1. Pediatric Assessment

2. Principles of Physical Assessment
Least invasive to most invasive
Developmentally appropriate (ex. Talk directly to adolescent, get down to toddler’s eye level)
Developmentally appropriate language

3. Across the room assessment-
the Pediatric Assessment Triangle

4. Vital Signs Vary by Age

5. Differences in Anatomy & Physiology
Newborn- 3 months obligatory nose breathers
Child’s airway is shorter and more narrow<6 years breathe with diaphragm- intercostal muscles immature
A newborn’s chest is circular until age 6.
Decreased muscularity is responsible for the thin chest wall in infants

6. Differences in Anatomy & Physiology
Child epiglottis longer, floppier
Higher oxygen demand in children
Immature Infant Respiratory and Neurologic System Offers Less-Efficient Response to Hypoxia and Elevated PCO2

7. Differences in Anatomy & Physiology
Pulses
Infant
Brachial, Femoral
> 1 year
Radial, Carotid
Stroke Volume-Cardiac Output
Immature fluid balance compensatory mechanisms
Murmurs
S3 is normal in children

8. Differences in Anatomy & Physiology
Newborn stomach small with increased peristalsis
4-6 months- Insufficient enzymes to aid digestion
First 2 years- kidneys less efficient regulation of acid-base balance, less able to concentrate urine
Infants & Children- greater body surface area
Urine output
Infants 2 cc/kg/hr.
Children 1 cc/kg/hr.

9. Differences in Anatomy & Physiology
Kidneys less efficient until 2 years
Kidney grow most in first 5 years
Bladder capacity increases with age
Bladder capacity age + 2 in oz.
Bladder control >2 years due to nerve development

10. Differences in Anatomy & Physiology
Child’s Bones
More porous and pliable
Less dense
Infant Skull
Fontanel closure: 18 months
Overall growth completion: 2 yrs
Child Bone Growth from Epiphyseal Plate
Muscles
Number same as adult
Only length and circumference grow
Ligaments and Tendons
Stronger than bone until puberty

11. Differences in Anatomy & Physiology
Brain & spinal cord
Large head
Brain growth
Cranial Nerves
Intact from birth
Myelination
Head to toe
Cranial bones
Not complete
Head vs. chest size
Blood brain barrier
First year neurons become myelinated
Blood brain barrier less effective than adults