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3-4. The Physical Examination

The goals of the pediatric examination are also the same as the goals of adult physical examinations: assessment and management of life-threatening injuries and assessment of other injuries. The techniques vary according to the age of the child. When a child of any age presents with acute, life-threatening illness or injury, conduct the primary survey rapidly and with a minimum of preliminaries. Manage life- threatening conditions as you would in an adult. Being aware of the characteristics and differences of children in the various age groups and conducting the examination accordingly will help make the examination less stressful for both the child and you.

Included in the age group differences are the following:

a. Infant Under 6 Months Old.

(1) Place the infant on a bed for examination.

(2) Remove the infant's clothes so you can examine him thoroughly.

(3) Provide entertaining distractions for the infant; for example, make cooing, pleasant noises to him. A child this age needs to be distracted when undergoing a physical examination.

(4) Start at the feet and work upward (toe-to-head order). Small children do not like strangers poking at their faces.

b. Child 6 Months to 24 Months of Age.

(1) Remove the child's clothes so you can examine him thoroughly.

(2) Examine the child while he is sitting on his mother's lap.

NOTE: A child in this age range will not appreciate being taken from his mother to be put on a bed or stretcher.

(3) Again, start examining the child at his feet and work your way upward. You are examining him in the toe-to-head sequence.

(4) If there is time, try the distracting noises. The cooing and pleasant noises may not work as well as these distractions did with the younger child.

c. Child 2 Years to 3 Years of Age.

(1) A child in this age range is usually difficult to deal with.

(a) This child does not like his clothes removed.

(b) He does not want to be touched, especially by strangers.

(c) A child in this age range has no desire to "play" with the medic.

(2) This patient is frightened and in no mood to be conciliatory. Therefore, proceed in this manner:

(a) Decide which parts of the examination are absolutely essential and get through them the best way you can.

(b) Set ground rules. The rules may be that crying is allowed, but kicking and biting are not.

(c) Complete your examination as quickly as possible.

d. Child 4 Years to 5 Years of Age.

(1) A child in this age range is usually cooperative except when he is extremely frightened.

(2) This child may be examined on a chair or bed.

(3) He likes to help out; for instance, listen to his own heart.

(4) Generally, there is little problem in completing a standard head-to-toe survey of a child in this age group.

e. School Age Child.

(1) The school age child likes to be cooperative.

(2) He appreciates being treated with respect.

(3) He likes an explanation of what you are doing.

f. Adolescent. Not all adolescents fit into one category. Some are very immature and childish. At the other extreme, adolescents can be very mature and grown up. When dealing with them, remember the point mentioned before that adolescents are unusually concerned that they are healthy. It is often helpful to reassure an adolescent patient as each part of the examination is completed that things are all right--assuming that things really are all right.

Section III. SPECIAL CONSIDERATIONS OF THE ILL OR INJURED CHILD

David L. Heiserman, Editor

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Revised: June 06, 2015