pediatric exam Flashcards
height/length
length: cannot walk or stand; done supine between birth and 24 months (make sure to plot growth curve)
- height: when can walk (2 years)
head circumference
measured at every well child check ups until age 2-3
BP
can be measured, but more important to measure growth vitals (over 2-3 years of age)
vision screening
use senile charge starting at 3 years of age
- point direction of E
- infants, try for red reflex
hearing screening
- infants: bell, whisper, rub fingers
- toddler: observe response to whispered voice/noisemakers (stay positioned behind child) -> expect child to respond to sound consistently (development indicates hearing acuity)
nutritional assessment
- breast vs bottle fed (frequency, duration)
- note additional intake of vitamins/minerals
- adol: preoccupation with weight and concern about developing muscle mass and losing body fat
- monitor protein intake, calories, vits and mins
assessment of developmental milestones
smile (3 months), say 1-2 words (1 y/o)
common difficulties associated with meds hx and physical exam
●Preschool aged children will take time to warm up to you
●Start on the other side of the room and let them get comfortable with you before approaching
●Allow children to explore and check out equipment before using it
●Do least stressful tests first and progress to most anxiety producing last (heart and lungs)
●Be prepared for a wiggling child when doing an exam (finger strut!!)
●Most information will come from the adult present with them but if the child is old enough, engage them in the history taking
prenatal hx/birth hx
- How did the pregnancy go? (general sense of how it went)
- Did mother take any prenatal meds besides vitamins and iron?
- Plans for baby: breast vs bottle; labor/delivery plans (does OB know what you want?); circumcision; safety issues (car seat, furniture, electrical outlet plugs, etc)
- How long did labor last? Any difficulties/complications with labor?
- Any infections or other conditions -How long were mom and baby together in the nursery? (usu 48 hr max, more if baby was
- What was birth weight? (and discharge weight, which will be less than birth weight)
social hx
- Who lives in the home?
- Are siblings prepared?
- Smoking/alcohol?
- Support: friends? Mother-in-law moving in?
- Work, maternity/paternity leave
- Pets
- Diet – eg are parents vegan, and will they be raising baby vegan?
past medical history
- Previous pregnancies? How’d they go?
- Assisted pregnancies (in vitro, etc)
- Hx of post-partum depression, gestational diabetes, pre-eclampsia, etc
- Hx of miscarriages? GU surgeries?
- Infections/treated conditions during pregnancy/labor (eg active herpes outbreak)?
review of systems
Vomiting, pelvic/abd pain, vaginal bleeding, abnormal vaginal discharge?
- Psych – depression, SI, HI
- HA, other HTN symptoms
- infectious symptoms? sore throat, cough, UTI sxs, etc.
5 things to look at during well child visit
Nutrition, Elimination, Sleep, Immune, Development
components of well child visit
a. Developmental assessment: meeting growth parameters e.g. head circumference , observing milestones (reflexes should be going away when they should)
b. Physical: skin, umbilicus, fontanels, ears, mouth, palate, mucous membranes
c. Supine: heart, lungs, abdomen, femoral pulses, hips, genitalia, eyes
d. Prone: spine, anus, head raise
e. Neuro: DTR, Babinski, clonus, rooting, suck, palmar grasp, plantar grasp, Moro (startle reflex birth -6mo) , placing, stepping, Galant’s (truncal incurvation), tonic neck,
f. Behavioral assessment/ interaction
g. The parent/ child: model behavior
h. Anticipatory guidance: patient education
close visit ad reassure
18 months
when they can be more fussy and scared
