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PEDI | Health Assessment
• Infants & Toddlers:
◦ Positioning: Perform the exam on the caregiver’s lap to reduce anxiety,.
◦ Sequence: Use a "least invasive to most invasive" approach. Auscultate the heart and lungs while the child is quiet; perform traumatic procedures (ears, throat, hips) last,,,.
◦ Technique: Use distractions (toys, bubbles) and simple terms. For toddlers, avoid asking "yes/no" questions if there is no choice; instead, use short phrases to direct them,.
• Preschoolers (3–5 years):
◦ Fears: They often fear bodily mutilation. Allow them to inspect equipment (like the stethoscope) before use to reduce anxiety,.
◦ Cooperation: Use games (e.g., "blow out the light" for lung sounds) and offer choices when possible,.
• School-Age (6–12 years):
◦ Agency: They value control and understanding. Explain how things work and answer questions truthfully. They can generally tolerate a head-to-toe sequence,.
◦ Privacy: Respect their modesty and need for privacy,.
◦ Respect: Communicate directly with the adolescent, not just the parent,.
The Health History (The Foundation)
The health history provides the context for the physical exam and includes the Chief Complaint, Review of Systems, and Family History (often visualized with a genogram),.
• Observation is Key: Much of the assessment occurs before touching the child. Observe the parent-child interaction for eye contact, comfort measures, and behavioral cues to assess family dynamics and potential attachment issues,,,.
• Functional History: Beyond medical issues, assess "daily life" factors:
◦ Safety: Car seats, smoke detectors, bicycle helmets,.
◦ Nutrition: 24-hour dietary recall and "junk food" consumption,.
◦ Sleep & Activity: Screen time habits and sleep patterns,.
Key Physical Exam Techniques & Findings
Pediatric anatomy requires specific examination adjustments and interpretation of "normal" variations.
1. Vital Signs & General Appearance
• Sequence: Measure vital signs (HR, RR) while the child is calm. Blood pressure can be frightening and is often done last or with age-appropriate explanation,.
• Red Flags: Watch for lethargy, listlessness, or lack of response to the environment, which may indicate serious illness,.
2. Head, Eyes, Ears, Nose, Throat (HEENT)
• Fontanels: The posterior fontanel closes by 2 months; the anterior fontanel closes between 9 and 18 months. A sunken fontanel suggests dehydration; a bulging one may indicate increased intracranial pressure,.
• Ear Exam:
◦ Under 3 years: Pull the pinna down and back to straighten the canal,.
◦ Over 3 years: Pull the pinna up and back,.
• Eyes: Check for the "red reflex"; absence may indicate cataracts or retinoblastoma,. Strabismus (crossing eyes) is intermittent/normal up to 4 months but requires referral if persistent,.
• Nose: Infants <1 month are obligate nose breathers; nasal obstruction can cause respiratory dis.
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By Regular Guy• Infants & Toddlers:
◦ Positioning: Perform the exam on the caregiver’s lap to reduce anxiety,.
◦ Sequence: Use a "least invasive to most invasive" approach. Auscultate the heart and lungs while the child is quiet; perform traumatic procedures (ears, throat, hips) last,,,.
◦ Technique: Use distractions (toys, bubbles) and simple terms. For toddlers, avoid asking "yes/no" questions if there is no choice; instead, use short phrases to direct them,.
• Preschoolers (3–5 years):
◦ Fears: They often fear bodily mutilation. Allow them to inspect equipment (like the stethoscope) before use to reduce anxiety,.
◦ Cooperation: Use games (e.g., "blow out the light" for lung sounds) and offer choices when possible,.
• School-Age (6–12 years):
◦ Agency: They value control and understanding. Explain how things work and answer questions truthfully. They can generally tolerate a head-to-toe sequence,.
◦ Privacy: Respect their modesty and need for privacy,.
◦ Respect: Communicate directly with the adolescent, not just the parent,.
The Health History (The Foundation)
The health history provides the context for the physical exam and includes the Chief Complaint, Review of Systems, and Family History (often visualized with a genogram),.
• Observation is Key: Much of the assessment occurs before touching the child. Observe the parent-child interaction for eye contact, comfort measures, and behavioral cues to assess family dynamics and potential attachment issues,,,.
• Functional History: Beyond medical issues, assess "daily life" factors:
◦ Safety: Car seats, smoke detectors, bicycle helmets,.
◦ Nutrition: 24-hour dietary recall and "junk food" consumption,.
◦ Sleep & Activity: Screen time habits and sleep patterns,.
Key Physical Exam Techniques & Findings
Pediatric anatomy requires specific examination adjustments and interpretation of "normal" variations.
1. Vital Signs & General Appearance
• Sequence: Measure vital signs (HR, RR) while the child is calm. Blood pressure can be frightening and is often done last or with age-appropriate explanation,.
• Red Flags: Watch for lethargy, listlessness, or lack of response to the environment, which may indicate serious illness,.
2. Head, Eyes, Ears, Nose, Throat (HEENT)
• Fontanels: The posterior fontanel closes by 2 months; the anterior fontanel closes between 9 and 18 months. A sunken fontanel suggests dehydration; a bulging one may indicate increased intracranial pressure,.
• Ear Exam:
◦ Under 3 years: Pull the pinna down and back to straighten the canal,.
◦ Over 3 years: Pull the pinna up and back,.
• Eyes: Check for the "red reflex"; absence may indicate cataracts or retinoblastoma,. Strabismus (crossing eyes) is intermittent/normal up to 4 months but requires referral if persistent,.
• Nose: Infants <1 month are obligate nose breathers; nasal obstruction can cause respiratory dis.