Examination of a child Flashcards
Discuss height and length measurement
Length: measured in those <2yrs
- mean of three measurements is taken
Height: measured in those 2+
Can a conclusion be drawn regarding growth following one measurement plot?
No - at least 2 measurements taken 3 months apart to draw any conclusions
Patterns of concern regarding growth
Fall across 2 centiles
Fall across any centile if abnormal findings also present
How do we measure a child’s temperature?
Tympanic measurement
o Unless baby is tiny in which case ear is too small so axillary measurement is taken
When is an up-going plantar sign normal in a child?
Up to the age of 2 because their nervous system is not full myelinated
- After this age up-going plantars is a sign of MND
Newborn examination of the head and neck
- Inspect for birth injuries/ congenital anomalies
- Plot head circumference
- Look at hard and soft palate
- Some babies are born with teeth – can become loose and need removing to avoid aspiration
- Check red reflexes
- Hearing screen
- Check for any facial anomalies
Abnormal head and neck signs in a newborn
o Abnormal swelling due to birth injury e.g. caput succedaneum or cephalohematoma
o Cranial synostosis: fusion of cranial bones leading to an absent fontanelle
o Head circumference greater than weight - asymmetrical growth restriction
o Absent red reflex- congenital cataracts or retinoblastoma
o Low set ears - genetic disorder e.g. Down’s or Turner’s
Upper limb examination in newborn
- Inspect babies arms and hands to look for defects or asymmetry
- Observe spontaneous movements and check tone
- Floppy arms are a sign of brachial plexus injury secondary to shoulder dystocia
o Erbs palsy is cause by damage to the upper part of the brachial plexus when neck is stretched durig birth
o Arm is held in waiters tip position with shoulder adducted, elbow extended and wrist pronated
Most cases resolve within a few weeks
- Single palmar crease can be normal but is often suggestive of Down’s
- Count fingers
- Blue hands are common in newborns and is often not pathological and resolves within a few hours
Chest examination in newborn
Inspection, RR, auscultation, cap refill, HR, auscultate heart sounds
Oxygen sats
- Important to do one measurement from hand and one from foot to measure post-ductal oxygen saturation
- Done to screen for cyanotic congenital heart disease – highlights babies whose blood is poorly oxygenated
- Further investigation if there is >5% difference between pre and post-ductal sats because it indicated congenital heart disease or persistent pulmonary HTN
- Normal sats do not exclude congenital heart disease
Abdominal examination in newborn
- Inspect for umbilical cord abnormalies
- Normal cord insertion
- Signs of infection at the umbilicus
- Palpate to feel for organomegaly
Groin/ genital examination in newborn
- Palpate femoral pulses – absent or weak pulses may suggest coarctation of the aorta
- Look for masses suggesting hernia
- Check testes are palpable in scrotum
- Check for anal opening for atresia
Hip examination in newborn
• Galeazzi’s test: comparison of leg length
• Ortolani’s and Barlows: looks for instability
• An audible clunk when performing Ortolani’s shows that a hip is already dislocated
o For the result of the test to be positive the abnormality must also be reducible
- Barlow = Is is dislocataBle
- Ortolani = Out to in
Lower limb and spine examination in newborn
o Malformations or limb disproportion
o Abnormal movements
o Asymmetry of skin fold creases which indicates DDH
o Range of movement limitation
o Talipes – club foot
o Abnormal number of toes
o Inspect spine for tufts of hair
Primitive reflexes
- Moro’s reflex: observe movements of baby’s arms when they fall backwards
- Stroking cheek and putting finger in mouth tests root and sucking reflexes
- Palmar and plantar grasp reflexes tested by putting finger in palm of baby’s hand
- Stepping reflex tested by putting baby in standing position and they will lift feet as if stepping
Absence of primitive reflexes suggests neurological problem e.g. asymmetrical Moro’s reflex may suggest brachial plexus injury
Symbols depicting family hx
