Examination in paediatric medicine
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Jun 12, 2012
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About This Presentation
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Slide Content
Examination in PaediatricExamination in Paediatric
Dr. Varsha Atul ShahDr. Varsha Atul Shah
Senior ConsultantSenior Consultant
Dr. Varsha Atul ShahDr. Varsha Atul Shah
Senior ConsultantSenior Consultant
Physical ExaminationPhysical Examination
Perform physical examination from head to toe on a Perform physical examination from head to toe on a
pediatric patient. pediatric patient.
You may need to alter the order of the examination for You may need to alter the order of the examination for
patient compliance for uncooperative or hyperactive patient compliance for uncooperative or hyperactive
patients.patients.
Do not force a child to do something that may be Do not force a child to do something that may be
frightening or uncomfortable to them.frightening or uncomfortable to them.
When examining an infant, toddler, or school-aged child When examining an infant, toddler, or school-aged child
it is suggested to have a parent or guardian in the room it is suggested to have a parent or guardian in the room
with you.with you.
Perform physical examination from head to toe on a Perform physical examination from head to toe on a
pediatric patient. pediatric patient.
You may need to alter the order of the examination for You may need to alter the order of the examination for
patient compliance for uncooperative or hyperactive patient compliance for uncooperative or hyperactive
patients.patients.
Do not force a child to do something that may be Do not force a child to do something that may be
frightening or uncomfortable to them.frightening or uncomfortable to them.
When examining an infant, toddler, or school-aged child When examining an infant, toddler, or school-aged child
it is suggested to have a parent or guardian in the room it is suggested to have a parent or guardian in the room
with you.with you.
Physical ExaminationPhysical Examination
Examination of an infant or toddler may be Examination of an infant or toddler may be
preformed on the lap of the patient.preformed on the lap of the patient.
With an adolescent, it may be more appropriate With an adolescent, it may be more appropriate
not to have the parent in the room with you, this not to have the parent in the room with you, this
may allow the patient to feel that they can be may allow the patient to feel that they can be
more candid.more candid.
To avoid possible legal issues, a male doctor To avoid possible legal issues, a male doctor
may want a female staff member to be in the may want a female staff member to be in the
examination room.examination room.
The doctor should verify confidentiality laws in The doctor should verify confidentiality laws in
their particular state.their particular state.
Examination of an infant or toddler may be Examination of an infant or toddler may be
preformed on the lap of the patient.preformed on the lap of the patient.
With an adolescent, it may be more appropriate With an adolescent, it may be more appropriate
not to have the parent in the room with you, this not to have the parent in the room with you, this
may allow the patient to feel that they can be may allow the patient to feel that they can be
more candid.more candid.
To avoid possible legal issues, a male doctor To avoid possible legal issues, a male doctor
may want a female staff member to be in the may want a female staff member to be in the
examination room.examination room.
The doctor should verify confidentiality laws in The doctor should verify confidentiality laws in
their particular state.their particular state.
Vital SignsVital Signs
Vital signs in pediatrics include temperature, heart rate, Vital signs in pediatrics include temperature, heart rate,
blood pressure, respiratory rate, weight, length, and blood pressure, respiratory rate, weight, length, and
head circumference.head circumference.
Vital signs in pediatrics include temperature, heart rate, Vital signs in pediatrics include temperature, heart rate,
blood pressure, respiratory rate, weight, length, and blood pressure, respiratory rate, weight, length, and
head circumference.head circumference.
WeightWeight
Height, weight, and head circumference should be Height, weight, and head circumference should be
plotted on a growth curve graph.plotted on a growth curve graph.
Decrease in weight percentile may be due to decreased Decrease in weight percentile may be due to decreased
intake (malnutrition, central nervous system intake (malnutrition, central nervous system
abnormality), malabsorption (cystic fibrosis, IBD, celiac abnormality), malabsorption (cystic fibrosis, IBD, celiac
disease, parasitic infestation), or an increased metabolic disease, parasitic infestation), or an increased metabolic
rate (hyperthyroidism, congestive heart failure).rate (hyperthyroidism, congestive heart failure).
Increase in weight is most commonly exogenous but Increase in weight is most commonly exogenous but
may also be associated with certain genetic syndromes may also be associated with certain genetic syndromes
(Prader- willi).(Prader- willi).
Height, weight, and head circumference should be Height, weight, and head circumference should be
plotted on a growth curve graph.plotted on a growth curve graph.
Decrease in weight percentile may be due to decreased Decrease in weight percentile may be due to decreased
intake (malnutrition, central nervous system intake (malnutrition, central nervous system
abnormality), malabsorption (cystic fibrosis, IBD, celiac abnormality), malabsorption (cystic fibrosis, IBD, celiac
disease, parasitic infestation), or an increased metabolic disease, parasitic infestation), or an increased metabolic
rate (hyperthyroidism, congestive heart failure).rate (hyperthyroidism, congestive heart failure).
Increase in weight is most commonly exogenous but Increase in weight is most commonly exogenous but
may also be associated with certain genetic syndromes may also be associated with certain genetic syndromes
(Prader- willi).(Prader- willi).
HeightHeight
A child’s length (lying flat on a table) is measured until 2 A child’s length (lying flat on a table) is measured until 2
to 3 years of age; after that it is measured as height to 3 years of age; after that it is measured as height
(standing). (standing).
Decrease height may be familial, or may be seen in Decrease height may be familial, or may be seen in
conditions affecting weight or independent of weight conditions affecting weight or independent of weight
(Turner syndrome).(Turner syndrome).
Increase height may be familiar or associated with Increase height may be familiar or associated with
certain genetic and endocrine abnormalities (Cerebral certain genetic and endocrine abnormalities (Cerebral
gigantism).gigantism).
A child’s length (lying flat on a table) is measured until 2 A child’s length (lying flat on a table) is measured until 2
to 3 years of age; after that it is measured as height to 3 years of age; after that it is measured as height
(standing). (standing).
Decrease height may be familial, or may be seen in Decrease height may be familial, or may be seen in
conditions affecting weight or independent of weight conditions affecting weight or independent of weight
(Turner syndrome).(Turner syndrome).
Increase height may be familiar or associated with Increase height may be familiar or associated with
certain genetic and endocrine abnormalities (Cerebral certain genetic and endocrine abnormalities (Cerebral
gigantism).gigantism).
Head CircumferenceHead Circumference
Head circumference is routinely measured until 2 to 3 Head circumference is routinely measured until 2 to 3
years of age.years of age.
Microcephaly may be part of a syndrome (Rett Microcephaly may be part of a syndrome (Rett
syndrome), congenital infection (CMV), or the result of syndrome), congenital infection (CMV), or the result of
abnormal brain growth (schizencephaly).abnormal brain growth (schizencephaly).
Macrocephaly may be familiar or may represent a Macrocephaly may be familiar or may represent a
pathologic state (Hydrocephalus, Canavaan disease, AV pathologic state (Hydrocephalus, Canavaan disease, AV
malformation).malformation).
Head circumference is routinely measured until 2 to 3 Head circumference is routinely measured until 2 to 3
years of age.years of age.
Microcephaly may be part of a syndrome (Rett Microcephaly may be part of a syndrome (Rett
syndrome), congenital infection (CMV), or the result of syndrome), congenital infection (CMV), or the result of
abnormal brain growth (schizencephaly).abnormal brain growth (schizencephaly).
Macrocephaly may be familiar or may represent a Macrocephaly may be familiar or may represent a
pathologic state (Hydrocephalus, Canavaan disease, AV pathologic state (Hydrocephalus, Canavaan disease, AV
malformation).malformation).
Blood PressureBlood Pressure
Blood pressure must be measured with a cuff wide Blood pressure must be measured with a cuff wide
enough to cover at least 1/2 to 2/3 of the extremity enough to cover at least 1/2 to 2/3 of the extremity
and its bladder should encircle the entire extremity.and its bladder should encircle the entire extremity.
A narrow cuff elevates the pressure, while a wide cuff A narrow cuff elevates the pressure, while a wide cuff
lowers it.lowers it.
Systolic hypertension is seen with anxiety, renal Systolic hypertension is seen with anxiety, renal
disease, coarctation of the aorta, essential disease, coarctation of the aorta, essential
hypertension, and certain endocrine abnormalities. hypertension, and certain endocrine abnormalities.
Diastolic hypertension occurs with endocrine Diastolic hypertension occurs with endocrine
abnormalities and coarctation of the aorta.abnormalities and coarctation of the aorta.
Hypotension occurs in hypovolemia and other forms Hypotension occurs in hypovolemia and other forms
of shock.of shock.
Blood pressure must be measured with a cuff wide Blood pressure must be measured with a cuff wide
enough to cover at least 1/2 to 2/3 of the extremity enough to cover at least 1/2 to 2/3 of the extremity
and its bladder should encircle the entire extremity.and its bladder should encircle the entire extremity.
A narrow cuff elevates the pressure, while a wide cuff A narrow cuff elevates the pressure, while a wide cuff
lowers it.lowers it.
Systolic hypertension is seen with anxiety, renal Systolic hypertension is seen with anxiety, renal
disease, coarctation of the aorta, essential disease, coarctation of the aorta, essential
hypertension, and certain endocrine abnormalities. hypertension, and certain endocrine abnormalities.
Diastolic hypertension occurs with endocrine Diastolic hypertension occurs with endocrine
abnormalities and coarctation of the aorta.abnormalities and coarctation of the aorta.
Hypotension occurs in hypovolemia and other forms Hypotension occurs in hypovolemia and other forms
of shock.of shock.
Blood PressureBlood Pressure
The level of systolic blood pressure increases gradually The level of systolic blood pressure increases gradually
throughout infancy and childhood.throughout infancy and childhood.
