Overview
This lecture covers key aspects of performing pediatric physical exams, growth and development benchmarks, safety guidelines, and communication techniques for infants through adolescents.
General Principles of Pediatric Physical Exam
- Always interact with the parent first, then the child to build trust.
- Encourage parent involvement, such as having the child sit on their parent's lap during assessment.
- Use age-appropriate, simple language when communicating.
- Keep medical equipment out of sight until needed to reduce stress and anxiety.
- Perform least invasive assessments first; save invasive procedures (e.g., BP, ear exams) for last.
Infant (0-12 Months) Assessment
- Height increases by 1 inch per month and is 50% higher at 12 months.
- Weight doubles by 6 months, triples by 12 months—report if below benchmarks.
- Only breast milk or iron-fortified formula; no cow’s milk.
- Introduce solids at 4-6 months, one new food per week.
- Head circumference larger than chest at birth, equalizes by 12-18 months.
- Fontanelles (soft spots) should be flat; bulging or sunken fontanelles are urgent findings.
- Posterior fontanelle closes by 2 months; anterior by 12-18 months.
- Assess for respiratory distress signs (nasal flaring, retractions).
- Document normal crying; assess pattern and quality before interventions.
- First tooth usually erupts at 6-10 months; care with washcloth.
Infant Reflexes
- Babinski: toes fan when sole is stroked (disappears by 12 months).
- Rooting/sucking: turns to suck when cheek stroked (disappears by 4 months).
- Tonic neck: fencing position when head turned (disappears by 4 months).
- Moro (startle), stepping, palmar and plantar grasp—know timing and responses.
Toddler (1-3 Years) Assessment
- Height increases by ~3 in/year; weight gain 4-6 lbs/year.
- Weight should be 4x birth weight by 2.5 years.
- Limit milk to 16-24 oz/day; juice to 4-6 oz/day.
- Cut food into bite-size, avoid round foods to prevent choking.
- Practice burn, drowning, and crib safety; remove crib mobiles at 4-5 months.
- Car seat must be rear-facing; transition as child grows.
Preschool (3-6 Years) & Kindergarten
- Growth: 2-3 in/year, 4.5-6.5 lbs/year.
- Requires five servings of fruits/vegetables and 1 hour physical activity daily.
- 12 hours of sleep recommended; consistent bedtime important.
- Magical thinking—may view pain or injury as punishment.
School-Age Children (6-12 Years)
- Height increases by 2 in/year; weight by 4.5-6.5 lbs/year.
- Encourage team play, 9 hours of sleep per night.
- Treat as "mini adults": explain results, respect privacy, use full head-to-toe exams.
- Use proper bike and car safety; never leave alone near water.
Adolescents (12-18 Years)
- Girls' growth ends ~2.5 years after menarche; boys grow until 18-20 years.
- Puberty: girls at 10, boys at 12.
- Encourage peer socialization during hospital stays (except post-op, immunocompromised, or contagious).
Key Terms & Definitions
- Fontanelle — soft spot between the bones of a baby’s skull.
- Babinski Reflex — fanning of toes when the sole is stroked, normal up to 12 months.
- Tonic Neck Reflex — arm/leg extension on side baby faces when head turned.
- Magical Thinking — belief that thoughts/actions cause unrelated outcomes, common in preschoolers.
- Menarche — a girl's first menstrual period.
Action Items / Next Steps
- Review reflex timings and associated ages.
- Memorize growth benchmarks for all age groups.
- Complete assigned quiz and download study guides as directed.