Which method is best for performing a physical examination on a toddler?
Summary Taking a history and performing a physical examination with children differs from adults and comes with a set of unique challenges. Symptoms are typically reported by a parent or guardian, who may not be able to accurately transmit the information from the child to the examiner and characterize the child's concerns. To fill in the gaps, a pediatrician must have good communication skills and the ability to develop a rapport with children as well as their families. Pediatricians must also pay special attention to growth and developmental issues unique to the pediatric population and be aware that certain diseases manifest differently in children than in adults. This article specifically covers nuances involved in history and physical examination for pediatric patients to supplement general information found in the “Medical history” and ”Physical examination” articles. Show
Medical historyIn addition to the details of a general medical history, there are some notable differences to be aware of when taking a pediatric medical history, including certain patient details, the source of information, and modes of communication. Chief concern and history of present illnessPast historyPrenatal and birth historyThis information is especially most important for young children and is often irrelevant for adolescent patients. It is usually best to get a history of these details from the patient's mother herself, but if the mother is unavailable, do your best to find out what you can to gain a fuller picture. Developmental historyFeeding or nutrition historyFamily historySocial historyThe social environment of the child is a key determinant of the child’s present and future health. The medically relevant social factors vary depending on age. Adolescent psychosocial screening: HEADSS assessmentThe mnemonic HEADSS helps to remember the components of a comprehensive social history in this age group. Start the interview with general topics before progressing to more sensitive issues like recreational drug use and sexuality. It is important to be direct and open when addressing these issues and not to hesitate to explore them further with the patient. Be prepared to counsel and educate patients about any sensitive issues! To remember the components of social history in adolescents, use the word “HEADSS”: Home, Education/employment, Activities, Drugs, Sexuality, Suicidal ideation/Screening for depression. Leading causes of death [1][2]The social history of adolescents in brief, with a special focus on the leading causes of death in this age group, is covered by the mnemonic SAFE TEENS: Sexuality, Accidents, Firearms/homicide, Emotions (suicide, depression), Toxins (e.g., alcohol, tobacco, recreational drug use), Environment (home, friends, school), Exercise, Nutrition (e.g., eating disorders), Shots/immunizations. Review of systemsPhysical examinationIt is important to remain flexible and consider patient preferences in the order with which the systems are examined. It is generally recommendable to perform examinations that the patient is likely to find uncomfortable and may decrease cooperation towards the end of the physical exam. In young children, it is often helpful to perform maneuvers on the guardian first to show that they will not hurt and so encourage the child's cooperation. Always record height, weight, and head circumference with percentileson a growth chart to track the progression of these values. Skin and lymphaticsHead and neckEar examEyesNoseOropharyngeal examCardiovascular examLung examAbdominal examMusculoskeletal examNeurological examIt is often challenging to have children under the age of 7 years perform all the tasks involved in a complete neurological examination. You may have to improvise or do it in different parts. Genitourinary examWhich technique is used in a physical examination?WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation.
How do you perform a general assessment on a pediatric patient?The collection of objective data includes the nurse doing a baseline measurement of the child's height, weight, blood pressure, temperature, pulse, and respiration.. Assess the range of motion. ... . Assess the fontanels. ... . Assess the eyes. ... . Assess the ears. ... . Asses the nose, mouth, and throat.. What are the six methods used in physical examinations?The components of a physical exam include:. Inspection. Your examiner will look at, or "inspect" specific areas of your body for normal color, shape and consistency. ... . Palpation. ... . Percussion. ... . Auscultation. ... . The Neurologic Examination:. What are the methods of physical?A physical examination involves the use of the techniques of inspection, palpation, percussion, auscultation, and smell. A complete examination includes a client's height, weight, vital signs, and a head-to-toe examination of all body systems.
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