Pediatric Assessment

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

Across the room assessment- the Pediatric Assessment Triangle

Vital Signs Vary by Age

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

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

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

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.

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

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

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