Child Health Assessment Quiz

Assessing the Child and Adolescent Health Assessment

• The assessment of a child or adolescent's health requires a family-centered approach.
• A strong correlation exists between the health of parents and the child.
• Establishing a trusting relationship with the child and parent is crucial before starting the assessment.
• A calm and relaxed demeanor by the healthcare professional is essential.
• Communication should occur at the child's eye level and use age-appropriate methods, such as play.

Developmental Principles

• Many events in a child's life affect growth and development.
• Development is directional, from head to toe and midline to periphery.
• Normal physical growth follows a sequential and predictable path guided by the maturing brain.
• Normal development doesn't always progress in all domains in a consistent, orderly manner.
• Respecting cultural differences is important for building trust and avoiding communication barriers.
• The child's assessment should be tailored to the individual child's developmental level.

Data Collection

• Data collection should use age-appropriate methods.
• Methods include observation and gathering information from the child, parents, and other relevant sources.
• Relevant data sources include parent-child interaction, diagnostics, health history, and physical exam.

Diagnostics

• Diagnostic tests used may include urinalysis, hematocrit, blood lead levels, lipid screening, testing for Tuberculosis and other sexually transmitted infections (STIs), and tympanometry.

Health History

• The reason for the visit should be determined: well-child, school/sports physical, pre-operative visit, sick visit, or emergency.
• Attributes of a symptom can be recorded using the COLDSPA mnemonic.
• Child and parent/caregiver interaction should be assessed.
• Information such as general health, birth history, past medical history, family history, psychosocial history, sleep history, nutrition, and elimination should be collected.
• Aspects of the physical examination, including skin, hair and nails, eyes and vision, ears, nose and sinuses, mouth, teeth, throat and respiratory system, female and male breast development should be noted.
• Information regarding cardiovascular status, abdominal issues, musculoskeletal issues, neurological issues, endocrine issues including diabetes, and pituitary gland issues all should be included.

Preliminary Steps

• Maintain privacy and confidentiality.
• Use a developmentally appropriate approach.
• A child's chronological age is not an indicator of their developmental stage.

Physical Examination

• Begin with less threatening and least intrusive procedures.
• Explain the procedure to the child and what to expect.
• Utilize age-appropriate diversions.
• Involve parents when the child is uncooperative.
• Use various developmental approaches depending on the child's age.

General Survey

• The purpose of the general survey is to assess the child's physical appearance, nutritional status, personality, interaction with others (including parents, siblings, nurse, and healthcare providers).
• Evaluate hygiene, clothing condition, overall development, motor skills, coordination, speech, behavior (activity, interactions, attention span, following directions, eye contact, and overall personality).

Normal and Abnormal Findings (General Survey)

• Normal findings include good hygiene, appropriate clothing, good posture, clear and appropriate speech for age, alertness, cooperation, good eye contact, appropriate motor skills and coordination for age, and positive social interaction.
• Abnormal findings include poor hygiene, body odor, inappropriate clothing, poor posture, decreased motor skills, and coordination, lack of eye contact, and/or negative interactions.

Measurements

• Plot findings on standard growth charts.
• Assess weight, length, or height.
• Appropriately document temperature (oral, rectal, tympanic, axillary, temporal).
• Take measurements for heart rate, respiratory rate, blood pressure, and pain. Specific guidelines are presented for assessing weight and height.

Assessing Weight

• A child must be able to stand independently to get an accurate weight.
• Children older than 36 months are generally weighed standing up.
• Ensure appropriate clothing is considered when taking weight measurements.
• Document weight in pounds and kilograms.
• Normal findings include a weight appropriate for age; abnormal findings include growth failure indicated by a weight lower than the 5th percentile.

Assessing Length or Height

• Determine the appropriate equipment (stadiometer, length board, or measuring tape).
• Two people are generally needed to measure length accurately.

Assessing Height

• Instruct the patient to remove shoes and place feet together.
• Have the patient stand upright and as straight as possible, under a stadiometer.
• Carefully lower the horizontal bar until it touches the patient's head.
• Normal findings are height appropriate for age; abnormal findings include short stature.

Head Circumference

• Measure head circumference in children under 2 years old.
• Plot results on an appropriate age and gender growth chart.
• Results should fall within similar ranges as height and weight.

Assessing Temperature

• Use an electronic thermometer, temporal artery thermometer, or tympanic thermometer.
• Choosing the appropriate method depends on age and institutional policy.
• Normal ranges vary according to method (rectal, oral, tympanic, temporal).
• Abnormal findings include temperatures outside of the normal range.