2years 96/60 112/782years 96/60 112/78
6years 98/64 116/806years 98/64 116/80
9years 106/68 126/849years 106/68 126/84
12years 114/74 136/8812years 114/74 136/88
The level of systolic blood pressure increases gradually The level of systolic blood pressure increases gradually
throughout infancy and childhood.throughout infancy and childhood.
2years 96/60 112/782years 96/60 112/78
6years 98/64 116/806years 98/64 116/80
9years 106/68 126/849years 106/68 126/84
12years 114/74 136/8812years 114/74 136/88
PulsePulse
An elevated heart rate is seen in infections, hypovolemia, An elevated heart rate is seen in infections, hypovolemia,
hyperthyroidism, and anxiety.hyperthyroidism, and anxiety.
A rule of thumb is that the heart rate increases by A rule of thumb is that the heart rate increases by
10/minute for each 1 degree of temperature Centigrade.10/minute for each 1 degree of temperature Centigrade.
Bradycardia is seen in hypertension, increased Bradycardia is seen in hypertension, increased
intracranial pressure, certain intoxications, or other intracranial pressure, certain intoxications, or other
hypometabloic states.hypometabloic states.
It is best to examine an infant’s heart first during the It is best to examine an infant’s heart first during the
exam.exam.
An elevated heart rate is seen in infections, hypovolemia, An elevated heart rate is seen in infections, hypovolemia,
hyperthyroidism, and anxiety.hyperthyroidism, and anxiety.
A rule of thumb is that the heart rate increases by A rule of thumb is that the heart rate increases by
10/minute for each 1 degree of temperature Centigrade.10/minute for each 1 degree of temperature Centigrade.
Bradycardia is seen in hypertension, increased Bradycardia is seen in hypertension, increased
intracranial pressure, certain intoxications, or other intracranial pressure, certain intoxications, or other
hypometabloic states.hypometabloic states.
It is best to examine an infant’s heart first during the It is best to examine an infant’s heart first during the
exam.exam.
Heart RateHeart Rate
Birth 140Birth 140
1 - 6 months 1301 - 6 months 130
6 - 12 months 1156 - 12 months 115
1 - 2 years 1101 - 2 years 110
2 - 6 years 1032 - 6 years 103
6 - 10 years 956 - 10 years 95
10 - 14 years 8510 - 14 years 85
14 - 18 years 8214 - 18 years 82
Birth 140Birth 140
1 - 6 months 1301 - 6 months 130
6 - 12 months 1156 - 12 months 115
1 - 2 years 1101 - 2 years 110
2 - 6 years 1032 - 6 years 103
6 - 10 years 956 - 10 years 95
10 - 14 years 8510 - 14 years 85
14 - 18 years 8214 - 18 years 82
RespirationRespiration
Tachypnea is seen with increased activity, Tachypnea is seen with increased activity,
hypermetabolic states, fever, or respiratory distress. hypermetabolic states, fever, or respiratory distress.
A decreased respiratory rate is seen with conditions A decreased respiratory rate is seen with conditions
affecting the central nervous system, including affecting the central nervous system, including
medications/toxins, congenital malformations, and medications/toxins, congenital malformations, and
other lesions. other lesions.
A variable respiratory rate, known as periodic A variable respiratory rate, known as periodic
breathing, is commonly seen in neonates but more breathing, is commonly seen in neonates but more
than a 20 second pause is always abnormal.than a 20 second pause is always abnormal.
Cheyne-Stokes breathing is seen with brainstem Cheyne-Stokes breathing is seen with brainstem
abnormalities.abnormalities.
Tachypnea is seen with increased activity, Tachypnea is seen with increased activity,
hypermetabolic states, fever, or respiratory distress. hypermetabolic states, fever, or respiratory distress.
A decreased respiratory rate is seen with conditions A decreased respiratory rate is seen with conditions
affecting the central nervous system, including affecting the central nervous system, including
medications/toxins, congenital malformations, and medications/toxins, congenital malformations, and
other lesions. other lesions.
A variable respiratory rate, known as periodic A variable respiratory rate, known as periodic
breathing, is commonly seen in neonates but more breathing, is commonly seen in neonates but more
than a 20 second pause is always abnormal.than a 20 second pause is always abnormal.
Cheyne-Stokes breathing is seen with brainstem Cheyne-Stokes breathing is seen with brainstem
abnormalities.abnormalities.
Respiratory RateRespiratory Rate
Newborn 30 - 75Newborn 30 - 75
6 - 12 months 22 - 316 - 12 months 22 - 31
1 - 2 years 17 - 231 - 2 years 17 - 23
2 - 4 years 16 - 252 - 4 years 16 - 25
4 - 10 years 13 - 234 - 10 years 13 - 23
10 - 14 years 13 - 1910 - 14 years 13 - 19
15 + same as adult15 + same as adult
Newborn 30 - 75Newborn 30 - 75
6 - 12 months 22 - 316 - 12 months 22 - 31
1 - 2 years 17 - 231 - 2 years 17 - 23
2 - 4 years 16 - 252 - 4 years 16 - 25
4 - 10 years 13 - 234 - 10 years 13 - 23
10 - 14 years 13 - 1910 - 14 years 13 - 19
15 + same as adult15 + same as adult
TemperatureTemperature
Temperature may be elevated with infections, tumors, Temperature may be elevated with infections, tumors,
hyperthyroidism, autoimmune disease, environmental hyperthyroidism, autoimmune disease, environmental
exposures, certain medications, or increased activity.exposures, certain medications, or increased activity.
Temperature may be decreased with infections Temperature may be decreased with infections
(especially in neonates), hypothyroidism, certain (especially in neonates), hypothyroidism, certain
medications, environmental exposures, shock, or CNS medications, environmental exposures, shock, or CNS
disease affecting the hypothalamus.disease affecting the hypothalamus.
Control of heat production and heat loss is maintained by Control of heat production and heat loss is maintained by
the thermoregulatory center in the hypothalamus.the thermoregulatory center in the hypothalamus.
Temperature may be elevated with infections, tumors, Temperature may be elevated with infections, tumors,
hyperthyroidism, autoimmune disease, environmental hyperthyroidism, autoimmune disease, environmental
exposures, certain medications, or increased activity.exposures, certain medications, or increased activity.
Temperature may be decreased with infections Temperature may be decreased with infections
(especially in neonates), hypothyroidism, certain (especially in neonates), hypothyroidism, certain
medications, environmental exposures, shock, or CNS medications, environmental exposures, shock, or CNS
disease affecting the hypothalamus.disease affecting the hypothalamus.
Control of heat production and heat loss is maintained by Control of heat production and heat loss is maintained by
the thermoregulatory center in the hypothalamus.the thermoregulatory center in the hypothalamus.
Methods of Taking TemperatureMethods of Taking Temperature
Rectal 96.8* to 98.6* FRectal 96.8* to 98.6* F
Axillary 2* F LowerAxillary 2* F Lower
OralOral 1* F Lower 1* F Lower
Infrared same as rectalInfrared same as rectal
For the appropriately clothed child a fever is considered For the appropriately clothed child a fever is considered
100.4* F rectal.100.4* F rectal.
3 months of age and less always take temperature 3 months of age and less always take temperature
rectally.rectally.
Rectal 96.8* to 98.6* FRectal 96.8* to 98.6* F
Axillary 2* F LowerAxillary 2* F Lower
OralOral 1* F Lower 1* F Lower
Infrared same as rectalInfrared same as rectal
For the appropriately clothed child a fever is considered For the appropriately clothed child a fever is considered
100.4* F rectal.100.4* F rectal.
3 months of age and less always take temperature 3 months of age and less always take temperature
rectally.rectally.
General InspectionGeneral Inspection
A comment should be made about the patients general A comment should be made about the patients general
appearance.appearance.
Activity level and whether the patient is ill, is interacting Activity level and whether the patient is ill, is interacting
with the surroundings, and level of distress, if any.with the surroundings, and level of distress, if any.
Comment about unusual odors.Comment about unusual odors.
A comment should be made about the patients general A comment should be made about the patients general
appearance.appearance.
Activity level and whether the patient is ill, is interacting Activity level and whether the patient is ill, is interacting
with the surroundings, and level of distress, if any.with the surroundings, and level of distress, if any.
Comment about unusual odors.Comment about unusual odors.
HeadHead
In an infant the size and topography of the anterior In an infant the size and topography of the anterior
fontanel should be noted.fontanel should be noted.
Ant. Fontanel is the largest 4 to 6 cm and closes between 4 and Ant. Fontanel is the largest 4 to 6 cm and closes between 4 and
26 months.26 months.
Post. Fontanel is 1 to 2 cm and closes by 2 months.Post. Fontanel is 1 to 2 cm and closes by 2 months.
Bulging of the fontanel may indicate increased Bulging of the fontanel may indicate increased
intracranial pressure found in infections, neoplastic intracranial pressure found in infections, neoplastic
diseases of the central nervous system, or obstruction of diseases of the central nervous system, or obstruction of
the ventricular circulation.the ventricular circulation.
Depression of the fontanel is found in decreased Depression of the fontanel is found in decreased
intracranial pressure and may be a sign of dehydration.intracranial pressure and may be a sign of dehydration.
In an infant the size and topography of the anterior In an infant the size and topography of the anterior
fontanel should be noted.fontanel should be noted.
Ant. Fontanel is the largest 4 to 6 cm and closes between 4 and Ant. Fontanel is the largest 4 to 6 cm and closes between 4 and
26 months.26 months.
Post. Fontanel is 1 to 2 cm and closes by 2 months.Post. Fontanel is 1 to 2 cm and closes by 2 months.
