Pediatric Examination

Pediatric Examination
Presentation by:Lawrence D. Beem, D.C., FASA,FICPA, IME
Professor, Cleveland Chiropractic College
Kansas City

Physical Examination

* Perform physical examination from head to toe on a pediatric patient.
* You may need to alter the order of the examination for patient compliance for uncooperative or hyperactive patients.
* Do not force a child to do something that may be frightening or uncomfortable to them.
* When examining an infant, toddler, or school-aged child it is suggested to have a parent or guardian in the room with you.
* Examination of an infant or toddler may be preformed on the lap of the patient.
* With an adolescent, it may be more appropriate not to have the parent in the room with you, this may allow the patient to feel that they can be more candid.
* To avoid possible legal issues, a male doctor may want a female staff member to be in the examination room.
* The doctor should verify confidentiality laws in their particular state.

Vital Signs
* Vital signs in pediatrics include temperature, heart rate, blood pressure, respiratory rate, weight, length, and head circumference.
Weight
Height
Head Circumference
Blood Pressure

* Blood pressure must be measured with a cuff wide enough to cover at least 1/2 to 2/3 of the extremity and its bladder should encircle the entire extremity.
* A narrow cuff elevates the pressure, while a wide cuff lowers it.
* Systolic hypertension is seen with anxiety, renal disease, coarctation of the aorta, essential hypertension, and certain endocrine abnormalities.
* Diastolic hypertension occurs with endocrine abnormalities and coarctation of the aorta.
* Hypotension occurs in hypovolemia and other forms of shock.
Blood Pressure
Pulse
Heart Rate
Respiration
Respiratory Rate
Temperature
Methods of Taking Temperature
General Inspection
Head
Eyes
Nose
Ears
Throat
Mumps
Thrush
Thrush on the Tongue
Oral Thrush
Acute Tonsillitis
Diphtheria Bull Neck
Diphtheria Psudomembrane
Stomatitis
Stomatitis of the Tongue
Mastoiditis
Mumps
Kippel Feil
Congenital Muscular Torticollis
Thorax and Heart
Pectus Excavatum
Pigeon Breast
Gynecomastia
Upper Extremity

* Examination of the upper extremities should include inspection for normal anatomy and limb position, palpation for structural integrity, and joint range of motion.
* The extremities should be examined for clubbing, cyanosis, and edema.
* Acrocyanosis is a common finding in neonates, characterized by cyanotic discoloration, coldness, and sweating of the extremities, especially the hands.
* Any deformities or extra digits should be noted.
* Range of motion, swelling, erythema, and warmth should be noted of any joint.
* Check for signs of contusions, abrasions, and edema which are common signs of trauma.

Polydactyly
Upper Extremity

* Check for muscle tone and strength of the upper extremity.
* Evaluate all range of motion of each joint.
Abdomen
Rectum
Genitalia
Lower Extremity
Orthopedic Testing
Neurological Testing
Emotional Attitudes

Pediatric Examination.ppt