Chapter 33: Physical Assessment of Children

The assessment process begins with building trust and employing a quiet-to-active examination sequence, where non-invasive techniques such as listening and observation precede more distressing procedures to maximize cooperation and diagnostic accuracy. A thorough health history forms the foundation of pediatric assessment, encompassing birth circumstances, vaccination records, family medical conditions, and the nature of the current visit, whether episodic or routine interim evaluation. Vital sign measurement requires knowledge of age-specific normal ranges and proper techniques, including apical pulse assessment for infants and appropriate thermometer placement for various ages. Anthropometric data collection and interpretation represent critical health indicators; weight, length or height, and head circumference measurements are plotted on standardized growth curves from the Centers for Disease Control and Prevention and World Health Organization to identify developmental trajectories and screen for conditions such as failure to thrive or excessive weight gain. The physical examination systematically incorporates inspection, palpation, percussion, and auscultation across all organ systems. Assessment of integumentary health evaluates skin turgor, lesions, and pigmentation variations. Cranial and cervical evaluation monitors fontanel status and suture line progression. Ocular assessment includes age-appropriate visual screening tools and strabismus detection through occlusion testing. Otoscopic examination techniques differ between infants and older children, with hearing acuity screening appropriate to developmental level. Thoracic assessment identifies anatomic landmarks, locates the point of maximal impulse, and distinguishes normal heart sounds from pathological murmurs and abnormal breath sounds. Abdominal examination follows a modified sequence to preserve the validity of auscultation findings. Genitourinary evaluation incorporates Tanner staging to assess pubertal progression and identifies developmental variations. Musculoskeletal examination screens for spinal curvatures and evaluates hip stability in infants using specific maneuvers. Neurologic assessment evaluates mental status, cranial nerve function, motor coordination, balance, primitive reflexes, and deep tendon reflexes to identify developmental concerns or neurological dysfunction.