Bulging of the fontanel may indicate increased Bulging of the fontanel may indicate increased
intracranial pressure found in infections, neoplastic intracranial pressure found in infections, neoplastic
diseases of the central nervous system, or obstruction of diseases of the central nervous system, or obstruction of
the ventricular circulation.the ventricular circulation.
Depression of the fontanel is found in decreased Depression of the fontanel is found in decreased
intracranial pressure and may be a sign of dehydration.intracranial pressure and may be a sign of dehydration.
HeadHead
Symmetry should be examined from various Symmetry should be examined from various
perspectives:perspectives:
Plagiocephaly: is characterized by flattening of the occipital Plagiocephaly: is characterized by flattening of the occipital
skull.skull.
Scaphocephaly: describes an elongated head with flattening Scaphocephaly: describes an elongated head with flattening
of the bones in the temporoparietal regions.of the bones in the temporoparietal regions.
Cephalhematoma: term applied when there is bleeding over Cephalhematoma: term applied when there is bleeding over
the outer surface of a skull bone elevating the periosteum.the outer surface of a skull bone elevating the periosteum.
Caput succedaneum a localized pitting edema in the scalp Caput succedaneum a localized pitting edema in the scalp
that may overlie sutures of the skull, usually formed during that may overlie sutures of the skull, usually formed during
labor as a result of circular pressure of the cervix on the fetal labor as a result of circular pressure of the cervix on the fetal
occiput.occiput.
Craniosynostosis refers to premature fusion of one or more Craniosynostosis refers to premature fusion of one or more
of the sutures of the cranial bones, and should be of the sutures of the cranial bones, and should be
considered in any neonate with an asymmetric cranium.considered in any neonate with an asymmetric cranium.
Symmetry should be examined from various Symmetry should be examined from various
perspectives:perspectives:
Plagiocephaly: is characterized by flattening of the occipital Plagiocephaly: is characterized by flattening of the occipital
skull.skull.
Scaphocephaly: describes an elongated head with flattening Scaphocephaly: describes an elongated head with flattening
of the bones in the temporoparietal regions.of the bones in the temporoparietal regions.
Cephalhematoma: term applied when there is bleeding over Cephalhematoma: term applied when there is bleeding over
the outer surface of a skull bone elevating the periosteum.the outer surface of a skull bone elevating the periosteum.
Caput succedaneum a localized pitting edema in the scalp Caput succedaneum a localized pitting edema in the scalp
that may overlie sutures of the skull, usually formed during that may overlie sutures of the skull, usually formed during
labor as a result of circular pressure of the cervix on the fetal labor as a result of circular pressure of the cervix on the fetal
occiput.occiput.
Craniosynostosis refers to premature fusion of one or more Craniosynostosis refers to premature fusion of one or more
of the sutures of the cranial bones, and should be of the sutures of the cranial bones, and should be
considered in any neonate with an asymmetric cranium.considered in any neonate with an asymmetric cranium.
HeadHead
Craniotabes is a term for softening of the skull Craniotabes is a term for softening of the skull
bones, with pressure the skull may be bones, with pressure the skull may be
momentarily indented before springing out momentarily indented before springing out
again. The major clinical significance is with again. The major clinical significance is with
congenital rickets. Rarely, osteogenesis congenital rickets. Rarely, osteogenesis
imperfecta or congenital hypophosphatasia may imperfecta or congenital hypophosphatasia may
be causes. Pressure to skull makes a sound be causes. Pressure to skull makes a sound
“Crack” like a ping pong ball.“Crack” like a ping pong ball.
Macewen’s Sign: is characterized by a “Cracked Macewen’s Sign: is characterized by a “Cracked
pot” sound when the cranium is percussed with pot” sound when the cranium is percussed with
the examining finger. A positive Macewen’s sign the examining finger. A positive Macewen’s sign
may be evident until fontanel closure.may be evident until fontanel closure.
Craniotabes is a term for softening of the skull Craniotabes is a term for softening of the skull
bones, with pressure the skull may be bones, with pressure the skull may be
momentarily indented before springing out momentarily indented before springing out
again. The major clinical significance is with again. The major clinical significance is with
congenital rickets. Rarely, osteogenesis congenital rickets. Rarely, osteogenesis
imperfecta or congenital hypophosphatasia may imperfecta or congenital hypophosphatasia may
be causes. Pressure to skull makes a sound be causes. Pressure to skull makes a sound
“Crack” like a ping pong ball.“Crack” like a ping pong ball.
Macewen’s Sign: is characterized by a “Cracked Macewen’s Sign: is characterized by a “Cracked
pot” sound when the cranium is percussed with pot” sound when the cranium is percussed with
the examining finger. A positive Macewen’s sign the examining finger. A positive Macewen’s sign
may be evident until fontanel closure.may be evident until fontanel closure.
HeadHead
The shape of the head can reveal much about the The shape of the head can reveal much about the
baby’s trip through the birth canal.baby’s trip through the birth canal.
Palpate suture lines for abnormalities.Palpate suture lines for abnormalities.
Palpate for any bumps or points of tenderness.Palpate for any bumps or points of tenderness.
Examine the hair and eyebrows for texture, quantity, Examine the hair and eyebrows for texture, quantity,
and pattern.and pattern.
Abnormalities in hair may be associated with Abnormalities in hair may be associated with
systemic disease or abnormality. Dry, course and systemic disease or abnormality. Dry, course and
brittle hair may be associated with congenital brittle hair may be associated with congenital
hypothyroidism.hypothyroidism.
Alopecia Areata: well circumscribed areas of Alopecia Areata: well circumscribed areas of
complete or almost complete hair loss, the scalp is complete or almost complete hair loss, the scalp is
smooth w/o signs of inflammation. Hair loss usually smooth w/o signs of inflammation. Hair loss usually
begins suddenly, and total loss of scalp and body hair begins suddenly, and total loss of scalp and body hair
may develop.may develop.
The shape of the head can reveal much about the The shape of the head can reveal much about the
baby’s trip through the birth canal.baby’s trip through the birth canal.
Palpate suture lines for abnormalities.Palpate suture lines for abnormalities.
Palpate for any bumps or points of tenderness.Palpate for any bumps or points of tenderness.
Examine the hair and eyebrows for texture, quantity, Examine the hair and eyebrows for texture, quantity,
and pattern.and pattern.
Abnormalities in hair may be associated with Abnormalities in hair may be associated with
systemic disease or abnormality. Dry, course and systemic disease or abnormality. Dry, course and
brittle hair may be associated with congenital brittle hair may be associated with congenital
hypothyroidism.hypothyroidism.
Alopecia Areata: well circumscribed areas of Alopecia Areata: well circumscribed areas of
complete or almost complete hair loss, the scalp is complete or almost complete hair loss, the scalp is
smooth w/o signs of inflammation. Hair loss usually smooth w/o signs of inflammation. Hair loss usually
begins suddenly, and total loss of scalp and body hair begins suddenly, and total loss of scalp and body hair
may develop.may develop.
HeadHead
Tinea Capitis is a fungal infection of the scalp Tinea Capitis is a fungal infection of the scalp
characterized by a patch of short broken off hairs and the characterized by a patch of short broken off hairs and the
patches of hair loss may be scaly or they may be marked patches of hair loss may be scaly or they may be marked
with inflammation, bogginess, and pustules called with inflammation, bogginess, and pustules called
“kerion.”“kerion.”
Tinea Capitis is a fungal infection of the scalp Tinea Capitis is a fungal infection of the scalp
characterized by a patch of short broken off hairs and the characterized by a patch of short broken off hairs and the
patches of hair loss may be scaly or they may be marked patches of hair loss may be scaly or they may be marked
with inflammation, bogginess, and pustules called with inflammation, bogginess, and pustules called
“kerion.”“kerion.”
EyesEyes
The shape and position of the eyes should be noted.The shape and position of the eyes should be noted.
Any abnormal eye movement and the ability to focus on Any abnormal eye movement and the ability to focus on
the examiner are important to note.the examiner are important to note.
Hard to examine because of the bright lights.Hard to examine because of the bright lights.
The shape and position of the eyes should be noted.The shape and position of the eyes should be noted.
Any abnormal eye movement and the ability to focus on Any abnormal eye movement and the ability to focus on
the examiner are important to note.the examiner are important to note.
Hard to examine because of the bright lights.Hard to examine because of the bright lights.
NoseNose
Look for deformities, obstruction of the airway, color Look for deformities, obstruction of the airway, color
of the mucosa, discharge, and tenderness.of the mucosa, discharge, and tenderness.
Check the nose for foreign bodies (beans, carrots, Check the nose for foreign bodies (beans, carrots,
crayons) younger children often putting foreign crayons) younger children often putting foreign
objects into the various orifices of the body and they objects into the various orifices of the body and they
often get stuck their.often get stuck their.
A green, foul smelling, purulent discharge from only A green, foul smelling, purulent discharge from only
one side of the nose is common with a foreign object one side of the nose is common with a foreign object
being left in the nose.being left in the nose.
Purulent discharge bilaterally indicates infection.Purulent discharge bilaterally indicates infection.
Delivery can give nasal obstruction due to Delivery can give nasal obstruction due to
displacement of the septal cartilage.displacement of the septal cartilage.
Look for deformities, obstruction of the airway, color Look for deformities, obstruction of the airway, color
of the mucosa, discharge, and tenderness.of the mucosa, discharge, and tenderness.
Check the nose for foreign bodies (beans, carrots, Check the nose for foreign bodies (beans, carrots,
crayons) younger children often putting foreign crayons) younger children often putting foreign
objects into the various orifices of the body and they objects into the various orifices of the body and they
often get stuck their.often get stuck their.
