ASSESSING PEDIATRIC CLIENTS

SUBSEQUENT INFANT PHYSICAL

ASSESSMENT 7. Use physical restraints for young
children as needed.
After restraining, let parents comfort
1. General Appearance and Behavior the child.
2. Developmental Assessment
3. Vital Signs 8. Use distraction & play
4. Measurements
5. Skin, Hair, and Nails 9. Approach and techniques may be
6. Head, Neck, and Cervical Lymph Nodes altered depending on development
7. Eyes level of child
8. Ears
9. Mouth, Throat, Nose, and Sinuses
10. Thorax
11. Breasts IF NEEDED:
12. Heart 1. Pause the assessment
13. Abdomen 2. Wait to calm
14. Genitalia (Male & Female) 3. Use physical restraints
15. Anus and Rectum - Gunitan ang patient
16. Musculoskeletal 4. Let parents distract and calm the patient
17. Neurologic System 5. Distract

GENERAL ASSESSMENT GUIDELINES DEVELOPMENTAL APPROACHES TO

ASSESSMENT
1. Information from pediatric clients should
be validated for reliability by an adult 1. INFANTS (0 to 12 months old)
informant
 PROVIDE A PACIFIER
- Verify from parents or SO - Esp if restless ang baby

2. Be gentle & genuine  Encourage parent or caregiver to ask

during P.E.
- Incorporate play
- Smile  Speak softly

 Child may need to be placed on

3. Use simple straightforward questions restraints
in layman’s term.
Avoid words with double meanings - Cloth, habol, or assistant from
parents
- Eg: Right (Direction-Correct)
2. TODDLERS (1 to 3 years old)

4. Let client set the pace for conversations  Allow toddler to sit on parent’s lap

5. Use direct eye contact; sit at client’s  Enlist parent’s aid

eye level.
 Use play
6. Orient parents or caregiver
 Focus on a favorite toy or unique
characteristic about the child

 Praise cooperation
 - Feeding Hx
3. PRESCHOOLERS (3 to 6 years old) - History sa mother during pregnancy;
so that we can “link” the condition of
 Use story telling the patient
- To gain cooperation and trust
NOT INCLUDED IF:
 Use doll & puppet play - Mother cannot recall
- Old client na like 15 y.o
 Give choices when able

 Allow child to manipulate equipment 4. Health Hx

- Let them hold the stet or penlight
5. Family Hx

4. SCHOOLAGERS (6 to 12 years old) 6. Personal/Social Hx

- Conscious sa body We want to know:

 Maintain privacy - Developmental problems

- Autism
 Use gown

 Explain procedures & equipment

 Teach about their body

- Expectations about their body

5. ADOLESCENTS (12 to 18 years old)

 Ensure privacy and confidentiality

 Provide option of having parent

present or not

 Emphasize normality

 Provide health teaching

- Esp changes sa body

PEDIATRIC HEALTH HISTORY

- Pedia has LESSER assessment
than ADULT

1. Biographical Data/ Identifying

Information

2. Chief Complaint & Hx of Present

Illness

3. Past Hx
- Prenatal Hx
- Labor & Delivery
- Birth Hx
 PHYSICAL ASSESSMENT FOR PEDIATIC CLIENTS: GENERAL MEASUREMENTS
SUMMARY

1. General Measurements
2. Physiologic Measurements
3. Head-to-Toe Assessment
4. Current Development Assessment FOR MORE THAN 2 YEARS OLD

 TECHNIQUE
GENERAL MEASUREMENTS
- Remove shoes
- Stand straight with head midline &
1. HEIGHT (LENGTH) vision parallel between ceiling and
floor
FOR LESS THAN 2 YEARS OLD - Back, buttocks, & back of heels
against the wall

 POSITIONING MEASURE: CM
- Fully extent the body
- Holding head midline
CALCULATION OF HEIGHT
- Pushing knees downward to extent
legs
-
 TECHNIQUE
- Measure from vertex of HEAD to
heel of FOOT

