Introduction to

Physical Examination
in Pediatric Patient

Wiwiek Setiowulan
 General Approach
• Gather as much data as possible by observation first
• Position of child: parent’s lap vs. exam table
• Stay at the child’s level, do not tower
• Rapport with child: include child (explain to the child’s level), distraction
• Examine painful area/uncomfortable/terrifying last
• Be honest
• Understand developmental stages’ impact on child’s response
Vital signs
• Normal vital signs according to age
• Temperature: tympanic vs. oral vs. axillary vs. rectal
• Heart rate:
• Infant: auscultate/palpate apical pulse or palpate femoral pulse
• Older child: palpate antecubital/radial pulse
• Respiratory rate: observe for a minute
• Blood pressure: appropriate size cuff: 1/2 - 2/3 width upper arm
Normal heart rate
Normal respiratory rate
• 0 – 2 months: <60x/minutes
• 2 – 12 months: <50x/minutes
• 1 – 5 years: <30x/minutes
Nutritional
Status
A girl, 24 months age
Weight: 8,6 kg
Height: 75 cm

Birth weight: 2 kg
At 21 months:
Weight: 8,1
Height: 73

How is her nutritional status

and growth?
 Head circumference-for-age GIRLS
Birth to 2 years (z-scores)
52 52
3
51 51
50 2 50
49 49
1
48 48
47 0 47
46
-1 46
45 45
Head circumference (cm)

-2
44 44
43 -3 43
42 42
41 41
40 40
39 39
38 38
37 37
36 36
35 35
34 34
33 33
32 32
31 31
30 30
Months 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years
Age (completed months and years)
WHO Child Growth Standards
 BMI-for-age GIRLS Height-for-age GIRLS
5 to 19 years (z-scores) 5 to 19 years (z-scores)

32 32
3
180 180
30
Obesity 2
30
2

28 28 170 1 170

26
Overweight 26
0
160 160
1 -1
24 24
150 -2 150
BMI (kg/m²)

22 22

Height (cm)
Normal 0 -3
140 140
20 20

18 18 130 130

-2
Thinness
16 16
120 120

-3
14 14
110 110

12 Severe thinness 12

100 100
Months
10 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 10
Years 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age (completed months and years) Months 90 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 90
Years 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
2007 WHO Reference
Age (completed months and years)
2007 WHO Reference
Neonates
Diagnosis:
A: preterm infant (PTI), appropriate for gestational age (AGA)
B: term infant (TI), small for gestational age (SGA)
Head

Neonates:
Anterior fontanel: diameter 4-6 cm
Closes 4-24 months
Posterior fontanel: closes 2 months

Notes symmetry of head

Notes swelling (caput succedaneum, cephalhematoma?)
Craniotabes
Macrocephaly
Eyes
Conjuctivitis
Palpebra
Sclera
Dacriocystitis
Nasolacrimal duct obstruction
Optic blink reflex
Lymph node
Ear
Chest
Abdomen

• Inspection
• Auscultation: bowel sound 5 – 34/minutes
• Palpation: liver & spleen palpable 1-2 cm
• Percussion
Thank You