A green, foul smelling, purulent discharge from only A green, foul smelling, purulent discharge from only
one side of the nose is common with a foreign object one side of the nose is common with a foreign object
being left in the nose.being left in the nose.
Purulent discharge bilaterally indicates infection.Purulent discharge bilaterally indicates infection.
Delivery can give nasal obstruction due to Delivery can give nasal obstruction due to
displacement of the septal cartilage.displacement of the septal cartilage.
NoseNose
Flaring of the nostril almost always shows respiratory Flaring of the nostril almost always shows respiratory
distress.distress.
Mucosal Assessment:Mucosal Assessment:
Red: Acute infectionRed: Acute infection
Blue and Boggy: AllergyBlue and Boggy: Allergy
Gray and Swollen: RhinitisGray and Swollen: Rhinitis
Maxillary and Ethmoid are developed in infancy.Maxillary and Ethmoid are developed in infancy.
Frontal sinus developed by 5 years of age.Frontal sinus developed by 5 years of age.
The size, shape and symmetry of the nose should be The size, shape and symmetry of the nose should be
noted.noted.
A horizontal crease may be seen in the skin on the A horizontal crease may be seen in the skin on the
surface of the nose, this signifies repetitive wiping of surface of the nose, this signifies repetitive wiping of
the nose commonly seen in allergic rhinitis.the nose commonly seen in allergic rhinitis.
Flaring of the nostril almost always shows respiratory Flaring of the nostril almost always shows respiratory
distress.distress.
Mucosal Assessment:Mucosal Assessment:
Red: Acute infectionRed: Acute infection
Blue and Boggy: AllergyBlue and Boggy: Allergy
Gray and Swollen: RhinitisGray and Swollen: Rhinitis
Maxillary and Ethmoid are developed in infancy.Maxillary and Ethmoid are developed in infancy.
Frontal sinus developed by 5 years of age.Frontal sinus developed by 5 years of age.
The size, shape and symmetry of the nose should be The size, shape and symmetry of the nose should be
noted.noted.
A horizontal crease may be seen in the skin on the A horizontal crease may be seen in the skin on the
surface of the nose, this signifies repetitive wiping of surface of the nose, this signifies repetitive wiping of
the nose commonly seen in allergic rhinitis.the nose commonly seen in allergic rhinitis.
EarsEars
The size and any aberration in shape of the external The size and any aberration in shape of the external
ear (Pinna) should be noted.ear (Pinna) should be noted.
A low position (below the level of the eyes) or small A low position (below the level of the eyes) or small
deformed auricles may be an indication of a brain deformed auricles may be an indication of a brain
defect or congenital kidney abnormality, especially defect or congenital kidney abnormality, especially
renal agenesis.renal agenesis.
Inspection of the auricle and pariauricular tissues can Inspection of the auricle and pariauricular tissues can
be done by checking the 4 D’s:be done by checking the 4 D’s:
DischargeDischarge
DiscolorationDiscoloration
DeformityDeformity
DisplacementDisplacement
The size and any aberration in shape of the external The size and any aberration in shape of the external
ear (Pinna) should be noted.ear (Pinna) should be noted.
A low position (below the level of the eyes) or small A low position (below the level of the eyes) or small
deformed auricles may be an indication of a brain deformed auricles may be an indication of a brain
defect or congenital kidney abnormality, especially defect or congenital kidney abnormality, especially
renal agenesis.renal agenesis.
Inspection of the auricle and pariauricular tissues can Inspection of the auricle and pariauricular tissues can
be done by checking the 4 D’s:be done by checking the 4 D’s:
DischargeDischarge
DiscolorationDiscoloration
DeformityDeformity
DisplacementDisplacement
EarsEars
Discharge: from the ear canal can be a result of otitis Discharge: from the ear canal can be a result of otitis
external or chronic untreated otitis media.external or chronic untreated otitis media.
Discharge may be thick and white, it may accompany Discharge may be thick and white, it may accompany
a bright pink or red canal.a bright pink or red canal.
To differentiate between otitis externa and otitis To differentiate between otitis externa and otitis
media, pull on the pinna, if this elicits pain, it is most media, pull on the pinna, if this elicits pain, it is most
likely otitis externa.likely otitis externa.
Prolonged moisture in the ear canal promotes Prolonged moisture in the ear canal promotes
bacteria and fungal growth which predisposes the bacteria and fungal growth which predisposes the
child to otitis externa (swimmers ear).child to otitis externa (swimmers ear).
Equal mixture of alcohol and vinegar used as a rinse Equal mixture of alcohol and vinegar used as a rinse
will keep the ears dry and keep bacteria from will keep the ears dry and keep bacteria from
growing.growing.
Discharge: from the ear canal can be a result of otitis Discharge: from the ear canal can be a result of otitis
external or chronic untreated otitis media.external or chronic untreated otitis media.
Discharge may be thick and white, it may accompany Discharge may be thick and white, it may accompany
a bright pink or red canal.a bright pink or red canal.
To differentiate between otitis externa and otitis To differentiate between otitis externa and otitis
media, pull on the pinna, if this elicits pain, it is most media, pull on the pinna, if this elicits pain, it is most
likely otitis externa.likely otitis externa.
Prolonged moisture in the ear canal promotes Prolonged moisture in the ear canal promotes
bacteria and fungal growth which predisposes the bacteria and fungal growth which predisposes the
child to otitis externa (swimmers ear).child to otitis externa (swimmers ear).
Equal mixture of alcohol and vinegar used as a rinse Equal mixture of alcohol and vinegar used as a rinse
will keep the ears dry and keep bacteria from will keep the ears dry and keep bacteria from
growing.growing.
EarsEars
If the discharge is accompanied with perforation of the If the discharge is accompanied with perforation of the
tympanic membrane, otitis media is suspected.tympanic membrane, otitis media is suspected.
The presence of a foreign bodies in the ear is common The presence of a foreign bodies in the ear is common
and if left in the ear for a period of time may cause an and if left in the ear for a period of time may cause an
inflammatory response which may produce a foul-inflammatory response which may produce a foul-
smelling purulent discharge.smelling purulent discharge.
DiscolorationDiscoloration in the form of eccymosis over the mastoid in the form of eccymosis over the mastoid
area is called “Battle Sign”, and is associated with area is called “Battle Sign”, and is associated with
trauma and should be considered an emergency.trauma and should be considered an emergency.
If the discharge is accompanied with perforation of the If the discharge is accompanied with perforation of the
tympanic membrane, otitis media is suspected.tympanic membrane, otitis media is suspected.
The presence of a foreign bodies in the ear is common The presence of a foreign bodies in the ear is common
and if left in the ear for a period of time may cause an and if left in the ear for a period of time may cause an
inflammatory response which may produce a foul-inflammatory response which may produce a foul-
smelling purulent discharge.smelling purulent discharge.
DiscolorationDiscoloration in the form of eccymosis over the mastoid in the form of eccymosis over the mastoid
area is called “Battle Sign”, and is associated with area is called “Battle Sign”, and is associated with
trauma and should be considered an emergency.trauma and should be considered an emergency.
EarsEars
Deformity of the ears may develop from intrauterine positioning or Deformity of the ears may develop from intrauterine positioning or
could be the results of hereditary factors.could be the results of hereditary factors.
These deformities are of minor concern unless gross deformities are These deformities are of minor concern unless gross deformities are
present.present.
Gross deformities of the external ear are often associated with Gross deformities of the external ear are often associated with
anomalies of the middle and inner ear structures.anomalies of the middle and inner ear structures.
Displacement of the auricle away from the skull is a distressing sign Displacement of the auricle away from the skull is a distressing sign
associated with mastoiditis, other signs of mastoiditis are erythema associated with mastoiditis, other signs of mastoiditis are erythema
and tenderness over the mastoid and pinna, fever, and purulent and tenderness over the mastoid and pinna, fever, and purulent
discharge.discharge.
Other conditions associated with displacement of the auricle are Other conditions associated with displacement of the auricle are
parotitis, primary cellulitis, contact dermatitis, and edema.parotitis, primary cellulitis, contact dermatitis, and edema.
Deformity of the ears may develop from intrauterine positioning or Deformity of the ears may develop from intrauterine positioning or
could be the results of hereditary factors.could be the results of hereditary factors.
These deformities are of minor concern unless gross deformities are These deformities are of minor concern unless gross deformities are
present.present.
Gross deformities of the external ear are often associated with Gross deformities of the external ear are often associated with
anomalies of the middle and inner ear structures.anomalies of the middle and inner ear structures.
Displacement of the auricle away from the skull is a distressing sign Displacement of the auricle away from the skull is a distressing sign
associated with mastoiditis, other signs of mastoiditis are erythema associated with mastoiditis, other signs of mastoiditis are erythema
and tenderness over the mastoid and pinna, fever, and purulent and tenderness over the mastoid and pinna, fever, and purulent
discharge.discharge.
Other conditions associated with displacement of the auricle are Other conditions associated with displacement of the auricle are
parotitis, primary cellulitis, contact dermatitis, and edema.parotitis, primary cellulitis, contact dermatitis, and edema.
ThroatThroat
Examine the external mouth for symmetry, such as Examine the external mouth for symmetry, such as
drooping of the corner of the mouth.drooping of the corner of the mouth.
The lips and mucous membrane should be examined The lips and mucous membrane should be examined
for evidence of cyanosis.for evidence of cyanosis.
