Aims and purposes of paediatric examination
It is important to distinguish between:
The examination of children for other specific purposes such as, for example:
The routine examination of well babies (to screen largely for abnormalities of growth and development).
- The examination of ill babies (to establish the nature and cause and extent of any illness or injury).
- To establish fitness for education or certain activities
- To examine for signs of sexual abuse in child protection cases
- However, this is not an absolute distinction. Whether ill or well the examining doctor should have a good working knowledge of routine examination and normal findings in children at different ages.
- Problems with development, behaviour and growth may thus be identified opportunistically whilst examining an ill child.
- Doctors working with children should have a good knowledge of normal developmentalmilestones, as well as routine physical development and findings at different ages.
- It is important to have established rapport with parents and child when taking the history.
- The approach to the examination will be determined by the age, level of development and level of understanding of the child.
- Inspection and observation are the most important parts of the examination. Observations can be made whilst taking the history and establishing rapport.
- Observe the child's behaviour and level of awareness and take these into account with the parents own reports.
- Consider if the childs appearance is unusual at all and in what way.
- Note the shape of the head, mould of ears, position of eyes, body proportions, posture.
- Does the child look like their parents
- Are there any recognisable major or minor anomalies
- Record the nature and distribution of skin lesions and rashes.
- Note the colouring, shape and positions of bruises. If they have suspicious appearance, consider the possibility of non-accidental injury.
- Avoid waking sleeping children.
- Approach the child at their level, if necessary kneel on the floor. It may be impossible to examine pyrexial, irritable children without provoking crying and they should be carefully observed before attempting closer examination.
- Start examining peripherally with hands and feet as this is less threatening.
- Make the examination fun to help with their anxiety.
- Make sure the child is comfortable, and that your hands, stethoscope and other instruments are warm.
- Ask parents to assist with dressing or undressing children and be aware of sensitivities about this.
- Wherever possible avoid unpleasant procedures (for example, rectal examination). These are seldom necessary and can put children off being examined for a lifetime.