The Physical Examination Interview: Pediatric Examination

Pediatric examination: Cont.

Average pediatric vital signs:
Respiratory
Age Pulse Systolic BP Weight (Kg)
Rate
Infant 30 - 50 120 - 160 > 60 3-4
6–12 month 30 - 40 120 - 140 70 - 80 8 - 10
2 – 4 years 20 - 30 100 - 110 80 - 95 12 - 16
5 – 8 years 14 - 20 90 - 100 90 - 100 18 - 26
8 – 12 years 12 - 20 80 - 100 100 - 110 26 - 50
> 12 years 12 - 16 60 - 90 100 - 120 > 50

3- Focused exam by systems:

As in adults with some considerations:

Head and Neck:

Head: Neonate and infants. Supine
1- Head Shape and symmetry:
During first week and only due to vaginal vertex delivery:
- Head is occipiato-frontally elongated,
- Overriding cranial bone sutures (flattened by 6 months),
- Scalp swelling (either: caput succedaneum (subcutaneous edema
resolves in few days), or cepahalhematoma (subperiosteal
hemorrhage resolves in few months))
A markedly flattened occiput results from consistently placing the infant
supine.
2- Auscultate the temples and the vertex:
Loud harsh bruits suggest arteriovenous malformation (AVM).
To the examiner “Head shape and sutures are normal and
symmetrical. No scalp swelling. No loud harsh
bruits on the temples or vertex.”
Ears:
1. Inspection:
- Position: - The top of the ear is at the level of a line drawn from the
outer eye’s corner.
- The pinna should only deviate 10 0 from the vertical axis.
- The neonate’s ear is flat against the head.
- Hygiene: - Absence of wax: Over cleaning, Acute otitis media.
- Foul smelling discharge: Ruptured tympanic membrane,
recent myringotomy tube insertion.
- Bloody discharge: Foreign body, scratching.

To the examiner “Ears’ shape and position are normal & symmetrical.
Good hygiene. No discharge, normal wax.”… Continued

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