The document outlines the steps for conducting a general pediatric examination, including inspection, palpation, percussion, and auscultation of the head, neck, chest, abdomen, back, and extremities. Key aspects to examine include general appearance, vital signs, skin, hair, eyes, ears, nose, mouth, lymph nodes, heart, lungs, abdomen, joints, and neurological function. The examination procedure is described in detail for each body system.

1. Pediatrics’ General Examination1 Ped(6-C) TUCOM
GENERAL RULES:
1-child stripped off clothes
2-inspect, palpate, percuss and auscultate.
3-one of the parents should be present.
4-unpleasant items left to the end:
 Temperature
 Thyroid
 Exam of the tender parts
General appearance:
1-age and sex of the patient:
 Newborn
 Neonate
 Toddler
 Child
1-consciousness:
 Conscious: aware of himself and the surrounding & can response properly to various types of stimuli.
 Drowsy: respond to pain stimuli & need continuous stimuli to maintain his arousable (waked up) state.
 Stupor: unware of himself and the surrounding &respond only to vigorous stimuli.
 Unconscious (comatose): unware of himself and the surrounding & cannot respond to any type of
stimuli.
2-facial expression:
 Toxic face: in septicemia and infective endocarditis
 Mongolian face: in down syndrome and thalassemia
 Cushingoid face: in prolonged steroids therapy.
 Senile face: in marasmus
 Frog face: in mucoploysaccharidosis
 Risus sardonicus: in tetanus
 Etc….
3- Attitude in bed: (sitting-lying-in lap of his mother-comfortable or not)
 Orthopnea attitude: in LSHF
 Squatting position: in TOF
 Leaning forwards and protruding the tongue: in epiglottitis
 Etc…
4-Gait:
 Hemiplegic gait: in hemiplegia
 Scissoring gait: in spastic CP
 Drunken gait: in cerebellar lesion
 Waddling gait: in rickets with ow leg deformity
 Limping gait: in arthritis or osteoarthritis
5-body build:
 Average build
 Thin
 Emaciated
 Obese
6- Any external corrections (cannula, IV fluid).

2. Pediatrics’ General Examination2 Ped(6-C) TUCOM
Examination of the head:
1-Scalp for examine the Hair:
1- Distribution of the hair.
2- Fragile or not
3- Texture of the hair: normal or Thick or silky
4- Density  Alopecia (loss of hair) : localized as in skin disease or generalized(diffused)as SLE
2- Fontanels:
 Examine it when baby is sitting and not crying
 Size  normal 2.5 cm  if large  decrease of bone  hypothyroidism
 Depressed or sunken  dehydration
 Bulging  increased intra-cranial pressure ICP – hypernatremia – fluid therapy
 Anterior fontanel  diamond shape – close in 6-18 months
 Posterior fontanel  triangular shape – close in 3 months
 Delayed closure: rickets, achondroplasia, down syndrome, congenital hypothyroidism, hydrocephalus
 Early closure: before 6 mo. CRANIOSTENOSIS
3- Face Skin color:
 Pallor  anemia, nephrotic syndrome, hypopituitarism, shock, hypercarotenemia, edema, thick skin …etc.
 Jaundice  increased serum bilirubin
 Plethoric face  polycythemia
 Earthy pale complexion  uremia
 Pigmentation  racial, actinic, in disease like Addison's
 Malar flask  in mitral stenosis
4- Eye:
 Anemia  look at palpebral conjunctiva
 Polycythemia  congested conjunctiva
 Jaundice  look at sclera
 Puffiness (edema of the eyelids)  in renal disease and myxedema and allergic
 Xanthelasma  yellowish plaques around the eye
 Sub-conjunctival hemorrhage  in bleeding tendency, conjunctivitis, severe
cough
 Sunken eye  dehydration
 Tears on crying or not
 Any discharge
 White spots in the iris  Vit. A deficiency
5- Ear:
 Discharge
 Large or small ears
 Low set ears
 Boat ear (congenital)
6- Nose:
 Nasal discharge
 Look inside for any polyps
 Bleeding
 Flaring of ala nasi (sign of respiratory distress)

