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Paediatric Examination

From Mediwikis

Examining a child is just as important for elucidating clinical signs as in adults, however many signs can differ in different age groups. Your examination should always be tailored to the age and demeanour of the child. This guide is a general approach for children useful on the wards or in OSCE situations, and should be guided by the clinical presentation.

Overview

  • Build rapport with both parents and child- this could save you time in the long run!
  • Avoid waking sleeping children
  • Approach the child on their level
  • Try easier steps that are less likely to upset the child, before moving onto more challenging steps
  • Warm stethoscopes and hands before contact

Introduction

  • Confirm patient name, age, Date of birth
  • Confirm any attending relatives- relationships to patient
  • Explain examination- purpose, duration, any steps involved
  • Gain consent

General Inspection

End of the bed

  • Observe general behaviour, activity level, and alertness.
  • Any abnormal features across the face, head, ears
  • Any skin rashes- note distribution
  • Any bruises- distribution
  • Assessment of puberty

Measurement

For pull procedure, see Growth Measurement

  • Head circumference
  • Length
  • Weight
  • Plot on appropriate growth charts

Examination by system

Cardiovascular

  • Inspect the chest for any abnormality
  • Press on the sternum to check central refill time
  • Palpate for the heart size and apex beat
  • Auscultate heart sounds

Respiratory

  • Listen from the end of the bed
    • Stridor
    • Wheeze
    • Rhonchi- persistent harsh breath sounds
  • Observe respiratory effort
    • Respiratory Rate
    • Intercostal/subcostal recession
    • Use of accessory muscles
    • Head bobbing
    • Shoulders back
    • Nasal flaring
  • Percuss liver border for overinflation of the liver
  • Auscultate the lungs
    • Crepitations
    • Added sounds

Gastrointestinal

  • Observe the abdomen
    • Remove any nappies
    • Swellings
    • Bruises
    • Rash
  • Palpate the abdomen in all 4 quadrants
    • Any organomegaly
  • Assess hydration

Musculoskeletal

  • Deformity
  • Abnormal curvature of the spine
  • Any bowing or knocking of legs

Nervous