The tongue should be palpated for movement and The tongue should be palpated for movement and
strength of suck, this evaluates the function of the strength of suck, this evaluates the function of the
glossopharyngeal, vagus, and hypoglossal nervesglossopharyngeal, vagus, and hypoglossal nerves
The soft palate should be examined for presence of The soft palate should be examined for presence of
the gag reflex, evaluates the vagus nerve.the gag reflex, evaluates the vagus nerve.
The hard palate should be evaluated for structure, The hard palate should be evaluated for structure,
absence of clefts, and alignment of the arch. A high absence of clefts, and alignment of the arch. A high
arched palate may possibly indicates future dental arched palate may possibly indicates future dental
problems associated with insufficient space for teeth ( problems associated with insufficient space for teeth (
high arched palate may indicate syndromes like high arched palate may indicate syndromes like
Marfan syndromeMarfan syndrome).).
Examine the external mouth for symmetry, such as Examine the external mouth for symmetry, such as
drooping of the corner of the mouth.drooping of the corner of the mouth.
The lips and mucous membrane should be examined The lips and mucous membrane should be examined
for evidence of cyanosis.for evidence of cyanosis.
The tongue should be palpated for movement and The tongue should be palpated for movement and
strength of suck, this evaluates the function of the strength of suck, this evaluates the function of the
glossopharyngeal, vagus, and hypoglossal nervesglossopharyngeal, vagus, and hypoglossal nerves
The soft palate should be examined for presence of The soft palate should be examined for presence of
the gag reflex, evaluates the vagus nerve.the gag reflex, evaluates the vagus nerve.
The hard palate should be evaluated for structure, The hard palate should be evaluated for structure,
absence of clefts, and alignment of the arch. A high absence of clefts, and alignment of the arch. A high
arched palate may possibly indicates future dental arched palate may possibly indicates future dental
problems associated with insufficient space for teeth ( problems associated with insufficient space for teeth (
high arched palate may indicate syndromes like high arched palate may indicate syndromes like
Marfan syndromeMarfan syndrome).).
MumpsMumps
ThroatThroat
The color of the oropharynx should be noted, The color of the oropharynx should be noted,
the size of the tonsils and tonsillar pillars and the size of the tonsils and tonsillar pillars and
any discharge should be noted.any discharge should be noted.
Cobblestoning of the posterior pharyngeal Cobblestoning of the posterior pharyngeal
wall is a sign of chronic allergic disease.wall is a sign of chronic allergic disease.
The quality of the patient’s voice should also The quality of the patient’s voice should also
be noted.be noted.
The tongue should be examined for size, The tongue should be examined for size,
shape, color, and coating.shape, color, and coating.
A coated tongue is nonspecificA coated tongue is nonspecific
A smooth tongue is found in avitaminosisA smooth tongue is found in avitaminosis
A strawberry or raspberry tongue is seen in A strawberry or raspberry tongue is seen in
specific stages of Scarlet Fever.specific stages of Scarlet Fever.
A geographic tongue is a common finding.A geographic tongue is a common finding.
The color of the oropharynx should be noted, The color of the oropharynx should be noted,
the size of the tonsils and tonsillar pillars and the size of the tonsils and tonsillar pillars and
any discharge should be noted.any discharge should be noted.
Cobblestoning of the posterior pharyngeal Cobblestoning of the posterior pharyngeal
wall is a sign of chronic allergic disease.wall is a sign of chronic allergic disease.
The quality of the patient’s voice should also The quality of the patient’s voice should also
be noted.be noted.
The tongue should be examined for size, The tongue should be examined for size,
shape, color, and coating.shape, color, and coating.
A coated tongue is nonspecificA coated tongue is nonspecific
A smooth tongue is found in avitaminosisA smooth tongue is found in avitaminosis
A strawberry or raspberry tongue is seen in A strawberry or raspberry tongue is seen in
specific stages of Scarlet Fever.specific stages of Scarlet Fever.
A geographic tongue is a common finding.A geographic tongue is a common finding.
ThrushThrush
Thrush on the TongueThrush on the Tongue
Oral ThrushOral Thrush
Acute TonsillitisAcute Tonsillitis
Diphtheria Bull NeckDiphtheria Bull Neck
Diphtheria PsudomembraneDiphtheria Psudomembrane
StomatitisStomatitis
Stomatitis of the TongueStomatitis of the Tongue
MastoiditisMastoiditis
MastoiditisMastoiditis
MumpsMumps
ThroatThroat
Examine the oral mucosa may have creamy Examine the oral mucosa may have creamy
white reticular plaques commonly seen with white reticular plaques commonly seen with
thrush caused by Candida Albicans.thrush caused by Candida Albicans.
A gray/white, sand grain sized dots on the A gray/white, sand grain sized dots on the
buccal mucosa opposite the lower molars, buccal mucosa opposite the lower molars,
called Koplik Spots are seen with Rubeola.called Koplik Spots are seen with Rubeola.
Examine the teeth for dental caries, color of Examine the teeth for dental caries, color of
the teeth, number of teeth and for dental the teeth, number of teeth and for dental
occlusion.occlusion.
Examine the neck for masses, enlarged Examine the neck for masses, enlarged
glands, tracheal tugging, carotid bruits, glands, tracheal tugging, carotid bruits,
mobility, and webbed neck.mobility, and webbed neck.
Examine the oral mucosa may have creamy Examine the oral mucosa may have creamy
white reticular plaques commonly seen with white reticular plaques commonly seen with
thrush caused by Candida Albicans.thrush caused by Candida Albicans.
A gray/white, sand grain sized dots on the A gray/white, sand grain sized dots on the
buccal mucosa opposite the lower molars, buccal mucosa opposite the lower molars,
called Koplik Spots are seen with Rubeola.called Koplik Spots are seen with Rubeola.
Examine the teeth for dental caries, color of Examine the teeth for dental caries, color of
the teeth, number of teeth and for dental the teeth, number of teeth and for dental
occlusion.occlusion.
Examine the neck for masses, enlarged Examine the neck for masses, enlarged
glands, tracheal tugging, carotid bruits, glands, tracheal tugging, carotid bruits,
mobility, and webbed neck.mobility, and webbed neck.
Kippel FeilKippel Feil
Congenital Muscular TorticollisCongenital Muscular Torticollis
Thorax and HeartThorax and Heart
Note the symmetry of the chest, asymmetric expansion may be Note the symmetry of the chest, asymmetric expansion may be
seen with pneumothorax or diaphragmatic paralysis. Also note seen with pneumothorax or diaphragmatic paralysis. Also note
any abnormal shapes (Pectus Excavatum or Pectus carinatum. any abnormal shapes (Pectus Excavatum or Pectus carinatum.
Barrel-shaped chest are sometimes seen in patients with Barrel-shaped chest are sometimes seen in patients with
chronic obstructive pulmonary disease(chronic asthma or cystic chronic obstructive pulmonary disease(chronic asthma or cystic
fibrosis).fibrosis).
A rechitic rosary may be seen or palpated in rickets.A rechitic rosary may be seen or palpated in rickets.
Widely-spaced nipples may be a sign of Turner Syndrome.Widely-spaced nipples may be a sign of Turner Syndrome.
Note the pubertal development of the breast (Tanner staging) in Note the pubertal development of the breast (Tanner staging) in
females.females.
Note any masses, tenderness, or discharge of the breast and Note any masses, tenderness, or discharge of the breast and
describe in detail.describe in detail.
Breast buds are commonly seen in neonates.Breast buds are commonly seen in neonates.
The integrity of the clavicles should be noted in newbornsThe integrity of the clavicles should be noted in newborns
Males sometimes develop unilateral or bilateral breast Males sometimes develop unilateral or bilateral breast
hypertrophy during puberty, called gynecomastia, with milk hypertrophy during puberty, called gynecomastia, with milk
production may or may not be present.Approximately 40% of all production may or may not be present.Approximately 40% of all
males between the ages of 10 and 16.males between the ages of 10 and 16.
Note the symmetry of the chest, asymmetric expansion may be Note the symmetry of the chest, asymmetric expansion may be
seen with pneumothorax or diaphragmatic paralysis. Also note seen with pneumothorax or diaphragmatic paralysis. Also note
any abnormal shapes (Pectus Excavatum or Pectus carinatum. any abnormal shapes (Pectus Excavatum or Pectus carinatum.
Barrel-shaped chest are sometimes seen in patients with Barrel-shaped chest are sometimes seen in patients with
chronic obstructive pulmonary disease(chronic asthma or cystic chronic obstructive pulmonary disease(chronic asthma or cystic
fibrosis).fibrosis).
A rechitic rosary may be seen or palpated in rickets.A rechitic rosary may be seen or palpated in rickets.
Widely-spaced nipples may be a sign of Turner Syndrome.Widely-spaced nipples may be a sign of Turner Syndrome.
Note the pubertal development of the breast (Tanner staging) in Note the pubertal development of the breast (Tanner staging) in
females.females.
Note any masses, tenderness, or discharge of the breast and Note any masses, tenderness, or discharge of the breast and
describe in detail.describe in detail.
Breast buds are commonly seen in neonates.Breast buds are commonly seen in neonates.
The integrity of the clavicles should be noted in newbornsThe integrity of the clavicles should be noted in newborns
Males sometimes develop unilateral or bilateral breast Males sometimes develop unilateral or bilateral breast
hypertrophy during puberty, called gynecomastia, with milk hypertrophy during puberty, called gynecomastia, with milk
production may or may not be present.Approximately 40% of all production may or may not be present.Approximately 40% of all
males between the ages of 10 and 16.males between the ages of 10 and 16.
Pectus Excavatum Pectus Excavatum
Pectus ExcavatumPectus Excavatum
Pigeon BreastPigeon Breast
GynecomastiaGynecomastia
GynecomastiaGynecomastia
Thorax and HeartThorax and Heart
Female breast usually develop Female breast usually develop
asymmetrically.asymmetrically.