Assessing Heart Rate

• Use a watch or clock with a second hand.
• Use an appropriate stethoscope.
• Normal rates vary depending on age.
• Abnormal findings could include tachycardia (a heart rate that is too fast) or bradycardia (a heart rate that is too slow).

Assessing Respiratory Rate

• Use a clock and stethoscope.
• Normal rates vary according to age.
• Abnormal findings include rates that are too fast or too slow, retractions, nasal flaring, grunting, pale/mottled/blue skin, and changes in consciousness.

Assessing Blood Pressure

• Use non-invasive blood pressure (BP) devices and appropriate-sized BP cuffs.
• Accurate BP measurements depend on appropriate cuff size for the child's age.
• There are given normal ranges of systolic and diastolic blood pressures for different ages.

Assessing Pain

• Assess pain using age-appropriate tools, considering factors such as cognitive ability, language, and culture.
• The FLACC Scale and Wong-Baker FACES Pain Rating Scale are examples of appropriate tools.
• The Oucher Scale is another recommended tool.

Inspecting/Palpating Skin

• Purpose: Identify changes in skin, rashes, lesions, masses; assess moles.
• Method: Inspect color, odor, lesions, rashes; palpate texture, temperature, moisture, turgor, and edema.
• Normal findings: Good hygiene, warm and moist skin, uniform color, no abnormal lesions, nevi appropriate in size/shape & location.
• Abnormal findings: Bruises, vascular lesions, skin texture changes, rash, bluish or yellowing skin.

Inspecting/Palpating Hair and Scalp

• Purpose: Assess for hair and scalp changes/abnormalities.
• Method: Observe distribution, characteristics, infestations, unusual hair.
• Normal findings: Clean hair with appropriate texture, uniform thickness and distribution, appropriate color, clean scalp with no lesions.
• Abnormal findings: Dirty, matted hair, dry/dull/brittle hair, hair loss, alopecia (baldness), tinea capitis (ringworm), lice.

Inspecting/Palpating Fingernails and Toenails

• Purpose: Assess nail health.
• Method: Observe color, shape, texture; palpate tenderness.
• Normal findings: Smooth nails, uniform thickness, nail base angle of 160 degrees, firmly adhering to the nail bed, pink nail beds, capillary refill <3 seconds. Non-tender to palpation.
• Abnormal findings: Changes in color, shape, texture, thickness; capillary refill > 2 seconds; tenderness with palpation, redness/infection, blue nailbeds/cyanosis, ragged short nails, clubbing.

Inspecting Head, Face, Mouth, and Neck

• Purpose: Assess for growth and developmental abnormalities in the head, face, mouth, and neck.
• Method: Measure head circumference for children under 3, assess shape, symmetry, ROM of the head/face; note fontanels, plagiocephaly, and opisthotonos. In the mouth examine the tongue, palate, teeth, and neck, looking for abnormalities in each.

Inspecting the Eyes

• Purpose: Assess for any eye abnormalities.
• Method: Use a penlight, have the child look at the light source and observe pupil reactivity, and use distraction techniques for young children.

Testing Visual Acuity

• Purpose: Test the child's near and far vision using appropriate charts.
• Method: Use Snellen charts, tumbling E, HOTV or appropriate Kindergarten charts. Ensure children wear glasses during testing.

Assessing the Respiratory System

• Purpose: Detect abnormalities in the respiratory system.
• Method: Use appropriate stethoscopes to assess for respiratory rate, depth, rhythm, lung sounds, and effort.
• Normal findings include appropriate anterior-posterior diameter ratios for children of specific ages , conical shape of the chest, sounds radiating from thin chest walls

Assessing the Cardiac System

• Purpose: Assess for cardiac system abnormalities.
• Method: Use an appropriate stethoscope to identify heart rate, sounds, and other characteristics.

Assessing the Abdomen

• Purpose: Evaluate the abdomen for abnormalities.
• Method: Use an appropriate stethoscope with the examiner noting stomach shape, peristalsis visibility, and presence of hernias

Special Considerations

• Newborns might have rounded or C-shaped spinal curves.
• Scoliosis might be apparent in older children/adolescents.
• Certain aspects of a health evaluation might be age-dependent.
• Consider age-specific approaches when examining the musculoskeletal system, performing a neurological evaluation, or doing an endocrine assessment
• Use age-appropriate techniques and language when evaluating the child and parents.