How to assess all pediatric conditions in physiotherapy practice.

1. Paediatric Assessment in
Physiotherapy
Hanine Hassan
Lecturer

2. • Demographic data
• Chief Complaints
• History of Presenting Illness
• Birth History (Prenatal, Perinatal, Postnatal)
• Family History
• Immunization History
• Developmental History

3. Demographic Data
• Name:
• Age:
• Gender:
• Date of birth:
• Expected date of delivery:
• Corrected Age:
• Birth weight:
• Birth Head circumference:
• Birth Height:

4. • Presenting complaints- use parents own words + chronological order
(since…)
• HISTORY:
• Antenatal history: Ask the mother if she went for regular antenatal
checkups. Took iron, calcium and folic acid supplementation? Felt
fetal movements at which month? Did they increase progressively?
Had any history of fever, rash, infection? (TORCH infections) Had
history of gestational diabetes, hypertension, any other
complications during pregnancy.

5. • Natal history: Ask the mother about the duration of labor, was it
induced? Ask the mother if the baby -Was born full term, pre term or
post term? Normal delivery or caesarian section? Presentation-
cephalic or breech? Any other complications during delivery- cord
around the neck, prolapsed cord etc. Did the baby cry immediately
after birth? If not, after how long? Was the baby kept in NICU for
any reason? When was the baby first breast fed? Was he able to
suck properly? Any history of fever, jaundice, seizures? Any history
of congenital deformities? Any other complications?
• Postnatal history: Is similar to history of present illness-It traces the
course of illness from when the problem first occurred till the date of
assessment. When did the parents first notice the problem, Any
history of seizures, meningitis, fever, trauma? Did the parents
consult a doctor? Was physiotherapy advised? Was it done
regularly? How is the condition progressing? Is the child better or
deteriorating?

6. Family history
• Includes fathers and mothers’
age, number of children their
age /any history of abortions,
deaths
• History of similar complaints
in the family
• Consanguinity
• Draw a family chart.

7. Development history
• Gross motor –
• Head control (4 months)
• Rolling supine to sidelying (4-5
months)
• Rolling supine to prone (5- 6
months)
• Rolling prone to supine (5-
6 months)
• Sitting with support (6- 7
months)
• Sitting without support ( 7- 8
months)
• Pull self to stand ( 11 months)
• Standing with support ( 10-
11months)
• Standing without support (11- 12
months)
• Walking with support (11-
12 months)
• Walking without support (12- 13
months)
• Climb stairs ( 2 -3 years)

8. • Fine motor-
• Voluntary grasp (5 months)
• Reach (4-5 months)
• Pincer grasp (1 year)
• Personal social –
• Social smile ( 2 months)
• Recognizes mother ( 2-3
months)
• Stranger anxiety ( 5-6
months)
• Communication –
• Cooing
• Monosyllables
• Bisyllables

9. ON OBSERVATION
• General – Is the child alert, playful, drowsy, irritable, crying
• Built
• Facial appearance
• OBSERVE THE CHILD IN EACH OF THE POSTURES HE IS
ABLE TO ATTAIN AND HOW HE ACHIEVES THOSE
POSTURES( Transitions) appropriate for the child’s age.
• For example Supine – Head in midline or not, turning to both
sides
• Visual tracking
• Position of upper limbs –able to bring to midline or not

10. • Position of hands, manipulation skills
• Position of lower limbs- movement of lower limbs
• Breathing pattern /rate, any flaring of ribs.
• Prone- Able to turn head to side in prone? ( for neonate)
• Able to lift head in prone? Able to sustain posture (for child 5 months
or above)
• Able to achieve prone on forearms?Able to reach for toys with one
hand?
• Sitting Describe the position in terms independent or dependent,
if independent- centre of mass and base of suppport

11. • Standing – Analyse the position, independent/ dependent – Center
of mass Base of support
• Transitions –Analyse how the child moves
from one position to other
• Supine to sidelying, sidelying to prone, supine to sitting, sit to stand
• Ambulation – Crawling / walking

12. EXAMINATION
• 1.Higher cortical functions-
• Alertness
• Recognize family members
• Gives response to play activities
• Follow commands
• Is able to communicate needs
• Is aware of surroundings
• Well oriented

13. • 2.Cranial Nerve examination-
• Child older than 5 years, tested as in adultsLess than 5 years-
• II- Blink reflexI
• II, IV, VI – Eyes follow movement
• V- Rooting ,sucking reflex, clenching of teeth
• VII – Facial symmetry while laughing or crying, nasolabial fold,
wrinkling forehead
• VIII – Loud nosies yields MOROS reflex until 4 months
• Eyes follow direction of sound
• Startle response

14. • IX, X – Gag reflex, swallowing, coordinates sucking, swallowing
• XII- Symmetry and tone of tongue

15. • 3.Sensory examination-
• Child older than 5 years, tested as in adults
• Less than 5 years-Check for awareness or response (eye ball
movement/ turns head toward side of touch etc)- when touched.
Check pain, if absolutely essential. Check for any signs
suggesting hyper response or aversive response to touch
• 4.Neuromuscular examination
• Tone – ( Modified Ashworth scale)
• Superficial reflexes- Abdominal, Corneal, Plantar
• Deep tendon reflexes – If more than 2-3 years old use reflex
hammer. Less than 2 yr old, tap using finger

16. • 5.Musculoskeletal examination
• Range of movement- active and passive of all joints
• Muscle strength – If child more than 5 years- MMT. If less than 5
years- Document if movement against gravity is present or absent
in limbs.
• Tightness
• Deformity/contracture
• Limb length and Limb girth if applicable
• 6. Cardio respiratory assessment
• Breathing pattern, Breathing Rate, Chest expansion, Chest
symmetry, Flaring of ribs

17. • 7. Oromotor assessment
• Tone of oral musculature
• Palate- high arched/norma
• lTongue- shape, tone, position
• Mouth closure
• Drooling of saliva
• Chewing of food in older children and swallowing. Asses if any
sensory seeking behavior is present
8) Any other assessment as appropriate, for eg, assessment of
balance, coordination, gait

18. • VI) SCALES
• INFANIB
• GMFM
• Posture and fine motor assessment of children
• Functional evaluation – weeFIM/ FIM
• VII) INVESTIGATIONS
• X –ray
• Ct scan
• Electrodiagnostic tests

19. • VIII) DIAGNOSIS
• IX) PROBLEM LIST
• X) GOALS
• –Short term
• –Long term
• XI) MANAGEMENT