3. Pediatrics’ General Examination3 Ped(6-C) TUCOM
7- Lips:
 Cyanosis
 Ulcer
 Herpes labialis
 Angular stomatitis and cheilosis  Iron deficiency anemia & vitamin deficiency
8- Gums:
 Red + swollen + suppuration  gingivitis
 Gingival hypertrophy  in scurvy, leukemia, drugs like phenytoin
 Bleeding gums  inflammation, Vit. C deficiency
9- Teeth:
 Number of teeth
 Dental caries
 Teeth loss
10- Tongue:
 Color  red in glossitis, pale in severe anemia, yellow in jaundice, blue in
central cyanosis
 Moisture  dry tongue in dehydration and air and drugs like anticholinergic
 Fur  in air breathers
 Smooth tongue  in anemia
11- Buccal mucosa:
 Thrush  candida infection
 Aphthus ulcer
 Petechial hemorrhage  bleeding tendency and infection
 Pigmentation  Addison's disease
 Pallor  anemia
12- Congenital anomalies:
 Cleft lip and cleft palate and Cleft uvula
 Ear Deformities
 Facial Paralysis
 Hemi facial Microsomia
 Nasal Deformities
 Treacher Collins Syndrome
Examination of Neck:
 Lymphadenopathy
 Swelling  midline or lateral
 Using of accessory muscle in respiration  sign of respiratory distress
Examination of chest:
 Abnormal shape
 Intercostal retractions
 Rachitic rosary  beaded ribs in rickets

4. Pediatrics’ General Examination4 Ped(6-C) TUCOM
Examination of Abdomen:
 Abdominal distention
 Groin and genitalia
 Skin rash  allergy, contact dermatitis, candidiasis
 Sings of wasting  loss of muscle + loss of subcutaneous fat + look at thigh, buttock,
arm and pectoralis major muscle
Examination of back:
 Sacral edema
 Rash
 Meningocele and myelomeningocele
 Vertebral column  pass your finger along the vertebral column
Examination of upper limbs:
 Joint swelling and deformities
 Muscle wasting
 Skin color  anemia, cyanosis, jaundice, pigmentations
 Skin lesions  purpura, petechiae, purpupic spots, ecchymosis, hematoma
 Palmer erythema, spider navei, central pallor of the palm
 Nails  clubbing, koilonychias, onycholysis ((GIT causes of clubbing in pediatric are:
celiac disease, cystic fibrosis, liver cirrhosis, IBD))
 Abnormal movements
 Hand moisture
 Skin retraction
 Creases
 Widening of wrist joint  on rickets
Examination of lower limbs:
 Joint swelling and deformities
 Muscle wasting
 Edema
 Bowing of leg  in rickets
 Ankle joint widening in rickets
 Color  jaundice, pallor, cyanosis
 Examination of the foot
Examination of vital signs:
1- Blood pressure
2- Temperature
 36.5 – 37.5 = normal
 < 36.5 = sub-normal
 < 35 = hypothermia
 > 37.5 = febrile
 > 41 = hyperpyrexia

5. Pediatrics’ General Examination5 Ped(6-C) TUCOM
3- Pulse rate
 Newborn (< 1 month)  120-160 bpm
 infant (1-12 month)  80-140 bpm
 toddler (1-3 year)  80-130 bpm
 preschooler (3-5 year)  80-120 bpm
 school age (6-12 year)  70-100 bpm
 adolescent (> 13 year)  60-100 bpm
4- Respiratory rate
 Newborn (< 1 month)  30-50
 infant (1-12 month)  20-30
 toddler (1-3 year)  20-30
 preschooler (3-5 year)  20-30
 school age (6-12 year)  20-30
 adolescent (> 13 year)  12-20
5- Anthropotric measures  height – weight – head circumference
Ahmed E Albayaty 2017-08-23