Physical Assessment of a Pediatric Patient

Question 1

What is the heart rate range for an infant?

Answer 1

80-150

Question 2

What is the heart rate range for a toddler?

Answer 2

70-120

Question 3

What is the heart rate range for a preschooler?

Answer 3

65-110

Question 4

What is the heart rate range for a school-age child?

Answer 4

60-100

Question 5

What is the heart rate range for a adolescent?

Answer 5

55-95

Question 6

What is the respiratory rate range for an infant?

Answer 6

25-55

Question 7

What is the respiratory rate range for a toddler?

Answer 7

20-30

Question 8

What is the respiratory rate range for a preschooler?

Answer 8

20-25

Question 9

What is the respiratory rate range for a school-age child?

Answer 9

14-26

Question 10

What is the respiratory rate range for a adolescent?

Answer 10

12-20

Question 11

Temperature

Answer 11

Multiple methods. Temps greater than 100.4 F most likely is treated. Child must be able to hold mouth closed around thermometer probe to use oral method.

Question 12

Average blood pressure for an infant?

Answer 12

80/55

Question 13

Average blood pressure for a toddler and/or preschooler?

Answer 13

90-110/55 to 75

Question 14

Average blood pressure for a school-age child?

Answer 14

100-120/60-75

Question 15

Average blood pressure for an adolescent?

Answer 15

100-120/70-80

Question 16

Pulse Ox

Answer 16

Generally greater than 94% is considered within normal limits. A wrap-around pulse oximeter probe may be used on the hand or foot instead of the one that clips on.

Question 17

Weight

Answer 17

> Infant/younger toddlers: weighed with no clothing on infant scale

> Older toddlers and Up: minimal clothing (t-shirt/shorts or pants) on standing scale

Question 18

Length/Height

Answer 18

Growth charts based on recumbent (laying) length up to 2 years of age. Standing height >2 years

Question 19

Head Circumference

Answer 19

Head circumference until 3rd birthday. Longer if concerns (hydrocephalus)

Question 20

FLACC Scale

Answer 20

Behavioral assessment tool based on facial expression, legs, activity, cry, consolability. For nonverbal use

Question 21

Ouch Scale

Answer 21

Used for 3-12 years old. Have child select face the represents how they feel

Question 22

FACES

Answer 22

Used for 3-8 years old. Have child select face that represents how they feel

Question 23

Visual Analog

Answer 23

Used in children 5 and older. Child makes line the represents level of pain

Question 24

Numeric Scale

Answer 24

Usually starting at age 8 years. Child should know how to count and quantify numbers.

Question 25

Skin

Answer 25

Skin: assess same parameters as adult. Some areas of concern based on age

Children in diapers pay attention to perineal areas for redness, rash, breakdown

Adolescents: assess for acne

Hygiene of child should also be assessed

Peripheral pulses: infants and younger children best palpated: brachial and femoral. Older children: radial and dorsals pedis/posterior tibial

Question 26

Hair

Answer 26

Distribution, texture, infestation (lice), cleanliness

Head: Infants-anterior (close by 9-18 months) and posterior fontanel (close by 2-3 months). Assess for symmetry, plagiocephaly, attainment of head control

Question 27

EENT

Answer 27

Similar areas as adults

Throat: For infants, easier to assess during a yawn or cry.

Assess for color, drainage, exudate. Tonsils usually not seen in infants, tend to be larger in toddlers and then decrease in size

Teeth: number, caries, cleanliness

Infants are nasal breathers- assess for latency of nares

Question 28

Chest

Answer 28

Inspection: symmetry, ease of respirations- not any retractions- infants and younger children may see retractions when in distress, accessory muscle use, AP:T- may be equal in infants and move to 1:2 ratio by 5-6 years

Lungs: Auscultate anteriorly, posteriorly and laterally. Note adventitious sounds. Note that nasal congestion in infants and younger children may refer to the lungs.

Auscultate: Listen to all 4 sites: aortic, pulmonic, tricuspid and mitral. Point of maximal impulse (apical point). Up to age 4 years: 3rd-4th intercostal space, just medial if left MCL.

4-6 years: 4th ICS at left MCL
7 and older: 5th ICS at MCL or just lateral to MCL

Question 29

Abdomen

Answer 29

Inspect size, shape, symmetry. Infants and toddlers rounded abdomen

Auscultate: All four quadrants

Palpate: in supine position, flex legs up

Question 30

Genitalia

Answer 30

Inspect for drainage, redness, pain with urination

Question 31

Tanner Staging

Answer 31

Looks at pubertal changes in male and female related to reproductive system, great development, body hair.

Question 32

Musculoskeletal

Answer 32

Monitor for range of motion, symmetry, hypertonia, hypotonia

Question 33

Nervous System

Answer 33

LOC: younger children demonstrate orientation by observing interactions with family members, crying/fussing appropriately

School-age should be oriented to name, place and time

Assess balance and coordination as appropriate for age

Reflexes- not prolonged newborn or primitive reflexes

Assess attainment of developmental milestone.