Pediatric exam Flashcards
Additions to the history portion of pediatric exam
Prenatal
Birth
APGAR
Gestational age
Size
Development
APGAR
Scoring system that evaluates newborns at birth, 5 mins, and 10 mins
10 point system (0-2 points for each item) where higher points are healthier
APGAR acronym
Activity (movement + muscle tone)
Pulse
Grimace (Irritability to noxious stimulus like flicking the heel)
Appearance
Respiration
Prenatal + birth factors to account for in the history
Health conditions of mother
Substance use
Pre term
Trauma
Purpose of development in history taking
can provide info on delays and how/when they started (onset)
Systems review
Screen systems separate from area of chief complaint
Consider screens of other developmental areas (communication, cognition, language); not usually first priority
Window into the CNS of young infants
State regulation (behavior)
State regulation
Spectrum of sleep to inconsolible crying/screaming
Ability to move through the stages and not be stuck in an extreme indicates normal CNS development
Getting stuck in a stage or in the extremes indicate an immature CNS
Behavior in older children
Assess:
attension
Communicatoin
Cognition
Direction following
What do impairments tell us
Capacity for movement
Pediatric considerations for ROM
Not crossing joints
Age related changes
Critical ranges
Avoiding passive trunk rotation before 4-5 months
Avoiding over pressure
What else can be evaluted with ROM
Orthopedic alignment
Tests for hip stability in peds
Barlow Ortolani
Galleazi
Rotational profile of ROM in peds
Anteversion/retroversion of femur
Tibial torsion
Foot alignment
Tight muscle groups that may indicate cerebral palsy
Adductors
Hamstrings
Gastroc
Categories of tone impairments
Spasticity
Athetoid
Ataxia
Hypotonia
Tone can indicate…
Area of pathology + distribution
Tests for tone
MAS (Modified ashworth scale)
Tardieu
Signs of hypotonia
Scarf sign
Popliteal angle
Slip through sign
Scarf sign
If hand can extend over the chest and beyond the trunk: + (hypotonia)
Popliteal angle indicating hypotonia
Newborn is able to extend the knee in 90 90 pos
Slip through sign
+: no stability around scapula when lifting child under the shoulders
Hypotonia may be caused by what in babies?
Chromosomal disorder
Muscle disease
What determines how we evaluate active movement + strength
Ability to follow directions + cooperation
