1. P AEDS G ASTRO Abigail Dunn

2. I NTRODUCTION To Mum/Dad and to child If parents are at ease in your company, the child will be too! Explain what you are going to do

3. G ENERAL I NSPECTION Observe!

4. G ENERAL I NSPECTION Well or ill? Appearance Nutritional status Behaviour Cannulae, Creon, inhalers, walking aids

6. UM

7. R APPORT Depends on age of child “I like your shoes!” “What school do you go to?” “Who’s your favourite teacher?” Get Mum/Dad involved “Shall we listen to Mummy’s arm?” Explain with detail appropriate to age of child

8. P OSITIONING On Mum or Dad’s lap for scared/wiggly children

9. H ANDS

16. Check pulse Check perfusion at sternum

17. F ACE

18. F ACE (/ HEAD )

19. F ACE

28. W ARM HANDS !! And stethoscope!

29. T UMMY ! Can be tickly Get down to their level Get them to puff out their tummy (rebound tenderness) Pain is less localised than in adults (abdo pain can = pneumonia) Normal to be rounded, and can feel up to 2 finger widths of liver and spleen in babies and toddlers

30. A BDOMEN Inspect – scars, PEG tubes, 4 F’s (not 5! – and constipation is very common), peristalsis (?pyloric stenosis), visible masses Palpate – as for adult in older child Check for pain and distension in babies (and toddlers if uncooperative) Hydration status (skin pinch) Percussion Auscultation – listen for cornflakes!!

31. D ON ’ T F ORGET ! PLOT HEIGHT AND WEIGHT ON A GROWTH CHART!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Dipstick the urine (PR not routinely done)

32. A BDO S URGICAL E MERGENCIES 4 week old Non bilious vomiting

33. 1 day old Bilious vomiting (though can be non-bilious) A BDO S URGICAL E MERGENCIES

34. 11 months old Vomiting (may be bilious or non bilious) A BDO S URGICAL E MERGENCIES

37. Q UESTIONS ?