Communication and Physical Assessment of the Child

Make communication developmentally appropriate

Get on child's eye level

Approach child gently and quietly

Always be truthful

Give child choices as appropriate

Avoid analogies/metaphors

Give instructions clearly/in positive manner

Avoid long sentences, medical jargon, "scary words" (little stick in the arm; cough your head off; cut, tubes, etc...)

Give older child opportunity to talk without parent present

• Nonverbal
• Crying-- type known to caregiver

(**Parents are source of hx/observation/exam)

Focus on child in your communication!!

Explain what, how, why

Use words he/she will understand

Be consistent (don't smile when doing painful procedures)

• Be honest with them-- helps gain trust
• Be aware of privacy needs
• Think about developmental regression
• Importance of peers
• Have confidential time

Minimize stress and anxiety associated with assessment of various body parts

Foster trusting nurse-child-parent relationships

Allow for maximum preparation of child

Preserve security of parent-child relationship

Maximize accuracy of assessment findings

Head-to-Toe sequence for assessing adult clients

Sequence for pediatric assessments generally altered to accommodate child's developmental needs

• Try not to wake baby
• Examine on parent lap if possible
• Leave diaper on
• Comfort measures such as pacifier or bottle
• Talk softly
• Start with heart/lung sounds
• Ear/Throat exam last

• Examine on parent lap if uncooperative
• Use play therapy
• Distract with stories
• Let toddler play with equipment/BP
• Call by name
• Praise frequently 
• Quickly do exam

• Allow parent to be within eye contact
• Explain what you are doing
• Let them feel the equipment
• Use simple explanations
• Offer available choices to the child
• Use games to get the child to cooperate

• Allow choice of having parent present
• Privacy/Modesty
• Ask if child has any questions or concerns
• Explain procedures/equipment
• Interact with child during the exam
• Be matter of fact about examining genital area

Ask about parent in the room

Should have some private interview time: time to ask difficult questions

Provide privacy

Provide info about physical changes in matter-of-fact manner

• Count Respirations FIRST
• Count apical heart rate SECOND
• Measure BP 3rd
• Measure temp LAST

1 full minute

• <10
• >60

Count for 1 full minute (usually before infant wakes...rates are elevated with crying/fever)

...if under 1 year count abdominal movements!

• Brachial artery
• Radial
• Popliteal
• Dorsalis Peds
• Posterior tibial

• R= 30-60
• P= 100-160
• SBP= >60

• R= 24-40
• P= 90-150
• SBP= >70

• R= 22-34
• P= 80-140
• SBP = >75

• R= 18-30
• P= 70-120
• SBP= >80

• R= 12-20
• P= 60-100
• SBP= >90

• Check fontanels
• -anterior (12-18 months)
• -posterior (closes by 2 months)

Shape- flat headed babies are due to back-to-back sleep position

• Symmetry
• Palpate for masses and lymph nodes

• External Structures
• Internal Structures
• Vision (parent role)

*Infants should be able to focus on one object referred to binocularity by the age of 3-4 months of age

Down and Back

Grunting or Nasal Flaring or Retractions