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

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Otitis Media

Otitis Media
Presentation by:Lawrence D. Beem, D.C., FICPA
Cleveland Chiropractic College
Assistant Professor: Pediatrics

Otitis Media
* Otitis Media is the second most common reason after a well baby visit to the pediatrician’s office.
* It is estimated that approximately 30 million office visits per year involve evaluation and treatment of Otitis Media and billions of dollars are spent annually for Otitis Media care.
* More than a quarter of all prescriptions written each year for oral antibiotics are for the treatment of middle ear infections.
* Many surgical procedures such as myringotomy with tympanostomy tube placement or tonsillectomy and adenoidectomy are preformed on children for treatment of recurrent diseases.

Otitis Media Classifications

* OM can be classified into 4 categories:
o Acute Otitis Media is the sudden onset of inflammation of the middle ear, which is often accompanied by fever and ear pain.
o Persistent Middle Ear Effusion also called subacute OM, is the presence of middle ear fluid after antimicrobial treatment. Resolution of acute inflammatory signs has occurred, with persistence of a more serous, less purulent effusion.
o Recurrent Otitis Media is frequent episodes of acute OM with complete clearing between each case. This condition affects approximately 20% of the children who are (Otitis Prone), such children are usually infants who have their 1st. Infection at less than a year of age.
o Chronic Otitis Media with effusion, (serous OM, secretory OM,) is a chronic condition characterized by persistence of fluid in the middle ear for 3 months or longer. The TM is retracted or concave with impaired mobility and shows no signs of acute inflammation and affected children may be asymptomatic. These individuals are at greatest risk for developing hearing deficits and speech delay.

Otitis Media Epidemiology

* Peak incidence is 6 to 36 months of age.
* OM is relative uncommon in older children and adolescents.
* The condition is more common in boys and the prevalence is greater in Alaskan natives, Native Americans, and Caucasians.
* Epidemiologic Risk Factors:
o Familial predisposition
o low socioeconomic status
o altered host defences
o environmental factors
o presence of underlying condition
* The highest rate of Otitis Media occurs during the winter months and early spring, coinciding with peaks in the incidence of URI’s.
* Breast feeding which provides infants with immunologic protection against URI’s, other viral and bacterial infections and allergies, is thought to have a preventive effect against OM.
* I has been hypothesized that facial muscles develop differently in breast-fed infants, thus influencing eustachian tube function and preventing aspiration of fluid into the middle ear.Positioning during breastfeeding also has been hypothesized to have some protective effect.

Diagnosis (Otitis Media)

* Ear pain or otorrhea
* Possibly fever
* Abnormal tympanic membrane
* Erythema or injection of tympanic
* Pus behind the tympanic membrane
* Bulging appearance
* Distorted or absent light reflex
* Decreased mobility via pneumatic otoscopy

Pathophysiology (OM)

* The most important factor in the pathogenesis OM is abnormal function of the eustachian tube.
* Reflux, aspiration or insufflation of nasopharyngeal bacteria into the middle ear via the dysfunctional eustachian tube may lead to infection.
* The causative microorganisms for OM are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
* Group A streptoccus, Staphylococcus aureus, and anaerobic bacteria are other less common causes.
* Eustachian tube dysfunction occurs primarily for 2 reasons: abnormal patency and obstruction.
* Obstruction is either functional or mechanical or both.
o Functional, secondary to collapse of the eustachian tube, obstruction or collapse of the eustachian tube occurs commonly in infants and young children because the tube is less cartilaginous and therefore less stiff than in adults.
o Intrinsic mechanical obstruction of the eustachian tube occurs as the result of inflammation secondary to a URI or allergy.
o Extrinsic causes of mechanical obstruction include masses such as tumors or adrenoidal enlargement.
* Differential Diagnosis:
o The most common cause of otalgia, or ear pain, is acute OM.
o Other causes include mastoiditis, which is almost always accompanied by OM; otitis externa; and referred pain from the oropharynx, teeth, adenoids, or posterior auricular lymph nodes.
o A foreign body in the canal can produce similar symptoms.

Ant in Ear
Ear tick
Bug in Ear
Leach in Ear

Physical Examination
Indications For Tympanocentesis or Myringotomy
Management

Otitis Media.ppt

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Retinopathy of Prematurity

Retinopathy of Prematurity
Medical and Surgical Update
Presentation by: Tim Stout MD PhD
Casey Eye Institute
Oregon Health Sciences University

Retinopathy of Prematurity - What is it?

An uncontrolled neovascular process in which retinal endothelial cells stop developing and die, then later, proliferate, migrate, organize, scar and cause a detachment of the retina

ROP - What is it ?

* Found in premature infants with immature retinal vasculature who have received supplemental oxygen.
* It is the most common cause of permanent blindness in children
o it lasts a lifetime
o it shares common pathophysiologic features with a variety of common diseases


Normal Human Eye
Normal Human Retina
ROP – Geography (Zones)
TEMPORAL
NASAL
SUPERIOR
INFERIOR, RIGHT EYE
ROP Classification

* Stage 1 : Line separates vascular and avascular retina
* Stage 2 : Ridge (intra-retinal neovascularization)
* Stage 3 : Extra-retinal neovascularization
* Stage 4 : Subtotal retinal detachment
* Stage 5 : Total retinal detachment

PLUS Disease - dilated and tortuous retinal vessels
ROP Classification
THRESHOLD DISEASE
ROP Progression
ROP Incidence - Gestational Age
ROP Incidence - Birth Weight
ROP Screening - When
ROP - Current Treatment
Surgical Treatment
ROP - Laser Technique
Laser Treatment for ROP
ROP - Scleral Buckle
ROP - Late Sequelae
ROP - Retinal Dragging

ROP is a BIOLOGIC process which we currently treat MECHANICALLY

Retinopathy of Prematurity.ppt

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