Inspect the thorax for color, Inspect the thorax for color,
respiration, type of breathing.respiration, type of breathing.
Auscultate breath sounds (rate, Auscultate breath sounds (rate,
ease, depth, rhythm).ease, depth, rhythm).
Palpate thorax (tenderness, Palpate thorax (tenderness,
respiratory excursion, vocal or respiratory excursion, vocal or
tactile fremitus, and areas of tactile fremitus, and areas of
abnormality)abnormality)
Measure chest circumference at Measure chest circumference at
nipple line.nipple line.
Auscultate the heart (murmurs, Auscultate the heart (murmurs,
rubs, clicks, or gallops) should be rubs, clicks, or gallops) should be
noted.noted.
The point of maximum impulse is The point of maximum impulse is
at the forth intercostal space until at the forth intercostal space until
about age 7.about age 7.
Female breast usually develop Female breast usually develop
asymmetrically.asymmetrically.
Inspect the thorax for color, Inspect the thorax for color,
respiration, type of breathing.respiration, type of breathing.
Auscultate breath sounds (rate, Auscultate breath sounds (rate,
ease, depth, rhythm).ease, depth, rhythm).
Palpate thorax (tenderness, Palpate thorax (tenderness,
respiratory excursion, vocal or respiratory excursion, vocal or
tactile fremitus, and areas of tactile fremitus, and areas of
abnormality)abnormality)
Measure chest circumference at Measure chest circumference at
nipple line.nipple line.
Auscultate the heart (murmurs, Auscultate the heart (murmurs,
rubs, clicks, or gallops) should be rubs, clicks, or gallops) should be
noted.noted.
The point of maximum impulse is The point of maximum impulse is
at the forth intercostal space until at the forth intercostal space until
about age 7.about age 7.
Thorax and HeartThorax and Heart
A history of excessive perspiration and difficulties in A history of excessive perspiration and difficulties in
feeding are two of the most common complaints of early feeding are two of the most common complaints of early
congestive heart failure.congestive heart failure.
Important questions to ask the parent:Important questions to ask the parent:
How has the infant been feeding?How has the infant been feeding?
Does he or she get out of breath or appear exhausted?Does he or she get out of breath or appear exhausted?
Has the child’s growth pattern changed recently?Has the child’s growth pattern changed recently?
Does the child tire easily, with eating or with playing?Does the child tire easily, with eating or with playing?
Does the child perspire excessively, especially with efforts such Does the child perspire excessively, especially with efforts such
as feeding?as feeding?
Does the infant breathe rapidly, even at rest.Does the infant breathe rapidly, even at rest.
A history of excessive perspiration and difficulties in A history of excessive perspiration and difficulties in
feeding are two of the most common complaints of early feeding are two of the most common complaints of early
congestive heart failure.congestive heart failure.
Important questions to ask the parent:Important questions to ask the parent:
How has the infant been feeding?How has the infant been feeding?
Does he or she get out of breath or appear exhausted?Does he or she get out of breath or appear exhausted?
Has the child’s growth pattern changed recently?Has the child’s growth pattern changed recently?
Does the child tire easily, with eating or with playing?Does the child tire easily, with eating or with playing?
Does the child perspire excessively, especially with efforts such Does the child perspire excessively, especially with efforts such
as feeding?as feeding?
Does the infant breathe rapidly, even at rest.Does the infant breathe rapidly, even at rest.
Upper ExtremityUpper Extremity
Examination of the upper extremities should Examination of the upper extremities should
include inspection for normal anatomy and include inspection for normal anatomy and
limb position, palpation for structural integrity, limb position, palpation for structural integrity,
and joint range of motion.and joint range of motion.
The extremities should be examined for The extremities should be examined for
clubbing, cyanosis, and edema.clubbing, cyanosis, and edema.
Acrocyanosis is a common finding in Acrocyanosis is a common finding in
neonates, characterized by cyanotic neonates, characterized by cyanotic
discoloration, coldness, and sweating of the discoloration, coldness, and sweating of the
extremities, especially the hands.extremities, especially the hands.
Any deformities or extra digits should be Any deformities or extra digits should be
noted. noted.
Range of motion, swelling, erythema, and Range of motion, swelling, erythema, and
warmth should be noted of any joint. warmth should be noted of any joint.
Check for signs of contusions, abrasions, and Check for signs of contusions, abrasions, and
edema which are common signs of trauma.edema which are common signs of trauma.
Examination of the upper extremities should Examination of the upper extremities should
include inspection for normal anatomy and include inspection for normal anatomy and
limb position, palpation for structural integrity, limb position, palpation for structural integrity,
and joint range of motion.and joint range of motion.
The extremities should be examined for The extremities should be examined for
clubbing, cyanosis, and edema.clubbing, cyanosis, and edema.
Acrocyanosis is a common finding in Acrocyanosis is a common finding in
neonates, characterized by cyanotic neonates, characterized by cyanotic
discoloration, coldness, and sweating of the discoloration, coldness, and sweating of the
extremities, especially the hands.extremities, especially the hands.
Any deformities or extra digits should be Any deformities or extra digits should be
noted. noted.
Range of motion, swelling, erythema, and Range of motion, swelling, erythema, and
warmth should be noted of any joint. warmth should be noted of any joint.
Check for signs of contusions, abrasions, and Check for signs of contusions, abrasions, and
edema which are common signs of trauma.edema which are common signs of trauma.
PolydactylyPolydactyly
PolydactylyPolydactyly
Upper ExtremityUpper Extremity
Check for muscle tone and strength of the upper Check for muscle tone and strength of the upper
extremity.extremity.
Evaluate all range of motion of each joint.Evaluate all range of motion of each joint.
Check for muscle tone and strength of the upper Check for muscle tone and strength of the upper
extremity.extremity.
Evaluate all range of motion of each joint.Evaluate all range of motion of each joint.
AbdomenAbdomen
Inspection is the most important first step.Inspection is the most important first step.
The order of examination has been changed slightly The order of examination has been changed slightly
in that palpation is done last.in that palpation is done last.
It is a good idea, before performing abdominal It is a good idea, before performing abdominal
examination, to ask the child if they need to use the examination, to ask the child if they need to use the
restroom.restroom.
For the examination of the infant or toddler the knees For the examination of the infant or toddler the knees
may be bent in order to relax the abdomen and the may be bent in order to relax the abdomen and the
child’s arms down at their sides. child’s arms down at their sides.
Inspect for rashes, scars, lesions, or discoloration. Inspect for rashes, scars, lesions, or discoloration.
Observe overall contour and symmetry.Observe overall contour and symmetry.
Inspect the umbilicus for shape, signs of inflammation Inspect the umbilicus for shape, signs of inflammation
or herniaor hernia
Inspection is the most important first step.Inspection is the most important first step.
The order of examination has been changed slightly The order of examination has been changed slightly
in that palpation is done last.in that palpation is done last.
It is a good idea, before performing abdominal It is a good idea, before performing abdominal
examination, to ask the child if they need to use the examination, to ask the child if they need to use the
restroom.restroom.
For the examination of the infant or toddler the knees For the examination of the infant or toddler the knees
may be bent in order to relax the abdomen and the may be bent in order to relax the abdomen and the
child’s arms down at their sides. child’s arms down at their sides.
Inspect for rashes, scars, lesions, or discoloration. Inspect for rashes, scars, lesions, or discoloration.
Observe overall contour and symmetry.Observe overall contour and symmetry.
Inspect the umbilicus for shape, signs of inflammation Inspect the umbilicus for shape, signs of inflammation
or herniaor hernia
AbdomenAbdomen
Auscultation of the abdomen should be done before Auscultation of the abdomen should be done before
palpation or percussion since the latter may alter the palpation or percussion since the latter may alter the
frequency and quality of bowel sounds.frequency and quality of bowel sounds.
Listen to the 4 quadrants noting the frequency and Listen to the 4 quadrants noting the frequency and
quality of the bowel sounds.quality of the bowel sounds.
Abnormal sounds:Abnormal sounds:
gurglesgurgles
clicksclicks
growlsgrowls
Frequency of sounds is from 5 to 34 times per minute.Frequency of sounds is from 5 to 34 times per minute.
Auscultation of the abdomen should be done before Auscultation of the abdomen should be done before
palpation or percussion since the latter may alter the palpation or percussion since the latter may alter the
frequency and quality of bowel sounds.frequency and quality of bowel sounds.
Listen to the 4 quadrants noting the frequency and Listen to the 4 quadrants noting the frequency and
quality of the bowel sounds.quality of the bowel sounds.
Abnormal sounds:Abnormal sounds:
gurglesgurgles
clicksclicks
growlsgrowls
Frequency of sounds is from 5 to 34 times per minute.Frequency of sounds is from 5 to 34 times per minute.
AbdomenAbdomen
An increase in frequency or pitch of bowel sounds An increase in frequency or pitch of bowel sounds
may be associated with intestinal obstruction or may be associated with intestinal obstruction or
diarrhea.diarrhea.
Decreased or absent sounds may be associated with Decreased or absent sounds may be associated with
paralytic ileus or peritonitis.paralytic ileus or peritonitis.
To be certain that bowel sounds are absent listen for To be certain that bowel sounds are absent listen for
2 minutes in the area just inferior and to the right of 2 minutes in the area just inferior and to the right of
the umbilicus.the umbilicus.
Percussion in the pediatric patient is the same as the Percussion in the pediatric patient is the same as the
adult patient.adult patient.
Because children tend to swallow a lot of air when Because children tend to swallow a lot of air when
eating or crying the stomach and intestines has a eating or crying the stomach and intestines has a
great amount of air in them.great amount of air in them.
