|
|
Observation
- Observe toddler's general appearance:
- Comfort, wellbeing, activity level, grooming, temperament, body habitus, nutritional status
Head Circumference
- Measure at every visit until 24-36 months of age
- Observe head for shape, symmetry, tilt, lesions, contusions, and hair abnormalities
Growth Chart
- Plot height, weight, and head circumference at every visit
- Growth Charts available at the CDC website
General Considerations
- Undress down to diaper
- Examine in parent's lap
- Examiner must be flexible, especially in the sequence of the exam
- Begin with portions requiring calm patient
- Save less tolerated portions for later
- Examine areas of complaint at the end
- Use toys, games, stickers, and pictures to distract the toddler
- Allow toddler to touch the equipment
- Use the instrument on parent or toy first
- Vital Signs Normal Reference Range
Respiratory
- Note breathing pattern, skin color, signs of distress, use of accessory muscles
- Percuss
- Auscultate
Cardiovascular
- Compare brachial or radial pulses and femoral pulses bilaterally
- Palpate PMI
- Auscultate with diaphragm and bell
- Blood Pressure is not routinely measured in infants <3 yrs old
Abdominal
- Observe shape, contour, presence of hernias
- Auscultate bowel sounds in 4 quadrants
- Percuss
- Palpate, note size of liver and spleen
Lymph Nodes
- Palpate occipital, post auricular, pre auricular, anterior cervical, submandibular, submental, supraclavicular, axillary, and inguinal chains
Genitals
- Males: observe, gently retract foreskin to visualize urethral meatus, confirm bilaterally descended testicles, palpate for inguinal/femoral hernias
- Females: visual inspection of external genitalia sufficient
Eyes
- Note position and spacing of eyes, palpebral fissures, color, sclera and conjunctiva, eyelids, papillary size, and discharge
- Corneal Light Reflex
- Red Reflex
- Visual Tracking/Extraocular movements
- Cover/Uncover Test
- Formally assess visual acuity starting at 3 yrs of age
Mouth
- Inspect teeth, tonsils, oropharnyx
- Grossly assess cranial nerves IX, X, and XII
Back
- Observe for scoliosis, spinal defects, Mongolian spots, dimples, hair tufts
Neurologic Exam
- Grossly assess cranial nerves
- Assess strength and muscle tone
- Attempt to elicit deep tendon reflexes
Ears
- Observe appearance and placement
- Palpate pinnae, tragus, mastoid
- Otoscopic exam in parent's lap
- Pneumatic otoscopy if suspect otitis media
Special Considerations
- Pneumatic Otoscopy
- To evaluate for otitis media
|