 Can also use MEASURING BOARD

EX:
BL = 45
45 + 22.5
Expected in 1 year = 67.5 or 68

2. WEIGHT

For SMALLER CHILD

 Weigh naked, lying on a scale

- Not necessarily hubuan

- Basta light ang clothes

For OLDER CHILD

 Barefoot
 In underpants or light gown
 Standing on platform scale
 - Nipple Line

NORMAL VALUES:
 Chest Circumference: HC – 2 cm

CALCULATION ON WEIGHT
 Normal Birth Weight (BW): 2.5 – 4 kg

 DOUBLES on age 4 – 6 months

5. ABDOMINAL GIRTH
 TRIPLES at 1 year
 LANDMARK:
- Slightly above the umbilicus

3. HEAD CIRCUMFERENCE

 Used only for children BELOW 2

YEARS OLD
 Use “cm” unit

 LANDMARKS:

- Slightly above eyebrows

- Pinna of ears
- Skull: Occipital Prominence
6. MID-ARM CIRCUMFERENCE
NORMAL VALUE:
 Head circumference (HC) = 33 – 35  LANDMARK:
cm - Midway between SHOULDER &
ELBOW

7. ANTERIOR FONTANELLE
4. CHEST CIRCUMFERENCE
 Diamond-shape
 Closes at 12 to 18 months
 Only used for children BELOW 2
YEARS OLD

 LANDMARK:
8. POSTERIOR FONTANELLE

 Triangular
 Closes at 2 to 3 months

NOTE:
 Fontanelles normally bulge when child
is crying.

 BULGING fontanelles at rest is

ABNORMAL.

- Noted in infants with INCREASED

INTRACRANIAL PRESSURE (ICP).

 DEPRESSED fontanelles noted in

DEHYDRATION.

FROM BOOK:

NORMAL SIZE
 Anterior Fontanelle: 4-5 cm at its
widest part

 Posterior Fontanelle: 0.5 – 1 cm at

its widest part
 PHYSIOLOGIC MEASUREMENTS
1. TEMPERATURE

 NEWBORN:
- Use RECTAL
D. ORAL ROUTE

 IF SA WARD OR CLINIC: - May be used in children MORE 4

- Sa ears or tympanic YEARS of age

A. AXILLARY ROUTE - Hot usually used

- NOT ADVISABLE:
o Risk for injury sa mucosa

2. PULSE

FOR LESS THAN 2 YEARS OLD

B. RECTAL ROUTE  Measure APICAL PULSE for 1 full
minute
 LANDMARK: Nipple line

FOR 2 YEARS OLD AND ABOVE

 Radial pulse may be taken
NORMAL VALUES [ PULSE RATE ]
1 month or less 120 – 160 bpm
1 to 3 months 100 – 150 bpm
- Usually, used NEWBORN 3 months to 2 years
80 – 150 bpm
old
- Lubricated thermometer inserted no
more than 2 cm into rectum 2 to 10 years old 70 – 110 bpm
10 yr. to ADULT 60 – 100 bpm
C. TYMPANIC ROUTE

- Usually, gigamit sa ward 3. RESPIRATION

- Children should NOT BE CRYING
FOR LESS THAN 7 YEARS OLD
 Children under 7 years old are
abdominal breathers.

 Observe abdominal movements

- Tan-awon ang tiyan

FOR 7 YEARS OLD AND ABOVE

  Use same technique as adults if 7
years or older
- Use na kadtong RISE and FALL sa
chest
NORMAL VALUES [ RESPIRATORY RATE ]
Less 6 months 30 – 60 cpm
6 mos – 2 yrs. 20 – 30 cpm

3 yrs – 10 yrs 20 - 28 cpm

10 yrs to ADULT 12 – 20 cpm

4. BLOOD PRESSURE

 Use appropriate cuff size

 Child should NOT BE CRYING as
this INCREASES BP.

