An Approach to Assessing Children Flashcards
Where is the first place to start when trying to think about what is wrong with a child?
Age
->common things for each age vary, first few days to years change quickly
What are treatments in children depend on?
Age
Weight
What units do we measure a child’s weight in?
Kilos
->parents often want weight in pounds and ounces
How much weight should a baby gain?
About an ounce a day, 150-200g a week
->approximate
What do we measure feed volumes in?
mls
->parents may use fluid ounce- about 30ml/ounce, just for general knowledge
How much feed should a baby take per day?
Probably 140-180ml/day
What do you want to ask about poo in children?
Frequency
Appearance
Difficulties passing
Blood or mucus seen
Nappies or independent
Just some tips about various paeds consultations :)
Observe first
Be friendly and smile
Speak to the child (even if they are weeks old)
Get down to their level
Be careful moving them- keep parents close
Gentle handling and gradual exposure
Show interest in their toys + play
What do you observe for generally when examining a child?
Appearance, play, interaction, obs
What do you observe for in the respiratory system when examining a child?
Respiratory distress
Noise
Rate of breathing
What do you observe for in the cardiovascular system when examining a child?
Colour
What do you observe for in the GI system when examining a child?
Feeding
Vomit
Distension
What do you observe for in the neuro system when examining a child?
Play
Alertness
Interaction
Posture
What do you observe for in the MSK system when examining a child?
Mobility
Limb movements
Posture
Splints/mobility aids
What do you observe for in the skin when examining a child?
Signs of infection
Rashes
Skin changes
What are you checking when examining the hands/arms of a child?
Warmth, cap refill, radial/brachial pulses (rate/ rhythm)
Clubbing, nail changes, hand skills, pen marks
What are you checking for when examining the face and head of a child?
Eyes (jaundice), Lips (Colour, moisture), Tongue, Nose
Scalp changes, Bruises, Rashes, Fontanel
What are you checking for when examining the neck of a child?
Rashes and Nodes (easier from the front); size, shape, mobility, position, consistency, symmetry
Tracheal tug (Don’t push for carotid pulse or trachea)
What are you checking for in the chest when examining a child?
Murmurs (Timing, pitch, quality, location, radiation)
Apex beat, thrills, chest expansion (limited if small)
Breath sounds (all areas, reduced, symmetry, added)
Percussion (limited in infants, not routine, commonly forgotten when dealing with pneumonia)
Resonance and fremitus? (most are pre-school!)
Rashes and skin marks (inc neuro-cutaneous)
Spine alignment, deformity, sacral dimples
->don’t get overwhelmed, just want this noted somewhere
What would you check for when examining the abdomen/groin of a child?
Tenderness- watch their face and movement
Masses (esp stool) and organomegaly (liver, spleen, kidneys). Thumb can be used to feel
Bowel sounds and bruits (v.rare)
Femoral pulses (essential in infants)
Hernias (and testis)
Genital/ anal appearance (routine in nappies but often not appropriate for older children)
DON’T DO A RECTAL EXAM! (Senior staff only)
->again, for completeness
What would you check for in the lower limbs and feet when examining a child?
Mobility, changing posture, movements, tone
Reflexes (easy when v. young), plantars, clonus
Power, coordination, sensory assessment if older
Pulses, warmth, cap refill, colour, mottling,
Rashes, bruises, marks
Deformities and gait usually evident on inspection
->…yeah you’ve got it by now