An increase in frequency or pitch of bowel sounds An increase in frequency or pitch of bowel sounds
may be associated with intestinal obstruction or may be associated with intestinal obstruction or
diarrhea.diarrhea.
Decreased or absent sounds may be associated with Decreased or absent sounds may be associated with
paralytic ileus or peritonitis.paralytic ileus or peritonitis.
To be certain that bowel sounds are absent listen for To be certain that bowel sounds are absent listen for
2 minutes in the area just inferior and to the right of 2 minutes in the area just inferior and to the right of
the umbilicus.the umbilicus.
Percussion in the pediatric patient is the same as the Percussion in the pediatric patient is the same as the
adult patient.adult patient.
Because children tend to swallow a lot of air when Because children tend to swallow a lot of air when
eating or crying the stomach and intestines has a eating or crying the stomach and intestines has a
great amount of air in them.great amount of air in them.
AbdomenAbdomen
A distended abdomen may signify an obstruction, A distended abdomen may signify an obstruction,
infection, celiac disease, ascites, or an abdominal infection, celiac disease, ascites, or an abdominal
mass. mass.
Palpation will reveal masses (note size and location) Palpation will reveal masses (note size and location)
hepatosplenomegaly, and any sources of pain.hepatosplenomegaly, and any sources of pain.
If the liver is felt below the costal margin (it commonly If the liver is felt below the costal margin (it commonly
is 1 cm below the margin) its span in the is 1 cm below the margin) its span in the
midclavicular line should be percussed.midclavicular line should be percussed.
Danforth’s sign is right shoulder pain with RUQ Danforth’s sign is right shoulder pain with RUQ
palpation (represents an irritated diaphragm) is palpation (represents an irritated diaphragm) is
strongly suggestive of liver injury.strongly suggestive of liver injury.
Kehr’s sign is left shoulder pain with LUQ palpation Kehr’s sign is left shoulder pain with LUQ palpation
(represents an irritated diaphragm) is strongly (represents an irritated diaphragm) is strongly
suggestive of splenic injury.suggestive of splenic injury.
A distended abdomen may signify an obstruction, A distended abdomen may signify an obstruction,
infection, celiac disease, ascites, or an abdominal infection, celiac disease, ascites, or an abdominal
mass. mass.
Palpation will reveal masses (note size and location) Palpation will reveal masses (note size and location)
hepatosplenomegaly, and any sources of pain.hepatosplenomegaly, and any sources of pain.
If the liver is felt below the costal margin (it commonly If the liver is felt below the costal margin (it commonly
is 1 cm below the margin) its span in the is 1 cm below the margin) its span in the
midclavicular line should be percussed.midclavicular line should be percussed.
Danforth’s sign is right shoulder pain with RUQ Danforth’s sign is right shoulder pain with RUQ
palpation (represents an irritated diaphragm) is palpation (represents an irritated diaphragm) is
strongly suggestive of liver injury.strongly suggestive of liver injury.
Kehr’s sign is left shoulder pain with LUQ palpation Kehr’s sign is left shoulder pain with LUQ palpation
(represents an irritated diaphragm) is strongly (represents an irritated diaphragm) is strongly
suggestive of splenic injury.suggestive of splenic injury.
AbdomenAbdomen
Rovsing’s sign is RLQ pain with LLQ palpation is Rovsing’s sign is RLQ pain with LLQ palpation is
suggestive of appendicitis.suggestive of appendicitis.
McBurney’s point is 2/3 of the way from the umbilicus to McBurney’s point is 2/3 of the way from the umbilicus to
the anterior superior iliac crest in the RLQ and the anterior superior iliac crest in the RLQ and
tenderness there is also suggestive of acute tenderness there is also suggestive of acute
appendicitis.appendicitis.
Rovsing’s sign is RLQ pain with LLQ palpation is Rovsing’s sign is RLQ pain with LLQ palpation is
suggestive of appendicitis.suggestive of appendicitis.
McBurney’s point is 2/3 of the way from the umbilicus to McBurney’s point is 2/3 of the way from the umbilicus to
the anterior superior iliac crest in the RLQ and the anterior superior iliac crest in the RLQ and
tenderness there is also suggestive of acute tenderness there is also suggestive of acute
appendicitis.appendicitis.
RectumRectum
A chaperone may be necessary.A chaperone may be necessary.
The anus should be inspected for position (an The anus should be inspected for position (an
imperforated anus is associated with a host of other imperforated anus is associated with a host of other
anomalies; an abnormally places anus can also be anomalies; an abnormally places anus can also be
associated with constipation or encopresis, associated with constipation or encopresis,
depending on the position of the orifice with respect depending on the position of the orifice with respect
to the sphincter).to the sphincter).
Any fissures, trauma, or parasites should be noted.Any fissures, trauma, or parasites should be noted.
A rectal prolapse may be seen with many conditions A rectal prolapse may be seen with many conditions
including malnutrition, constipation, and cystic including malnutrition, constipation, and cystic
fibrosis.fibrosis.
The rectal exam is mandatory for any child The rectal exam is mandatory for any child
complaining of abdominal pain, encopresis, complaining of abdominal pain, encopresis,
constipation, hematochezia, or melena.constipation, hematochezia, or melena.
A chaperone may be necessary.A chaperone may be necessary.
The anus should be inspected for position (an The anus should be inspected for position (an
imperforated anus is associated with a host of other imperforated anus is associated with a host of other
anomalies; an abnormally places anus can also be anomalies; an abnormally places anus can also be
associated with constipation or encopresis, associated with constipation or encopresis,
depending on the position of the orifice with respect depending on the position of the orifice with respect
to the sphincter).to the sphincter).
Any fissures, trauma, or parasites should be noted.Any fissures, trauma, or parasites should be noted.
A rectal prolapse may be seen with many conditions A rectal prolapse may be seen with many conditions
including malnutrition, constipation, and cystic including malnutrition, constipation, and cystic
fibrosis.fibrosis.
The rectal exam is mandatory for any child The rectal exam is mandatory for any child
complaining of abdominal pain, encopresis, complaining of abdominal pain, encopresis,
constipation, hematochezia, or melena.constipation, hematochezia, or melena.
RectumRectum
A lubricated small finger is used to palpate A lubricated small finger is used to palpate
for any masses, tone of the sphincter, and for any masses, tone of the sphincter, and
any focal pain, as may be seen with any focal pain, as may be seen with
appendicitis.appendicitis.
The stool should be tested for occult The stool should be tested for occult
blood.blood.
Rectal examination on infants and young Rectal examination on infants and young
children should be performed in the supine children should be performed in the supine
position.position.
A lubricated small finger is used to palpate A lubricated small finger is used to palpate
for any masses, tone of the sphincter, and for any masses, tone of the sphincter, and
any focal pain, as may be seen with any focal pain, as may be seen with
appendicitis.appendicitis.
The stool should be tested for occult The stool should be tested for occult
blood.blood.
Rectal examination on infants and young Rectal examination on infants and young
children should be performed in the supine children should be performed in the supine
position.position.
GenitaliaGenitalia
Patient’s should always be examined is the presence of Patient’s should always be examined is the presence of
a parent or a caretaker or in the case of a pre-teen or a parent or a caretaker or in the case of a pre-teen or
teenager with a staff member present.teenager with a staff member present.
It is not common for Doctors of Chiropractic to do female It is not common for Doctors of Chiropractic to do female
genitalia or pelvic exam.genitalia or pelvic exam.
It is common for the D.C. to give a hernia examination It is common for the D.C. to give a hernia examination
and Tanner Staging for school or sports physicals.and Tanner Staging for school or sports physicals.
Tanner Staging is the measurement for sexual Tanner Staging is the measurement for sexual
maturation.maturation.
Patient’s should always be examined is the presence of Patient’s should always be examined is the presence of
a parent or a caretaker or in the case of a pre-teen or a parent or a caretaker or in the case of a pre-teen or
teenager with a staff member present.teenager with a staff member present.
It is not common for Doctors of Chiropractic to do female It is not common for Doctors of Chiropractic to do female
genitalia or pelvic exam.genitalia or pelvic exam.
It is common for the D.C. to give a hernia examination It is common for the D.C. to give a hernia examination
and Tanner Staging for school or sports physicals.and Tanner Staging for school or sports physicals.
Tanner Staging is the measurement for sexual Tanner Staging is the measurement for sexual
maturation.maturation.
Lower ExtremityLower Extremity
Visually inspect the lower extremity for abrasions, Visually inspect the lower extremity for abrasions,
contusions, rashes, edema, cyanosis, clubbing, and contusions, rashes, edema, cyanosis, clubbing, and
discoloration.discoloration.
Visually inspect for any abnormalities or deformities Visually inspect for any abnormalities or deformities
(any extra digits should be noted).(any extra digits should be noted).
Measure the extremity as to circumfrencial Measure the extremity as to circumfrencial
measurements, actual leg length (ASIS to Medial measurements, actual leg length (ASIS to Medial
malleolus) and apparent leg length (Umbilicus to malleolus) and apparent leg length (Umbilicus to
Medial Malleoolus).Medial Malleoolus).
A way to determine true leg length is to take a A way to determine true leg length is to take a
Scanogram (this is a x-ray procedure where three Scanogram (this is a x-ray procedure where three
views are taken of the extremities the first is through views are taken of the extremities the first is through
the head of the femurs, the second is through the the head of the femurs, the second is through the
knees, and the third is through the ankles) using a knees, and the third is through the ankles) using a
Bell Thompson Ruler.Bell Thompson Ruler.
