An approach to assessing children

Question 1

Learning outcomes

Answer 1

• Understand the components of a paediatric history
• Recognise the key differences in assessing children
• Develop a multisystem approach to children
• Describe the range of techniques used to facilitate examination
• Be able to make a basic assessment of each system

Question 2

What are the units of measurement for a child’s weight

Answer 2

?

Question 2

What are the units of measurement for a child’s weight

Answer 2

?

Question 3

How much weight should a baby gain

Answer 3

• 150-200g/ week
• 20-30 grams per day

Question 4

How much feed should a baby take

Answer 4

• 140-180ml/kg/day

Question 5

What to note about bowel movements

Answer 5

• Nappy or indépendant toileting
• Frequency
• Size, shape, appearance and consistency
• Difficulties passing
• Pain on passing
  
  • Blood and mucous seen

Question 6

Key stages in paediatric history

Answer 6

• Birth history → age and presentation
• Past medical history
• Immunisation
• Developmental
  
  • What can they do, any concerns
  • Basic enquiry words (walking, words, support)
• Drugs and allergies
• Family and social history

Question 7

Examination techniques in paediatrics

Answer 7

• ABCDE and baseline observations/ vital signs
• General condition and peripheries
• Respiratory system
• Cardiovascular system
• Alimentary system
• Neurological and musculoskeletal systems
• ENT and derm
• Developmental skills
• Measurements and centimes

Question 8

Observations in paediatric examination

Answer 8

• General → appearance, level of play, level of interaction,
• Resp → effort, noise, rate, recession, 02, nebuliser
• CVS → colour, perfusion
• GI → feeding, vomit, abode distension/ movement
• Neuro → alertness, interaction, play, posture
• MSK → mobility, limb movements, posture, splints, mobility aids
• Other → rashes, bruises, infusions, tubes, lines, toys, pictures, cards, caffeine, books

Question 9

Peripherall exam in paeds

Answer 9

• Hands and arms
  
  • Warmth, cap. refill, radial/brachial pulses (rate and rhythm)
  • Clubbing, nail changes, hand skills, pen marks)
• Head and face
  
  • Eyes → jaundice
  • Lips → colour and moisture)
  • Tongue
  • Nose
  • Scalp changes → bruises, rashes and fontanelle
• Neck
  
  • Rashes and nodes (size, shape, consistency, mobility, position, symmetry(
  • Tracheal tug
  • do not palpate for carotid or trachea
• Check ears and throat, measure and plot → difficult when noisy

Question 10

Chest and back examination in paediatrics

Answer 10

• Murmurs (timing, pitch, quality, location, radiation)
• Apex beat, thrills, chest expansion)
• Breath sounds (all areas, reduced/ increased, symmetry, added sounds)
• Percussion (limited to only infants, not routine(
• Resonance and fremitus (pre-schoolers)
• Rashes and skin marks
• Spinal alignment, deformities, sacral dimples

Question 11

Abdominal and groin examination in paediatrics

Answer 11

• Tenderness → watch facial expression and movements
• Masses → stools, organomegaly (spleen, liver, kidneys)
• Bowel sounds and bruits (very rare)
• Femoral pulse (essential in infants)
• Genita/ anal appearance (routine in nappies but innappropriate for older children)
• do not do rectale xam

Question 12

Leg and feet examination in paediatrics

Answer 12

• Mobility, changing posture, movements, tone
• Reflexes (easier in younger children, plantars, clonus)
• Power, co-ordination, sensory assessment in older children
• Pulse, warmth, cap refill, colour mottling
• Rashes, bruises, marks
• Deformities and gait → usually on inspection