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
Ways to evaluate active movement + strength
MMT
Observation of movement (considering gravity, resistance, and range)
Functional tests
Dynamometry
When would dynamometry be considered for strength assessment
Precise + objective info needed (muscular dystrophy, ie)
How to evaluate movement if non isolated
Observe + describe
What can reflexes provide in young infants
Info about innervation
SCALE
Assess selective control
Other pieces of pediatric evaluation
Neonatal reflexes + postural reactions
Development
Balance
Functional mobility
Post ambulatory
Pain
Endurance
Skin
Equipment
Sensation + perception
Postural reactions
Head righting
Equilibrium
Protection
Balance assessment
PBS
Functional reach
Early clinical assessment of balance
Post ambulatory skills
Running
Jumping
Hopping
Skipping
Galloping
Climbing
Throwing
Kicking
Catching
