Paeds history + examination Flashcards
What are the principles when approaching paediatric examination?
HELP - Hello, Engage interest, Level, Patter
INFANTS
-Examine from a warm platform / cot, have dummy / clean finger to pacify, make noises + smile
TODDLER
-Parents lap, play games + distract
OLDER CHILD
-On bed, explain
ADOLESCENT
-Consider need for chaperone / presence of parents
How do vital signs measurements differ in children?
CRT - measured centrally + peripherally
PAWS - remember it is a piece of the jigsaw, not as reliable as adults
Where do you observe for central cyanosis in children?
-Tongue / mouth and gums
-Peri-oral cyanosis can be associated with malaise, vomiting etc not strictly hypoxia
How do you assess the pulse in paediatric examination?
-Brachial, radial, femoral
NOT carotids
What are the 5 F causes of abdominal distension?
-Faeces
-Fat
-Flatus
-Fluid
-Foetus
What features of extra heart sounds should be noted on auscultation?
-Timing - when heard?
-Site - where heard?
-Radiation
-Pitch
-Grade (I-VI)
–Small septal defect / more stenosed valve –> louder murmur
-Change with inspiration / posture
How would you conduct a neurological exam on a baby / infant?
NB almost entirely inspection-based
INSPECTION (while dressed)
-Overall size / proportions of head / trunk / limbs
-Dysmorphic features
-Posture - symmetrical?
-Movement - symmetrical? accessory movements eg tics, tremor?
-Eyes - eye contact? fixing? squint, nystagmus, pupils
-CN - smile symmetry (VII), suck + swallow (VII, IX, X, XII), stick tongue out (XII)
-Head - shape, sutures, fontanelles
-Hands - wasting, handedness, grasp
-Undress to nappy
ACTIVE EXAMINATION
-Inspection
-Tone
-Power - grasp, pull to sit
-Coordination - playing, gait
-Reflexes - tendon + primitive
How would you assess gait in children of different ages?
3yr = walk on heels + toes, stand on 1 leg
4yr = hop
5yr = straight line
7yr = heel toe
