Examination of Children

Examination of Children : 

Examination of Children Dr S Sen SpR Paediatrics North Western Deanery

Observation : 

Observation Well or unwell? Active or lethargic? Vocal or quiet? Inquisitive or disinterested and “clingy”? Drinking +/- eating?

Dehydration : 

Dehydration Sunken fontanelle Sunken eyes ↓ Skin turgor ↑ CRT Dry mucous membranes No tears Dry nappies

Growth and Development : 

Growth and Development Appropriate growth for age? Appropriate development for age?

Dysmorphism : 

Dysmorphism Make sure you’ve checked for family resemblance! A constellation of features likely to suggest a syndrome Isolated features may be variants of normal

Respiratory : 

Respiratory Pink, pale of blue? Rate  or ↓? Work of breathing? Stridor? Grunting? Wheeze? Displaced liver (hyperinflation)? Good AE or silent chest? SaO2

Cardiovascular : 

Cardiovascular Pink, pale or blue? Mottled or well perfused? HR and BP  or ↓? Active precordium? Organomegaly? Heart sounds? Murmur? Femorals palpable? (Babies)

Abdominal : 

Abdominal Signs of nutritional deficiency? In pain? Where? Masses or organomegaly? Remember to leave potentially painful parts until last

Nervous System : 

Nervous System Can be quite a complex examination therefore tailor to developmental age (“tone, power, reflexes and sensation”) Gait Wasting, weakness, hypotonia and palsies Early hand preference? Pigeon steps Walk on tip toes Developmental milestones Presence and absence of protective reflexes Careful with that tendon hammer!

Musculoskeletal : 

Musculoskeletal Bony deformities? Limps? Muscle bulk Tone? Power? Muscle tenderness?

Skin : 

Skin Note distribution of lesions Papules, macules, pustules, vesicles and purpura Hair, teeth and nails

ENT : 

ENT Important part of paediatric examination Requires cooperation from parent and patient Generally leave until last as can be upsetting

Questions? : 

Questions?

Picture References : 

Picture References www.ljmu.ac.uk/StudyLJMU/Courses/66718.htm csindy.com/csindy/2002-06-20/cover.html www.dailytexanonline.com/news/2005/07/26/Worl... peds2.med.miami.edu/mailman/service_programs.htm www.cerebromente.org.br/.../down/down_i.htm www.bbc.co.uk/health/conditions/croup2.shtml www.who.int/.../referral_care/chap3/chap31.htm www.adhb.govt.nz/.../VascularLesions.htm www.tdhafghanistan.org/newsletter14.htm people.cornell.edu/.../Image6.html www.healthofchildren.com/B/Bell-s-Palsy.html www.neuro.wustl.edu/.../msys/cardiac.html www.allergycapital.com.au/Pages/delayed%20foo... www.healthwatcher.net/.../mm-meningitis.html www.nursingceu.com/courses/122/index_nceu.html

Thank You for your Attention : 

Thank You for your Attention