Pediatric Clinical Examination

Key Points
 Introduce yourself to parents + children
 Ask child’s name
 Establish rapport
 Inspection, inspection, inspection
 Position child
 Ask about pain  Always before touching  Can’t ask too often
 Permission
o For 2 year olds  If you ask they’ll say no
o 11-onwards  Fill silence + “I’m going to” + Explain as you go along
 Extra equiptment around the bed
 Ask someone to distract the child with a toy
 Measurements  Growth chart
CVS
 Inspection  Whole child // Hands // Face // Chest
o Scars + Asymmetries
 Palpation  Pulses // BP // Apex // Praecordium
o Offer to do them all
o Femoral in small children
o NB  Know how to find the apex
 Tension Pneumo
o Feel the praecordium  Heave or thump in first days of life is an emergency
 Auscultation
o Murmers / Heart Sounds
o Back
 Other
o BP // Femorals // Hepatomegaly // Growth
 Like to move onto LIVER EXAM  Length, location
 Investigations
o Sa02 // ABG // ECG // CXR // Echo // Cardiac Cath
Respiratory
 Inspection
o RR
 Small child // School age child // Teenage
o NB
 Intercostal retractions // Subcostal recession // Nasal flaring // Tracheal tug
// Tripod position // Look at videos
 Have distensible chest  More exaggerated movements
o Color
o Nasal flaring, recession
o Stridor, Wheeze
o Hands / Face / Tracheal tug
o Chest / Extras
 Palpation
o Lymphadenopathy  Mention that you’d examine them
o Tracheal position / Apex
o Chest expansion
 Percussion
o Not in a small child
o “I’m going to see if you sound like a drum”
o Compare both sides
o Liver  Upper border 6th ICS
 Auscultation
o I am going to listen to your tummy
o Examine yourself or inanimate object
o Breath sounds  Vesicular / Bronchial
 Tactile vocal fremitus in CF  Examine
o Added sounds
 Other
o Liver // PEFR // Sputum // Growth // Ent
 Tonsils  Sleep apnea
Abdominal Exam
 Inspection  Nipples to knees
o General // Head // Face // Mouth
o If there’s a nappy  Look in it
o Abdomen = 5Fs  Flatus, Fat, Faeces, Fluid, Fetus
o Scars // Visible organomegaly // Hernia
o Genetalia // Hydrocele
 Undescended testis
o IBD  Look at anus
 Palpation
o Neck
o Abdomen  Watch childs face
 Liver / Spleen / Kidneys  know locations // how to differentiate
 Percussion
 Auscultation
 Other
Neurological
 Deep tendon reflexes  Distraction
 Tone
o Power  Levels
 Primitive reflexes
o Ask about doing Babinski
 Visual fields
 Cranial Nerves

Musculoskeletal
 pGALS
 Screen on website

Know Development

NB
- Apex
- RR
- Development