Health assessment, development, defects & disorders Flashcards
Vital signs
● Temperature, Pulse, Respiration, Blood Pressure and Pain (TPR-BPP)
● For children 1 – 10 years old: Hypotension = <70mmHg + ( age in years x 2)
Body measurements
● Weight ● Height/ Length ● Head Circumference ● Chest Circumference ● Abdominal Circumference
Compare with growth standard, highlight if
● Weight fall => 2 centile
● Weight or length <3rd centile of the
Warnings signs to growth and development
at birth
Very irritable or inert; Stiff or floppy;
Cloudy or white pupil
Warnings signs to growth and development
3 months
Complete head lag; Hands always fisted;
Asymmetry of lack of movement of limbs;
No visual fixation; No social response
Warnings signs to growth and development
6 months
Any head lag; Moro reflex or asymmetric
tonic neck reflex persists; Poor social
response; Constant squint
Warnings signs to growth and development
9 months
Hand regard persists; No tuneful babbles;
Not smiling; Not chewing; Abnormal tone;
Constant use of 1 hand only
Warnings signs to growth and development
12 months
No imitating play or noises; No poking or
pincer grip; Not trying words; Not sitting
alone; Constant mouthing
Warnings signs to growth and development
18 months
No understanding of use or command;
Casting and mouthing; No spontaneous
words; Not standing alone
Warnings signs to growth and development
2 years
No words with meaning; Excessive
dribbling; Not walking alone; No
constructive play
Warnings signs to growth and development
3 years
Echolalia jargon; No sentences; Most
words unintelligible; Very clumsy
Warnings signs to growth and development
4 years
No cooperative play; Very immature
speech; Not drawing; No toilet
awareness
Warnings signs to growth and development
5 years
Marked confusion of sounds, grammar
and articulation; Very clumsy hands
Physical examination : head, face and neck
Inspection :
Shape and symmetry
Head control and posture
Range of motion
Palpation : Skull for sutures Fontanel Depression Swelling
Frontal fontanel
- diamond shaped
- 2.5 - 4cm
- closes at 12 - 18 months
Occipital fontanel
- triangular shaped
- 0.5 - 1cm
- closes at 2 months
Abnormal of head
● Bulging or depressed fontanels
● Widened sutures or fontanels
● Craniosyntosis - premature fusing of the sutures
● Caput Succedaneum – edema of soft scalp in
newborn
● Cephalohematoma – hematoma between
periosteum and skull bone
What do you examine for eyes?
Size : symmetry ; colour ; motility
What is abnormal for eyes?
● Absent of red eye reflex
What is vision testing?
● Binocularity; Visual acuity
● Peripheral Vision; Color Vision
What are the symptoms of eyes?
● Amblyopia (lazy eye)
● Strabismus (misaligned eyes)
● Ptosis (dropping upper eyelid)
● Cataract
What are the risk factors for visual problems?
● Low birth weight of less than 1500gm ● Needed resuscitation / oxygen at birth ● Maternal German measles or toxoplasmosis infections during pregnancy
What is the abnormal of mouth and palate?
- Cleft lips
what do we inspect for mouth?
● Cleft Palate
● Tonsilitis
what do we inspect for ears?
● Size, postion & structure
● Deafness (Drugs, maternal infection)
● Abnormal or absent of ear/canal
what do we inspect for neck?
● Size and orientation of associated structures
(Trachea, Thyroid gland, Lymph nodes)
● Webbing (Tuner’s Syndrome)
● Swelling (Infection)
what do we inspect gastrointestinal tract defects?
● Umblical hernia
● Inguinal hernia
● Anorectal Malformation
● Biliary Atresia
What is the genito-urinary tract defects?
● Cryptorchidism (undescended
testes)
● Phimosis
● Hypospadias
What is the physical examination of spine?
● Spinal column
● Symmetry of scapulae, buttocks
● Shape of curvature like letter “C” at birth,
the cervical spine gains its reverse ‘C’ by
3 months, and lumber spine at 6 months
● Tufts of hair, dimples and discoloration
along the intact spine. eg. underlying
spina bifida occulta
Spina bifidia occulta
Spina bifida occulta is when a baby’s backbone (spine) does not fully form during pregnancy.
Hair tuft
Meningocele
A meningocele is a birth defect where there is a sac protruding from the spinal column.
Spinal fluid
Lipomyelomeningocele
A lipomyelomeningocele is a fatty mass under the skin on the child’s back.
Myelomeningocele
A myelomeningocele (pronounced my-elo-men-IN-go-seal) is a defect of the backbone (spine) and spinal cord.
Spinal nerves
What is the physical examination of spine?
Skeletal Defects: Scoliosis
Arises at puberty
Lateral curvature of the spine that occurs most frequently during the linear growth spurt (before
12 years old) of especially in female at the onset of early puberty
What is the physical examination of extremities?
Fingers and Toes Abnormality Inspect for symmetry in length, size & shape bilaterally ● Polydactyly (Extra digit) ● Syndactyly (Fused digit) ● Clubbed Fingers
What are the skeletal defects ( congenital )
● Dysplasia of Hip
- Dislocation of the hip joint, ball out
of socket
Congenital Club Foot (Congenital Talipes
Equino Varus)
- Foot appears like a golf club (lateral or
medial) - Feet: Pigeon toe caused by internal
tibial torsion, persisting after 3 months - Gait: Toe walking persisting beyond
infancy.
Legs
Bowleg
Knockknee