- Usually NOT TAKEN

- Only if nay Dengue or nay
Bleeding.
FOR LESS THAN 3 YEARS OLD
- Use DOPPLER STETHOSCOPE

CALCULATE FOR BLOOD PRESSURE

 HEAD-TO-TOE ASSESSMENT: SKIN
NORMAL VARIATIONS ABNORMAL FINDING

1. ACROCYANOSIS 1. CENTRAL CYANOSIS

- Cyanosis of the extremities only - Indicates poor oxygenation

- Pink body; Bluish feet - Medical emergency
- Needs resuscitation
NORMAL: Within 12H after birth

2. VERNIX CASEOSA

- Cheesy, white substance found on

the skin and skin folds of newborns
- Matangtang ra
- Provides protection to regulate
temperature

3. DESQUAMATION

- Cracking or wrinkling of skin

- Seen in post-term newborns

POST TERM = More than 42 weeks

4. PHYSIOLOGIC JAUNDICE 4. PATHOLOGIC JAUDICE

NORMAL: ABNORMAL:
- If occurring more than 24H after birth - If occurring within 24H after birth
5. LANUGO

- Fine, downy hair covering the body

of newborns
- Abundant in pre-term infants (born
less than 37 weeks)

6. MILIA

- Small, white papules on the nose,

forehead, or chin of newborns

- Resolved within a few weeks

7. ERYTHEMA TOXICUM

- Cause is unknown
- Disappears within a week from birth
- Needs further confirmation

8. TELANGIECTATIC NEVI (STORK BITE)

- 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 is 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

- DOESN’T FADE with time

13. CAFÉ AU LAIT SPOT 13. CAFÉ AU LAIT SPOTS

- A light brown, round, or oval patch  ABNORMAL:

- If MORE THAN 6, SEPARATE,

LARGE PATCHES
- May have neurofibromas

- REMEMBER THE “NO S”

14. CHILD ABUSE

- Bruises or ecchymoses in various

areas or in unusual locations

- Circular burn areas

 HEAD-TO-TOE ASSESSMENT: HEAD AND NECK & LYMPH NODES
NORMAL VARIATIONS ABNORMAL FINDING

1. MOLDING 1. CEPHALHEMATOMA

- Oddly-shaped head due to overriding - Birth injury with bleeding into the
of sutures in newborns periosteal space

- Dugay mugawas ang baby

2. CAPUT SUCCEDANEUM 2. HYDROCEPHALUS

- Swelling of the newborn’s scalp from - Very large head due to excessive
vaginal birth accumulation of CSF.
- Heals spontaneously after a few days

3. MICROCEPHALY

- Small head
- Exposure of the mother to viral
infection (Zica virus, etc.) during
pregnancy

4. DOWN SYNDROME

- Third fontanelle between anterior &

posterior fontanelle
- Unusual facial proportions
- Short, webbed neck
- Wide, flat philtrum
5. TORTICOLLIS (WRY NECK)

- Twisted neck and head to the side

- Congenital condition
- Will not be able to move head fully
 HEAD-TO-TOE ASSESSMENT: EYES

 LEA SYMBOL CHART  SNELLEN LETTER CHART

- Used on children 4 – 6 yrs old - Already used on children aged 6

- Esp. those who are illiterate or years and above who know the
preliterate alphabet

- If the child can’t recognize, use a

RESPONSE CARD

(Child points symbol on the card

based on what he sees on the chart)

- If child is illiterate, use:

1. HOTV chart
2. Lea Symbol chart
3. Snellen E chart

 HOTV CHART  BLACKBIRD PRESCHOOL VISION

SCREENING TEST
- Can be used on children as young as
- Can also be used on children ages 4 age 3
to 6 yrs old - Uses a modified E that resembles a
- For those who don’t know the bird and a story to engage
alphabet, use a response card children’s attention
- The child “flies with black bird”
showing with their arms which way it
is flying.

 SNELLEN E CHART (FOR CHILDREN) NORMAL VISUAL ACUITY

1 year 20/200
- Can be used for illiterate children 2 years 20/70
aged 4 to 6 y.o. 5 years 20/30
6 years 20/20
- Not commonly used anymore

- Age 5 = Children should be able to

differentiate colors
 ABNORMAL FINDINGS

1. DOWN SYNDROME

- Wide-set position, upward slant, thick

epicanthal folds

2. BRUSHFIELD’S SPOTS

- Also often seen in children with Down

Syndrome
- Small white or grayish spots in the
periphery of the iris

3. “SUN-SETTING” APPEARANCE

- Suggests hydrocephalus
 HEAD-TO-TOE ASSESSMENT: EARS
ABNORMAL FINDINGS

1. LOW-SET EARS

- Often seen in children with Down

Syndrome

IMPORTANT POINTS TO REMEMBER:

