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Pediatric Patient Structural & Physiological Variations

Learn to differentiate between pediatric and adult patients, conduct health histories, perform examinations, and address childhood fears. Understand anatomy, physiology, and growth stages. Develop vital sign knowledge and enhance physical examination techniques.

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Pediatric Patient Structural & Physiological Variations

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  1. Chapter 25 The Pediatric Patient

  2. Competencies • Differentiate the structural and physiological variations between pediatric patients and adults. • Identify personal-social, language, and fine and gross motor findings when using the Denver II. (continues)

  3. Competencies • Elicit a complete health history from a patient or caregiver using standard components of a pediatric health history. (continues)

  4. Competencies • Identify various techniques of approaching patients at different developmental levels before initiating the physical examination. (continues)

  5. Competencies • Perform inspection, palpation, percussion, and auscultation in a head-to-toe examination of a pediatric patient.

  6. Physical Growth • Weight • Length or height • Head circumference (continues)

  7. Physical Growth • Average weight gain • Rapid growth periods • Infancy • Adolescence

  8. Allaying Childhood FearsDuring Physical Exam • Infant • Toddler • Preschooler • School age • Adolescent

  9. Anatomy and Physiology • Vital signs • Temperature regulation • Variations by age • Pulse • Respirations • Blood pressure (continues)

  10. Anatomy and Physiology • Skin and hair • Lanugo • Vernix caseosa • Head • Closure of fontanels (continues)

  11. Anatomy and Physiology • Eyes, ears, nose, mouth, and throat • Visual acuity • Variations in eustachian tube • Development of sinuses • Eruption of teeth (continues)

  12. Anatomy and Physiology • Breasts • Breast tissue begins to develop at 8 to 10 years of age • Thorax and lungs • Infant • Chest development • Nose breathing • Abdominal breathing (continues)

  13. Anatomy and Physiology • Heart and peripheral vasculature • Placement • Cardiac output • Abdomen • Musculoskeletal system • Bone growth ends at 20 years of age (continues)

  14. Anatomy and Physiology • Neurological system • Incomplete at birth • Neurons become myelinated • Urinary system • Bladder location (continues)

  15. Anatomy and Physiology • Female genitalia • Development of pubic hair • Male genitalia • Descent of the testes • Onset of puberty

  16. Health History • Biographical data • Name • Contact information • Source of data (continues)

  17. Health History • Chief complaint • Infants, toddlers, young preschoolers are unable to describe their health concerns; caregiver will describe • Older preschoolers, school-age children, and adolescents are able to describe their health concerns

  18. Past Health History • Birth history • Prenatal • Labor and delivery • Postnatal • Medical history • Hospitalizations • Emergency department visits (continues)

  19. Past Health History • Injuries and accidents • Childhood illnesses • Document exposure to measles, mumps, rubella, pertussis, chickenpox, RSV • Immunizations (continues)

  20. Past Health History • Family health history • SIDS • ADHD • Congenital disorders • Mental retardation

  21. Social History • School or day care environment • Academic performance (if applicable) • Home environment • Potential exposure to lead • Gun safety (continues)

  22. Social History • Child’s personal habits • Activities child enjoys • How does child cope with stress? • Domestic and intimate partner violence • Adolescents may be at risk

  23. Health Maintenance Activities • Sleep • Diet • Safety • Critical to assess childproofing the environment

  24. Developmental Examination • Denver II • Personal-social • Fine motor-adaptive • Language • Gross motor

  25. Physical Examination • Equipment • Appropriate child-sized equipment • Developmental examination tools • Ophthalmoscope, otoscope (continues)

  26. Physical Examination • General approach • Warm environment • Methods to reduce anxiety and promote security • Respect patient’s modesty (continues)

  27. Physical Examination • General approach (cont’d) • Interview older children and adolescents separate from caregiver • Perform uncomfortable procedures last

  28. Examination • Vital signs • Blood pressure • Heart rate • Temperature • Respiratory rate (continues)

  29. Examination • Physical growth • Weight • Height or length • Head circumference • Chest circumference • Apgar score (continues)

  30. Examination • Skin • Inspect color, lesions • Palpate texture • Hair (continues)

  31. Examination • Head • Inspect for symmetry, shape, head control • Palpate fontanels, suture lines, surface characteristics (continues)

  32. Examination • Eyes • Assess eyes toward the end of the exam in children up to 10 years old • Vision screening • Tumbling E chart • Allen test (continues)

  33. Examination • Eyes (cont’d) • Strabismus screening • Hirschberg test • Cover-uncover test • Color vision (continues)

  34. Examination • Eyes (cont’d) • Inspect • Eyelids • Lacrimal apparatus • Sclera • Iris • Pupils • Lens (continues)

  35. Examination • Eyes (cont’d) • Inspect • Red reflex • Retina • Optic disc (continues)

  36. Examination • Ears • Auditory testing • External ear • Internal ear • Nose • Inspect mucosa, nasal septum, presence of drainage (continues)

  37. Examination • Mouth and throat • Inspect lips, buccal mucosa, teeth, hard palate, soft palate, oropharynx (continues)

  38. Examination • Neck • Palpate thyroid and lymph nodes • Breasts • Inspection • Assess sexual maturity rating (continues)

  39. Examination • Thorax and lungs • Inspect shape of thorax, presence of retractions • Palpate for tactile fremitus • Percuss diaphragmatic excursion • Auscultate breath sounds (continues)

  40. Examination • Heart and peripheral vasculature • Usually performed at beginning of exam • Inspect • Apical impulse, precordium • Palpate • Thrill • Peripheral pulses (continues)

  41. Examination • Heart and peripheral vasculature (cont’d) • Auscultate • Heart sounds • Innocent murmurs (continues)

  42. Examination • Abdomen • Calm child before proceeding • Inspect • Contour • Peristaltic wave • Auscultate • Bowel sounds • Palpate (continues)

  43. Examination • Musculoskeletal system • General approach • Use of games to facilitate evaluation • Inspection • Muscles, joints, tibiofemoral bones • Palpation • Joints, feet, hip, femur

  44. Neurological Examination • General approach • Infant • Toddler (continues)

  45. Neurological Examination • Reflex mechanisms of the infant • Rooting • Sucking • Palmar grasp • Tonic neck • Stepping • Plantar grasp (continues)

  46. Neurological Examination • Reflex mechanisms of the infant (cont’d) • Babinski • Moro • Galant • Placing • Landau (continues)

  47. Neurological Examination • Cranial nerve testing • Infant • Toddler • School age • Adolescent

  48. Genitalia Examination • Tanner sexual maturity rating • Female • Age-specific guidelines • Inspect perineal area (continues)

  49. Genitalia Examination • Male • Age-specific guidelines • Inspect penis, scrotum • Palpate scrotum • Hernia

  50. Anus Examination • Performed if problem detected or abuse suspected • Inspect for bleeding, fissures, prolapse, skin tags

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