Assessment and Physical Examination of the Pediatric Patient
Assessment items test your ability to recognize a sick child quickly, obtain age-appropriate data, and sequence the exam so the child stays calm.
Core rules
- Pediatric Assessment Triangle first: appearance, work of breathing, circulation to skin. It takes seconds and needs no equipment.
- Sequence by age: infants - auscultate heart and lungs first while quiet, then palpate and inspect; toddlers - toe to head; school-age - head to toe with explanation.
- Expected vitals: newborn HR 100–160, RR 30–60; 1 year HR 90–150, RR 20–30; 6 years HR 70–110, RR 18–25; adolescent HR 60–100, RR 12–20.
- Weigh in kilograms only; measure length lying down until 2 years, standing after.
- Anterior fontanelle closes at 12–18 months; a sunken fontanelle suggests dehydration, a bulging one raises concern for increased intracranial pressure.
- Pain tools: N-PASS for neonates, FLACC for 2 months to 7 years, Wong-Baker faces from about 3 years, numeric scale from 8 years.
- Red flags: grunting, retractions, petechiae, altered mental status, poor perfusion.
Worked example
A 2-month-old has a rectal temperature of 38.2°C and is feeding poorly. Age under 3 months with fever of 38.0°C or higher mandates a full sepsis evaluation - blood, urine, and CSF cultures - and empiric IV antibiotics with admission, regardless of how well the infant appears. Observation alone is not acceptable at this age.
Traps
- Applying adult vital sign ranges.
- Examining the throat first in a toddler and losing cooperation.
- Attributing fever to teething.
- Failing to undress the infant fully to look for rash or injury.