- The ears and kidneys develop at the same time in utero

- So, malformed ears may be accompanied by renal problems
 HEAD-TO-TOE ASSESSMENT: NOSE, SINUSES, MOUTH, & THROAT
NORMAL VARIATIONS ABNORMAL FINDING

1. NATAL TEETH 1. CLEFT LIP & CLEFT PALATE

- Teeth present at the time of birth

- Usually removed by physician
- Not functional yet

2. EPSTEIN’S PEARLS

- Small yellow-white cysts on the hard

palate & gums of newborns
- Disappears after 1 week

IMPORTANT POINTS TO REMEMBER:

TEETH
1. DECIDUOUS TEETH

o LOWER CENTRAL INCISORS first to erupt between 4 to 6 mos.

o All 20 deciduous teeth erupt by 36 months (3 yrs)

2. PERMANENT TEETH

o 6 years = permanent tooth eruption begins

o Progresses until all 32 have erupted

TONSILS
 6 YEARS: Reach adult size
 10 to 12 YEARS: Twice the adult size
 End of adolescence: Atrophy, same as adult
 HEAD-TO-TOE ASSESSMENT: THORAX AND LUNGS
NOTE:
AUSCULTATION 5 TO 6 YEARS OLD
 Use bell of the stethoscope or small - Anteroposterior (AP) to
diaphragm Transverse Thoracic diameter
 Encourage deep breathing during ratio
auscultation
- 1:1 in young children
PERCUSSION - 1:2 when reaches adult
 HYPERRESONANCE
- Normal percussion tone elicited in
infants because of thinness of the
chest wall

BREAST
NORMAL VARIATION

1. WITCH’S MILK

- Enlarged, engorged breasts

sometimes with a white liquid
discharge in newborn

- Results from the influence of

maternal hormones

- Resolves within days

HEART

LOCATION OF THE APICAL PULSE

 1 TO 4 YEARS OLD
- Left 4th ICS to the Left of Midclavicular Line

 4 TO 6 YEARS OLD
- Left 4th ICS, Left MCL

 7 YRS OLD & ABOVE

- Left 5th ICS, left MCL

NOTE
 SINUS ARRYTHMIA (abnormal heart rhythm)

- is NORMAL in young children

 HEAD-TO-TOE ASSESSMENT: ABDOMEN
NOTE:
 UMBILICAL CORD OF NEWBORNS:

- Should demonstrate 2 arteries and 1 vein

- Remnant cord should appear dried 24 to 28 hrs. after birth

 4 to 6 YEARS OLD & BELOW

- Abdomen is prominent in standing & supine positions

ABNORMAL FINDING

1. UMBILICAL HERNIA

- Common in African American

children
- Usually disappear at age 1 yr.
 HEAD-TO-TOE ASSESSMENT: GENITALIA
NORMAL VARIATIONS ABNORMAL FINDING

1. PSEUDOMENSTRUATION 1. PHIMOSIS

- Scant vaginal bleeding in newborns

- Due to influence of maternal
hormones
- Resolves spontaneously

2. DIAPER RASH 3. HYPOSPADIAS

- Dapat dry and frequent ang changing - Opening of the urethra is below the
sa diaper end of the penis to the scrotum

4. EPISPADIAS

- Opening is on top on the penis

5. HYDROCELE

- Type of swelling in the scrotum that

occurs when fluid collects in the thin
sheath surrounding a testicle
 6. AMBIGUOUS GENITALIA

- Enlarged clitoris with fusion of the

posterior labia majora

7. PARAPHIMOSIS

8. IMPERFORATE ANUS

- No anal opening

NOTE:

 MECONIUM
- First stool
- Newborns should pass meconium within 24 to 48 hrs. from birth
 HEAD-TO-TOE ASSESSMENT: BACK AND EXTREMITIES
NORMAL VARIATIONS ABNORMAL FINDING

1. GENU VARUM 1. PALMAR SIMIAN CREASE

- Bow-legged - Suggests Down Syndrome

- Common in toddlers who have a
wide-based gait

2. GENU VALGUM 3. POLYDACTYLY

- Extra digits
- Knock-kneed
- also common in those aged 2 to 7

4. SYNDACTYLY

- Webbing of the digits

5. TALIPES EQUINOVARUS

- Clubfoot
- There is adduction of forefoot, inversion
of entire foot
- Entire foot points downward
6. CONGENITAL HIP DYSPLASIA

