Paediatrics - Queensland Health - Queensland Government

Paediatric presentation
Physical examination - child (continued)
Skin • Always check the whole body, particularly in a sick child
• Rash ? non blanching, petechiae, purpura
• Colour - unusually pale, mottled or cyanotic?
• Bruising, unexplained or unusual marks?
• Signs of infection: redness, swelling or tenderness?
• Inspect / palpate lymph nodes in the neck, axillae or groins for tenderness
• See Assessment and physical examination of skin, hair and nails for detailed
assessment
Growth • Height
• Weight - if child < 2 years weigh naked
• Head circumference if < 2 years
• Plot on growth charts appropriate for age and gender
Cardiovascular
system
Respiratory
system
Gastrointestinal
and
reproductive
systems
550
• Skin colour - pink, white, grey mottling? Compare the trunk with the limbs
• Skin temperature - hot, warm, cool, cold, sweating? Compare the trunk with the
limbs
• Palpate peripheral pulses - is rate fast, slow or normal - is the pulse volume weak
or strong?
• Central perfusion - blanch the skin over the sternum with your thumb for 5 seconds.
Time how long it takes for the mark to disappear
• Peripheral perfusion - ‘blanch’ the skin on a finger or toe for 5 seconds. Time how
long it takes for the mark to disappear
• Any evidence of oedema - particularly hands, feet and face?
• If skilled, listen to heart sounds
• Most information is gained through inspection
• Inspect anterior / posterior chest:
-- equal chest movement
-- use of accessory muscles of respiration? Look for retraction, recession - mild,
moderate or severe? Nasal flaring?
• Can they talk continuously, or only in words or sentences, or unable to talk at all?
• Measure respiratory rate over one minute, observe rhythm, depth and effort breathing
• Listen for extra noises - cough, ± sputum, wheeze, stridor, grunt, snore, hoarse
speech / cry
• Auscultate air entry in both lung fields - equal? Adequate, decreased or absent? Are
there wheezes or crackles? Do they occur on inspiration or expiration? (Note that
transmitted sounds from the upper respiratory tract are very common in children and
may mask other signs)
• Will the child lie flat?
• O saturation
2
• Look - are there any scars or abdominal distension / hernias
• Auscultate bowel sounds - present or absent?
• Palpate abdomen
-- soft or firm?
-- any obvious masses?
-- tender to touch? Identify which abdominal quadrant and exact area
-- any guarding / rigidity - even when the child is relaxed?
-- any rebound tenderness - press down and take your hand away very quickly - is
the pain greater when you do this?
• Question about change in bowel habits
• Feel for a palpable bladder
• Check the testes in boys - are they both in the scrotum?
-- any redness, swelling or tenderness?
Controlled copy V1.0
Primary Clinical Care Manual 2011