Assessment Of The Pediatric Client

Mr. Zafar Iqbal

Lecturer (BSN,MPH,MSN*)
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Outline
• Structure and Function
• Subjective Data—Health History Questions
• Objective Data—The Physical Exam
• Abnormal Findings

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Anatomic and physiologic
characteristics of infants and
children
• Children and infants are not only smaller than adults, but also
significantly different physiologically.

• Knowledge of pediatric anatomic and physiologic differences will aid

in recognizing normal variations found during the physical
examination. rm
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• It also assists with understanding the different physiologic responses , Ed
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children have to illness and injury. Da
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• Many techniques for assessment, physical findings, and abnormalities
in young patients differ as well.

• Children display great variations in physical, cognitive, and social

development compared with adults
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General Principles of Pediatric Assessment

• Complete Head to toe assessment within the first 24 hours of birth

• Expose body parts as necessary (Assure a warm environment)

• Examine the circulatory and respiratory systems when baby is not crying

• All intrusive procedures should be performed last

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• Assessment should be done in presence of parents l Pl
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Proper position during examination (Lap of mother) h , Ed
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• Go from simple to complex h
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History: Variations From Adults

Content Differences:

A. Prenatal and birth history

B. Developmental history

C. Social history of family tfo rm

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D. Immunization history ati
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Developmental History

A. Ages at which milestones were achieved and current developmental

abilities - smiling, rolling, sitting alone, crawling, walking, running, 1st
word, toilet training, riding etc.

B. School-present grade, specific problems, interaction with peers

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C. Behavior - enuresis, thumb sucking, nightmares etc. ona
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 Social history

• A. Living situation and conditions - daycare, safety issues

• B. Composition of family

• C. Occupation of parents

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Immunization history

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 Feeding History

• A. Breast or bottle fed, types of formula, frequency and amount,

reasons for any changes in formula

• B. Solids - when introduced, problems created by specific types

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History: Variations From Adults
Parent as Historian:

A. Parent’s interpretation of signs, symptoms

• Children above the age of 4 years may be able to provide some of their own history

• Reliability of parents’ observations varies

• Adjust wording of questions - “When did you first notice Johnny was limping”? instead
of “When did Johnny’s hip pain start”?
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B. Observation of parent-child interactions latf
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• Distractions to parents may interfere with history taking ati
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• Quality of relationship Dan
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C. Parental behaviors/emotions are important
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Preparation for Examination

• Comfortable environment

• Encourage parents to participate in examination

• Prepare child and parents for any new or painful procedure

• Equipment's Needed tfo rm

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Objective Data—The Physical Exam

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 INSPECTION OF THE SKIN
• Skin Color, Temperature, Texture, Moistness

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Color Variations of the Skin
• Plethora – Flushed red appearance; may indicate polycythemia

• Pallor – pale appearance; many indicate anemia or compromise of

cardiac status

• Jaundice – yellow appearance of the skin and sclera; may indicate rm

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Primary Skin Lesions associated Condition

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 Head
• Measure occipital-frontal circumference (OFC); note any asymmetry or
appearance out of relationship to the rest of the face and body; palpate
fontanels and sutures; inspect hair for color, texture, distribution, and
directional patterns
Size & Shape:
• Microcephaly – abnormal smallness of the head (OFC < 10th percentile for
GA); generally due to poor brain growth; it can be an isolated finding or it
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may be associated with genetic syndrome or congenital infection latfo
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• Macrocephaly – excessive head size (OFC > 90 percentile for GA); may be
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Sutures

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Assessing the chest for shape,
movement, respiratory effort, and
lung function

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Assessing the heart for heart sounds
and function

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Assessing the musculoskeletal system for bone and
joint structure, movement, and muscle strength

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Nervous System Variations
• Newborn have normal reflexes which are not present later in the life and also
the cranial nerves examination techniques are different from that of an adult.

REFLEXES:
Sucking reflex - stroking the lips causes the infant to open mouth and begin
sucking movements; disappears around 12 months
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Rooting reflex – stroking the cheek and corner of the mouth causes the infanttional
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to turn the head toward the stimulus and the mouth should open; usually , Educ
disappears at 3-4 months n ish
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 Palmar reflex (grasp reflex) – stroking the palm of the hand with a
finger should cause the baby to grasp the finger; the grasp will tighten
with attempts to withdraw the finger; usually disappears at 2 months

Babinski toe reflex – the infant will hyperextend and fan its toes apart
when the sole of the foot is stroked from the heel upward and across the
ball of the foot; usually disappears at 12 months tfo rm
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Cranial nerve function

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Thank you

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