Synopsis of General Pediatric Assessment & Child Development
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| 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
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| 4 differences in pediatric skin | thinner/more sensitive, less subcutaneous fat, grater body surface area to wt ration, viral/bact/fungal rashes (especially perianal)
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| 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
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| Pulmonary differences in children (3) | smaller airway, higher resting respiratory rate, use of accessory muscles may be normal finding
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| 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
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| 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
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| Pediatric Shock | tachy or bradycardia, Decreased perfusion to skin/brain/kidneys, hypotension is LATE sign, clinical presentation often worsens proior to VS change
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| 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
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| 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
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| communication with children | Position at child’s eye level Talk quietly Be specific/positive Use concrete terms Offer choices when you can Be honest
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| 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
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| How to approach the Preschooler | Likes to please Expose minimally Give child choice of where exam is to take place
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| How to approach the school age child | Provide privacy Involve child Teach about body
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| PE: abdomen/ Pelvis | Contour/movement Bowel sounds Check umbilicus Liver/spleen/kidneys Palpate for tenderness/masses Prominent in infants & children
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| 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
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| PE: Neruological | Cephalo caudal progression Mental status changes/LOC Sensory/motor recognition Fine/gross motor skills Coordination/balance Cranial nerves Changes from baseline
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| 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
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| Resp Red Flags in Kids | Respiratory RR >60 or <12/ air exchange Tachypnea/retractions/nasal flaring/grunting Head bobbing/LOC Cyanosis = LATE sign
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| Shock in kids | Shock Tachycardia/bradycardia decreased perfusion to skin/brain/kidneys Hypotension = LATE sign
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| Red flags in children | decreased LOC Temperature alterations Hypoglycemia/dehydration Suspicious trauma/neglect Pain
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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