is preferred to conduct exam without parent present
Heart and Peripheral Vascular System
•Pulse Oximetry •Murmur may be present •Acrocyanosis
Signs of Respiratory Distress Syndrome(RDS)
-Coughing -Stridor -Grunting -Retractions -Nasal flaring
Common primary skin lesions in newborns
-Milia -Erythema toxicum -Mongolian spot
Pain Scales
-Oucher (different skin tones) -Wong-Baker Faces Pain Rating Scale - Flacc - Neonatal Infant Pain Scale (NIPS)
Age Range: Preschool
3-5 years
Age Range: School Age
6-12 years
Palmar Reflex
Infant grasps finger
Rooting Response Reflex
Infant turns head in direction of stimulus and opens mouth
Step in place Reflex
Paces forward using alternate steps
Moro Relex
Startles to loud noise—abducts and extends arms and legs
Sucking Reflex
Sucking motion follows with lips and tongue when lips touched
Plantar Reflex
Toes flex down to grasp
Age Range: Adolescent
12-18 years
When is APGAR preformed?
Done at 1 and 5 minutes after birth (followed by 5 min increments if score <7)
Babinksi Reflex
Fans toes when lateral surface of sole is stroked
Newborn Vital Signs
Heart rate (beats/min): 120-160 Respiratory rate (breaths/min): 30-60 • Systolic range: 60-90 • Diastolic range: 20-60
Adolescent Vital Signs
Heart rate (beats/min): 60-90 Respiratory rate (breaths/min): 12-16 • Systolic range: 90-139 • Diastolic range: 62-88
School-Age Children Vital Signs
Heart rate (beats/min): 75-100 Respiratory rate (breaths/min): 18-30 • Systolic range: 84-120 • Diastolic range: 54-80
Toddler Vital Signs
Heart rate (beats/min): 90-140 Respiratory rate (breaths/min): 24-40 • Systolic range: 80-112 • Diastolic range: 50-80
Common hair variances in newborns
Lanugo: fine, soft, unpigmented hair
Abdomen and Gastrointestinal System
•Abdomen should be symmetric, soft, and rounded •Inspect the umbilicus - should be dry with no surrounding redness •Toddlers may have a rounded (potbelly) abdomen while standing and lying down
Musculoskeletal
•Assess hip stability in infant with Barlow and Ortolani maneuvers up until 3 months of age •Toddlers have wide stance and waddle gait until about 24 to 36 months •Gait should become progressively stronger, steadier, and smoother as child matures
Pediatric Health History
•Biographic Data •Reason for Seeking Health Care •History of Present Illness (OLD CARTS) •Present Health Status •Past Health History •Family History •Personal and Psychosocial History •Home Environment •Review of Systems •Developmental History