- For infants <1 year old

- Positive (+) Ortolani’s and Barlow’s
Sign
[A click is heard]

ORTOLANI’S MANEUVER

- Flex knees
- ABDUCT thigh
- Move knees outward and downward
table

BARLOW’S MANEUVER

- Flex knees
- ADDUCT thigh and legs until thumbs
touch
CONGENITAL HIP DYSPLASIA
- For infants there is limited abduction
and difference in limb length
- Leg on affected hip is longer

- For infants, there is also unequal gluteal

and thigh folds or creases

7. SCOLIOSIS

- SIDEWAY CURVATURE OF SPINE

8. SPINA BIFIDA

- Outpouching of the spinal cavity due to

incomplete closure of vertebrae
- The sac may rupture
 HEAD-TO-TOE ASSESSMENT: NEUROLOGIC ASSESSMENT
- Includes assessment of the child’s behavior, motor & sensory functioning as well as
reflexes.
NEWBORN REFLEXES

1. ROOTING FLEX  EXPECTED RESPONSE

- Moving of head towards the stimulated

area and mouth opens

 AGE OF DISAPPEARANCE

- 3 to 4 months

2. SUCKING REFLEX
 EXPECTED RESPONSE

- Sucking when gloved finger or nipple is

placed on mouth

 AGE OF DISAPPEARANCE

- 10 to 12 months

3. PALMAR GRASP REFLEX  EXPECTED RESPONSE

- Grasping of examiner’s finger when

pressed against palm of hand on ulnar
side

 AGE OF DISAPPEARANCE

- 3 to 4 months

4. PLANTAR GRASP REFLEX  EXPECTED RESPONSE

- Curling of toes downward as ball of the

foot is touched

 AGE OF DISAPPEARANCE

- 8 to 10 months

5. TONIC NECK REFLEX  EXPECTED RESPONSE

- Arms and legs on the side to which head

is turned EXTENDS

- Arms and legs of opposite side will FLEX

 AGE OF DISAPPEARANCE

- 4 to 6 months
6. MORO (or STARTLE) REFLEX  EXPECTED RESPONSE

- Slightly flexing and abducting the legs

- Laterally extending and abducting the
arms
- Forming a “C” with thumb & forefinger &
fanning other fingers (symmetric)

 AGE OF DISAPPEARANCE

- 3 months

7. BABINSKI REFLEX  EXPECTED RESPONSE

- Fanning of the toes after stroking up the

lateral edge of foot, across the ball

 AGE OF DISAPPEARANCE

- 2 years

8. STEPPING (OR DANCING)  EXPECTED RESPONSE

REFLEX
- Stepping with one foot
- The other foot is in a walking motion

 AGE OF DISAPPEARANCE

- 2 months

9. EXTRUSION REFLEX  EXPECTED RESPONSE

- Tongue protrudes outward as tip of the

tongue is touched

 AGE OF DISAPPEARANCE

- 3 to 4 months

10. GLABELLAR REFLEX  EXPECTED RESPONSE

- Newborn blinks eye when forehead is

tapped

11. CROSSED EXTENSION REFLEX

  TECHNIQUE:
- Position supine with legs extended
- Stimulate the foot

 EXPECTED RESPONSE:
- Flexion, adduction,
- then extension of opposite leg

12. TRUNK INCURVATURE  TECHNIQUE:

REFLEX - Position prone
- Run finger down either side of the spine

 EXPECTED RESPONSE:
- Flexion of trunk
- Hip moving towards the stimulated side

13. LANDAU REFLEX  TECHNIQUE:

- Position in prone with stomach faced
down

 EXPECTED RESPONSE:
- Raising of head
- Arching of back

14. CRAWLING REFLEX  EXPECTED RESPONSE:

- Newborn attempts to crawl when placed in
a PRONE position

NOTE:
- Absence of the newborn reflex at birth or persistence of a reflex past a certain age may
indicate a problem with CNS Function
CURRENT DEVELOPMENT ASSESSMENT
1. Gross motor skills
2. Fine Motor – Adaptive Skills
3. Language Skills
4. Personal – Social Skills