Visually inspect the lower extremity for abrasions, Visually inspect the lower extremity for abrasions,
contusions, rashes, edema, cyanosis, clubbing, and contusions, rashes, edema, cyanosis, clubbing, and
discoloration.discoloration.
Visually inspect for any abnormalities or deformities Visually inspect for any abnormalities or deformities
(any extra digits should be noted).(any extra digits should be noted).
Measure the extremity as to circumfrencial Measure the extremity as to circumfrencial
measurements, actual leg length (ASIS to Medial measurements, actual leg length (ASIS to Medial
malleolus) and apparent leg length (Umbilicus to malleolus) and apparent leg length (Umbilicus to
Medial Malleoolus).Medial Malleoolus).
A way to determine true leg length is to take a A way to determine true leg length is to take a
Scanogram (this is a x-ray procedure where three Scanogram (this is a x-ray procedure where three
views are taken of the extremities the first is through views are taken of the extremities the first is through
the head of the femurs, the second is through the the head of the femurs, the second is through the
knees, and the third is through the ankles) using a knees, and the third is through the ankles) using a
Bell Thompson Ruler.Bell Thompson Ruler.
Lower ExtremityLower Extremity
Range of motion should be preformed and any joint Range of motion should be preformed and any joint
swelling, erythemia, and warmth should be noted.swelling, erythemia, and warmth should be noted.
Hips are routinely examined in infants (see orthopedic Hips are routinely examined in infants (see orthopedic
sect.)sect.)
Foot abnormalities are common in infancy but not in later Foot abnormalities are common in infancy but not in later
life.life.
The peripheral pulses, especially the femoral pulses.The peripheral pulses, especially the femoral pulses.
Range of motion should be preformed and any joint Range of motion should be preformed and any joint
swelling, erythemia, and warmth should be noted.swelling, erythemia, and warmth should be noted.
Hips are routinely examined in infants (see orthopedic Hips are routinely examined in infants (see orthopedic
sect.)sect.)
Foot abnormalities are common in infancy but not in later Foot abnormalities are common in infancy but not in later
life.life.
The peripheral pulses, especially the femoral pulses.The peripheral pulses, especially the femoral pulses.
Orthopedic TestingOrthopedic Testing
Infant orthopedic testing should include all rang of motion Infant orthopedic testing should include all rang of motion
testing, static and motion palpation.testing, static and motion palpation.
Ortolani’s Test is a common test performed on the infant.Ortolani’s Test is a common test performed on the infant.
It is a reduction test.It is a reduction test.
With the baby relaxed in the supine position, the hips With the baby relaxed in the supine position, the hips
and knees are flexed to 90*, the examiner grasp the and knees are flexed to 90*, the examiner grasp the
baby’s thigh with middle finger over the greater baby’s thigh with middle finger over the greater
trochanter and lifts the thigh an simultaneously gently trochanter and lifts the thigh an simultaneously gently
abducting the thigh, thus reducing the dislocation and abducting the thigh, thus reducing the dislocation and
a “clunk” will be observeda “clunk” will be observed
Infant orthopedic testing should include all rang of motion Infant orthopedic testing should include all rang of motion
testing, static and motion palpation.testing, static and motion palpation.
Ortolani’s Test is a common test performed on the infant.Ortolani’s Test is a common test performed on the infant.
It is a reduction test.It is a reduction test.
With the baby relaxed in the supine position, the hips With the baby relaxed in the supine position, the hips
and knees are flexed to 90*, the examiner grasp the and knees are flexed to 90*, the examiner grasp the
baby’s thigh with middle finger over the greater baby’s thigh with middle finger over the greater
trochanter and lifts the thigh an simultaneously gently trochanter and lifts the thigh an simultaneously gently
abducting the thigh, thus reducing the dislocation and abducting the thigh, thus reducing the dislocation and
a “clunk” will be observeda “clunk” will be observed
Orthopedic TestingOrthopedic Testing
Barlow’s Test is a provocative test (dislocation) also Barlow’s Test is a provocative test (dislocation) also
called Reverse Ortolani’s test.called Reverse Ortolani’s test.
Barlow’s Test is performed to discover any hip instability.Barlow’s Test is performed to discover any hip instability.
The baby’s thigh is grasped with the middle finger along The baby’s thigh is grasped with the middle finger along
the baby’s thigh adducted and with a gentle downward the baby’s thigh adducted and with a gentle downward
pressure. pressure.
Dislocation is palpable as the femoral head slips out of Dislocation is palpable as the femoral head slips out of
the acetabulum.the acetabulum.
Barlow’s Test is a provocative test (dislocation) also Barlow’s Test is a provocative test (dislocation) also
called Reverse Ortolani’s test.called Reverse Ortolani’s test.
Barlow’s Test is performed to discover any hip instability.Barlow’s Test is performed to discover any hip instability.
The baby’s thigh is grasped with the middle finger along The baby’s thigh is grasped with the middle finger along
the baby’s thigh adducted and with a gentle downward the baby’s thigh adducted and with a gentle downward
pressure. pressure.
Dislocation is palpable as the femoral head slips out of Dislocation is palpable as the femoral head slips out of
the acetabulum.the acetabulum.
Orthopedic TestingOrthopedic Testing
Allis’ or Galeazzi’s Sign is another orthopedic test Allis’ or Galeazzi’s Sign is another orthopedic test
used to test for a dislocatable hip and is preformed by used to test for a dislocatable hip and is preformed by
flexing the child’s knees and hips placing feet on the flexing the child’s knees and hips placing feet on the
table the lower one the femoral head lies posterior to table the lower one the femoral head lies posterior to
the acetabulum.the acetabulum.
Another test for a dislocated hip, shortening of the Another test for a dislocated hip, shortening of the
thigh will bunch up the soft tissue and will thigh will bunch up the soft tissue and will
accentuation of the skin folds.accentuation of the skin folds.
Telescoping of the thigh is elicited because the Telescoping of the thigh is elicited because the
femoral head is not contained within the acetabulum.femoral head is not contained within the acetabulum.
Trendelenburg’s Test with the child standing with Trendelenburg’s Test with the child standing with
weight on the affected side the normal hip drops weight on the affected side the normal hip drops
down, indicating weakness of the abductor muscles down, indicating weakness of the abductor muscles
of the affected side.of the affected side.
Allis’ or Galeazzi’s Sign is another orthopedic test Allis’ or Galeazzi’s Sign is another orthopedic test
used to test for a dislocatable hip and is preformed by used to test for a dislocatable hip and is preformed by
flexing the child’s knees and hips placing feet on the flexing the child’s knees and hips placing feet on the
table the lower one the femoral head lies posterior to table the lower one the femoral head lies posterior to
the acetabulum.the acetabulum.
Another test for a dislocated hip, shortening of the Another test for a dislocated hip, shortening of the
thigh will bunch up the soft tissue and will thigh will bunch up the soft tissue and will
accentuation of the skin folds.accentuation of the skin folds.
Telescoping of the thigh is elicited because the Telescoping of the thigh is elicited because the
femoral head is not contained within the acetabulum.femoral head is not contained within the acetabulum.
Trendelenburg’s Test with the child standing with Trendelenburg’s Test with the child standing with
weight on the affected side the normal hip drops weight on the affected side the normal hip drops
down, indicating weakness of the abductor muscles down, indicating weakness of the abductor muscles
of the affected side.of the affected side.
Neurological TestingNeurological Testing
Much of the neurologic exam comes from Much of the neurologic exam comes from
observation of the child.observation of the child.
Any limitation in the use of the hands, legs, or Any limitation in the use of the hands, legs, or
pupillary light response.pupillary light response.
Babinski Reflex the baby’s foot is stroked from heel Babinski Reflex the baby’s foot is stroked from heel
toward the toes. The big toe should lift up, while the toward the toes. The big toe should lift up, while the
other toes fan out: absence of the reflex may suggest other toes fan out: absence of the reflex may suggest
immaturity of the CNS, defective spinal cord, or other immaturity of the CNS, defective spinal cord, or other
problems. This reflex may be seen up to age 12 to 24 problems. This reflex may be seen up to age 12 to 24
months. Then it will reverse with toes curling months. Then it will reverse with toes curling
downward.downward.
Doll’s Eye while manually turning baby’s head, his Doll’s Eye while manually turning baby’s head, his
eyes will stay fixed, instead of moving with the head. eyes will stay fixed, instead of moving with the head.
While normally vanishing around one month of age, if While normally vanishing around one month of age, if
it reappears later, there may be damage to the CNS.it reappears later, there may be damage to the CNS.
Much of the neurologic exam comes from Much of the neurologic exam comes from
observation of the child.observation of the child.
Any limitation in the use of the hands, legs, or Any limitation in the use of the hands, legs, or
pupillary light response.pupillary light response.
Babinski Reflex the baby’s foot is stroked from heel Babinski Reflex the baby’s foot is stroked from heel
toward the toes. The big toe should lift up, while the toward the toes. The big toe should lift up, while the
other toes fan out: absence of the reflex may suggest other toes fan out: absence of the reflex may suggest
immaturity of the CNS, defective spinal cord, or other immaturity of the CNS, defective spinal cord, or other
problems. This reflex may be seen up to age 12 to 24 problems. This reflex may be seen up to age 12 to 24
months. Then it will reverse with toes curling months. Then it will reverse with toes curling
downward.downward.
Doll’s Eye while manually turning baby’s head, his Doll’s Eye while manually turning baby’s head, his
eyes will stay fixed, instead of moving with the head. eyes will stay fixed, instead of moving with the head.
While normally vanishing around one month of age, if While normally vanishing around one month of age, if
it reappears later, there may be damage to the CNS.it reappears later, there may be damage to the CNS.
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