Advanced Pediatric Assessment

Neonate

Birth to 29 days.

Infant

1 month to 12 months.

Toddler

1 to 3 years.

Preschool children

4 to 5 years.

School-age children

6 to 12 years.

Adolescent

13 to 18 years.

Pediatric patient history parts

Chief complaint, History of present illness (HPI), Medical history (MH), Review of symptoms (ROS), Family history, Social/environmental histories.

Additional history items for a new pediatric patient

Maternal/birth history, Growth & development, Vaccinations.

Importance of patient history

Helps determine diagnosis, Guides the care plan, Directs clinical treatment and management.

Review for established pediatric patient

Past medical history (PMH), Current history, Changes since last visit or admission, Review of symptoms (ROS), Any new symptoms, Triggers with the primary disease, Disease management, Current medications, Family History.

Pediatric family history key points

Father and mother's health, Consanguinity (blood relation), Smoking history, Siblings' health, Family history of similar disease, genetic disorders, or unexplained sibling deaths.

Pediatric respiratory risk

They have smaller airways and softer tracheas, They can't handle ventilatory problems as well as adults, They become hypoxic faster if airway obstruction occurs.

Major cause of cardiac arrest in children

Respiratory problems.

Importance of pediatric assessment

Because rapid assessment is critical to survival and management.

Child's lung development age

Around 8 years old.

VOCP

Ventilation, Oxygenation, Circulation, Perfusion.

Key indicators of ventilation

Respiratory rate, breath sounds, end-tidal CO₂, and PaCO₂.

Indicators of oxygenation

Heart rate, skin color, SpO₂, and PaO₂.

Signs of circulation

Heart rate, pulse strength, capillary refill, and cardiac output.

Indicators of perfusion

Blood pressure, temperature, urine output, and hemodynamics.

Main steps of a pediatric pulmonary exam

Inspect, Take vital signs (HR, RR, temp, SpO₂, BP), Palpate, Percuss & auscultate, Check for retractions, grunting, chest wall movement, and tracheal position.

Common signs of pediatric respiratory distress

Tachypnea, Head bobbing, Grunting, Nasal flaring, Retractions, Low oxygen saturation, Changes in skin color.

Areas assessed in a non-pulmonary exam

General: growth, development, neuro signs, ENT: ear, nose, throat infections or drainage, Heart: rhythm or murmurs, Abdomen: distention or organ enlargement, Skin: dermatitis, poor circulation, cyanosis, Extremities: clubbing, swelling, arthritis.

Non-pulmonary signs of distress in a pediatric patient

Excessive secretions, Lethargy, Cyanosis (lips, fingers, mottled skin), Cold extremities, Anxiety, Extreme fussiness or irritability, Altered level of consciousness, Tachycardia.

Auscultation of breath sounds

Listen for two full cycles (inspiration and expiration), Check all lung fields (anterior and posterior), Compare right vs left, upper vs lower.

Common abnormal (adventitious) breath sounds

Wheezing, Croup, Stridor, Crackles/Rales, Rhonchi, Stertor.

Classifications of breath sounds

Normal and Adventitious.

Area listened to

Phase of breathing (inspiration/expiration)

Palpation

Helps detect abnormalities through touch. Checks for bronchial fremitus and tactile fremitus (vibrations felt on the chest wall).

Percussion in pediatric age group

Most useful in older children (less effective in infants or toddlers).

Five main percussion sounds

Resonant, Hyperresonant, Dull, Flat, Tympanic.

Normal respiratory rate for infants

30-60 breaths per minute.

Normal heart rate for infants

90-120 bpm.

Normal respiratory rate for school-age children

18-30 breaths per minute.

Normal heart rate for adolescents

60-80 bpm.

Normal rectal temperature range for pediatrics

36.6°C-38°C (97.9°F-100.4°F).

Febrile temperature in pediatrics

Above 100.4°F (38°C).

Celsius to Fahrenheit conversion

(°C × 9 ÷ 5) + 32.

Normal hemoglobin (Hb) range in children

10-14 g/dL.

Normal white blood cell (WBC) range in children

5,000-10,000/mm³.

Normal electrolyte ranges in pediatrics

Potassium (K⁺): 3.3-4.7 mEq/L, Sodium (Na⁺): 132-141 mEq/L, Chloride (Cl⁻): 80-100 mEq/L, Glucose: 54-117 mg/dL.

Normal respiratory rate for toddlers

24-40 breaths per minute.

Normal respiratory rate for preschool-age children

22-34 breaths per minute.

Normal respiratory rate for adolescents

16-22 breaths per minute.

Normal heart rate for toddlers

80-100 bpm.

Normal heart rate for preschool-age children

70-90 bpm.

Normal heart rate for school-age children

70-90 bpm.

Normal blood pressure for a 1-year-old

Systolic: 68-105 mmHg, Diastolic: 22-66 mmHg.

Normal blood pressure for a 2-year-old

Systolic: 70-105 mmHg, Diastolic: 26-66 mmHg.

Normal blood pressure for a 7-year-old

Systolic: 79-112 mmHg, Diastolic: 38-71 mmHg.

Normal blood pressure for a 15-year-old (adolescent)

Systolic: 93-128 mmHg, Diastolic: 66-85 mmHg.

Non-invasive monitoring methods in pediatrics

Transcutaneous monitoring, Pulse oximetry, Capnography, Apnea monitor.

Pulse oximetry

Measures oxygen saturation (SpO₂).

Capnography

Measures end-tidal CO₂ (ETCO₂) to monitor ventilation.

Types of blood gas samples used in infants

Arterial Blood Gas (ABG), Venous Blood Gas (VBG), Capillary Blood Gas (CBG).

Preferred blood gas sample for accuracy

Arterial Blood Gas (ABG).

Use of Capillary Blood Gas (CBG)

Typically used for acid-base balance and ventilation assessment only.

Ideal environment for pediatric assessment

Warm, well-lit, and comfortable environment.

Reducing anxiety during pediatric exams

Use distractions and make the assessment a game.

Counting respiratory rate in a child

For one full minute.

Checking pulse in infants and children

Infant: Brachial artery, Child: Radial artery.