1. Vitals Adapted from Mosby’s Guide to Physical Examination, 5 th Ed. Ch. 3

2. Vitals Pulse Respiration Blood pressure Temp Height & weight (infants and children)

3. Pulse Apical pulse –5 th intercostal space in the midclavicular line Femoral pulse –use a point halfway from the pubic tubercle to ASIS as a guide

4. Pulse AgeBeats per minute Newborn120-170 1 year80-160 3 years80-120 6 years75-115 10 years70-110

5. Respiration Infants – rise and fall of the abdomen facilitates counting –Rate –Regularity and rhythm –Depth –Difficulty; use of accessory muscles

6. Respiration AgeRespirations per minute Newborn30-80 1 year20-40 3 years20-30 6 years16-22 10 years16-20

7. Blood Pressure Cuff size (children) –Width should cover ~2/3 of the upper arm or thigh Too wide - underestimate BP Too narrow - artificially high BP http://store.datascope.com/Assets/product_images/0998-00-0003-21,22_s164_jpg.jpg

8. Temperature Tympanic thermometers are becoming increasingly popular –Accuracy depends on correct technique Must read tympanic membrane which shares blood supply with the hypothalamus

9. Temperature – Young Infants Traditional routes may be more accurate NOTE: axillary temp correlates well with core temp of newborns –due to the infant’s small body mass and uniform skin blood flow

10. Height - Infant Infant measuring mat OR Mark on a sheet of headrest paper

11. Height - Child “Stature measuring device” (or height chart) –child is able to stand without support –approx. 24 months old

12. Weight Infant platform scale –More accurate (ounces or grams) –Child may sit or lie –Place paper or blanket under the child “weigh it out”

13. Growth and Measurement Adapted from Mosby’s Guide to Physical Examination, 5 th Ed. Ch. 5 MacGregor, 2000

14. Newborn Most babies born to the same parents weigh within 6oz of each other at birth –Lower birth weight: consider an undisclosed congenital abnormality or intrauterine growth retardation

15. Average Weight 5 lb, 8 oz – 8 lb, 13oz (term newborn) Expected growth Double birth weight by 4-5 months Triple birth weight by 12 months NOTE: on average formula-fed babies are heavier after the 1 st 6 months than breast- fed babies

16. Average Length 18-22 in (45-55cm) long at birth Expected Growth Length increases by 50%in the 1st year of life

17. Growth Infancy –Growth of the trunk predominates –Fat increases until 9 months of age What happens at 9 months? Childhood –Legs are the fastest growing body part –Weight is gained at a steady rate –Fat increases slowly until 7 yrs of age when a prepubertal fat spurt occurs before the true growth spurt

18. Growth Adolescence –Trunk and legs elongate –About 50% of the ideal weight is gained –Skeletal mass and organ systems double in size

19. Gender Differences MalesFemales Broader shoulders & greater musculature Wider pelvic outlet Slight increase in body fat during early adolescence before the gain in lean tissue Persistent increase in fat throughout adolescence, occuring after the peak growth spurt

20. Measurement Infant Length Weight Head circumference Chest circumference Child Height Weight

21. Recumbent Length Measurement of choice for infants birth to 24-36 months

22. Recumbent Length 1.Tear a length of headrest paper 2.Lay the child on top of the paper 3.Mark the top of the child’s head 4.Ask mother to hold child in place 5.Extend leg and mark under the heel (foot dorsiflexed)

23. Recumbent Length Measure to the nearest 0.5 cm or ¼ in. Chart on appropriate growth curve for sex and age –Identify the infant’s percentile –Note any change or variation from the population standard or the child’s norm

24. Standing Height Child stands erect –Heels, buttocks and shoulders against the wall –Looking straight ahead Outer canthus of the eye should line up with the external auditory canal Slide the headpiece onto the crown

25. Standing Height Use once the child is walking well Usually about 24-36 months Stature is recorded to the nearest ¼ in (0.5 cm)

26. Infant scale (oz or g) Distract the infant and balance the scale Read the weight to the nearest ½ oz (10g) when the infant is most still Chart on appropriate growth curve for sex and age –Identify the infant’s percentile –Note any change or variation from the population standard or the child’s norm

27. Head Circumference Measure the infant’s head at every “health visit” until 2 years of age –Yearly from 2-6 years of age Newborn:13-14 in (33-35 cm) NOTE: By 2, the head is 2/3 its adult size

28. Head Circumference Measure the largest circumference with the tape snug –Occipital protuberance to the supraorbital prominence

29. Head Circumference Nearest 1/4 in (0.5 cm) Repeat to check the accuracy of your measurement Chart on appropriate growth curve for sex and age –Identify the infant’s percentile –Note any change or variation from the population standard or the child’s norm

30. What if…? Head circumference increases rapidly –Rises above percentile curves ~> Increased intracranial pressure Head circumference grows slowly –Falls off percentile curves ~> Microcephaly

31. Chest Circumference Measure around the nipple line to the nearest 1/4 in (0.5 cm) –Firmly but not tight enough to cause an indentation in the skin

32. Head vs. Chest Circumference Newborn to 5 months –Head may be equal or exceed the chest by 2 cm 5 months to 2 years –Chest should closely approximate the head circumference 2 years + –Chest should exceed head circumference

33. Growth/ Development Abnormalities What might you detect by recording height, weight, head & chest circumference? –Failure to thrive –Craniosynostosis –Hydrocephalus –Turner’s syndromeetc.

34. Failure to Thrive Failure of an infant to grow at “normal rates” May be related to: –Chronic disease –Congenital disorder (brain, heart, kidney) –Inadequate calories and protein –Improper feeding methods –Intrauterine growth retardation –Emotional deprivation

35. Failure to Thrive An emotionally deprived infant will not grow –Growth hormone levels will be low Once the child is given attention, growth hormone will be produced and the child will grow.

36. Craniosynostosis Early closure of suture(s) Associated with: –small head circumference (microcephaly) –rigid sutures www.emedicine.com/neuro/topic80.htm

37. Hydrocephalus Excess CSF accumulates between the brain and the dura or within the ventricular system Resultant increased ICP leads to: –head enlargement –widening of sutures and fontanels –lethargy, irritability, weakness –“setting sun eyes”

38. Turner Syndrome Abnormality of sex chromosomes Characteristics include: –Short stature –Absence of sexual development –Webbed neck –Shield-shaped chest –Hypoplastic axillary nipples –Increased carrying angle –Congenital abnormalities or heart or urinary tract