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Synopsis of General Pediatric Assessment & Child Development

6 general ways kids are not small adult head disproportionately large, higher metabolic rate, greater insensible losses, immature temp reg, immature immune system, less oerall organ maturation
4 differences in pediatric skin thinner/more sensitive, less subcutaneous fat, grater body surface area to wt ration, viral/bact/fungal rashes (especially perianal)
neurological difference in children (3) all brain cells present at birth, not matured until 5/6 yrs age; brain tissue softer, thinner, more flexible & sensitive to injury, infections, toxins; Brain recovers better
Pulmonary differences in children (3) smaller airway, higher resting respiratory rate, use of accessory muscles may be normal finding
Cardiac differences in children (7) Circulatory volume 80-90ml/kg, increase in CO is maintained by increasing HR not SV; Hypotension is a LATE sign of shock; less dysrhythmias seen; more congenital heart disease seen; sinus arrhythmia normal; innocent murmurs may be present
what is an 'innocent murmur" normal heart sound in children: soft, low pitched, short duration, during systole, @ 2nd & 3rd L IC space, do not radiate, disappear with position change
Pediatric Shock tachy or bradycardia, Decreased perfusion to skin/brain/kidneys, hypotension is LATE sign, clinical presentation often worsens proior to VS change
Components of a pediatric history prenata/birth hx, infant feeding type (breast vs formula, solids), eating pattern, fluid intake, elimination, sleep, rashes, jaundice, social history (who lives in home, pets, family structure, current Rx, recreational Rx/eoth/smokign, ROS, CC
Pediatric Well Child Check ups (WCC) Nurtition, Ht, wt, BMI, head circumference, social hx; childhood illnesses, developmenatl concers, potential for abuse/neglect, allergies/IZ, USE GROWTH CHART
communication with children Position at child’s eye level Talk quietly Be specific/positive Use concrete terms Offer choices when you can Be honest
how to approach the toddler for PE Use security objects Let handle equipment Use play to distract Call by name Praise frequently PE: Let parent hold child Chest to toe/then head Perform necessary exam quickly
How to approach the Preschooler Likes to please Expose minimally Give child choice of where exam is to take place
How to approach the school age child Provide privacy Involve child Teach about body
How to approach the adolescent Give choice to have parent in room Explain confidentiality Ask about: Home Education/Employment Activities/Exercise Drugs/Smoking Diet Sex practices Depression Suicide ideation
Initial assessment VS, HT, WT, HC, Age/proportionate size Tanner stage, General apperience; well versus ill, LOC, muscle tone, Respiratory effort, Color/perfusion Distress/pain Skin integrity/rashes, Communication. Denver Devel test to assess development< 6yr
PE: skin Skin Color/temperature Nail beds/cap refill Turgor/pulses Lesions/rashes Peri-anal “Diaper” rash Anal fissure/abscess Male genitalia Circumcision Urethral orifice Female genitalia Vagina labia/discharge Urethral orifice
PE: HEENT Head: Shape,fontanels,hair pattern/texture Eyes: Pupil, acuity, nystagmus, Tearing/drainage, Sclera, EOM, Ears Deformity/placement, Hearing, canals, TM. Nares: Drainage/patency, flaring, epistaxis. Mouth & pharynx, Neck: head control, lymph,ROM
PE: chest WOB, Retractions Rate/rhythm Symmetry Nipple appearance/discharge Lung sounds Adventitious breath sounds Air exchange, Heart sounds Rate/rhythm/murmur S1 and S2/extra heart sounds PMI at 4th ICS > 7 year old Sinus arrhythmia normal
Innocent murmur Innocent Murmurs Soft, low pitched, musical Short duration Occurs during systole Heard at 2nd & 3rd left interspace Do not radiate Disappear with position change
PE: abdomen/ Pelvis Contour/movement Bowel sounds Check umbilicus Liver/spleen/kidneys Palpate for tenderness/masses Prominent in infants & children
PE: Musculoskeletal Posture/position/gross deformity Bone/joint tenderness/deformity ROM/flexibility Muscle size/symmetry/strength Configuration/mobility of spine/back Scoliosis Coordination Bowlegs common < 2 years/age “Knock knees” common 2-7 years/age
PE: Neruological Cephalo caudal progression Mental status changes/LOC Sensory/motor recognition Fine/gross motor skills Coordination/balance Cranial nerves Changes from baseline
GENERAL RULES FOR WORKING WITH CHILDREN Family centered care Provide appropriate choices Understand developmental level Allow time for play Encourage having familiar objects "Kid friendly foods” Small portions “grazing” Open communication Respect/kindness to child/family
Resp Red Flags in Kids Respiratory RR >60 or <12/ air exchange Tachypnea/retractions/nasal flaring/grunting Head bobbing/LOC Cyanosis = LATE sign
Shock in kids Shock Tachycardia/bradycardia decreased perfusion to skin/brain/kidneys Hypotension = LATE sign
Red flags in children decreased LOC Temperature alterations Hypoglycemia/dehydration Suspicious trauma/neglect Pain
Cognitive Development Milestones Month 3-5 Attends to/reaches for object Month 4-8 Pulls string to secure a ring Month 8-15 Imitates patting a doll Month 14-20 Finds hidden object Month 18-28 Completes simple puzzles
Language Development Milestones Month 1-3 Squeals Month 3-5 Turns to locate voice Month 9-13 Says “Mama” or “Dada” Month 14-24 Combines 2 different words Month 21-36 Uses plurals
Social/ Emotional Developmental Milestones Month 1-4 Smiles at others Month 4-9 Seeks primary caregiver Month 8-15 Stranger anxiety Month 10-15 Displays 2 or more emotions Month 11-20 Self-play Month 21-36 Cooperative group play
Gross Motor Development milestones Month 2-4 Rolls over Month 5-8 Sits without support Month 10-14 Stands alone Month 14-20 Walks up steps Month 21-28 Pedals tricycle Month 30-44 Balances on one foot
Fine Motor Developmental Milestones Month 2-4 Grasps rattle Month 4-7 Transfers cube from hand to hand Month 8-12 Neat pincer grasp Month 15-20 Builds tower of 4 cubes Month 18-24 Imitates vertical line Month 28-36 Copies a circle
Self-help developmental milestones Month 4-8 Feeds self cracker Month 10-14 Drinks from cup Month 13-19 Removes clothes Month 18-28 Washes/dries hands Month 30-42 Dresses without supervision
Created by: JennRN