Pediatric Assessment and Growth/Development
Assessment and growth/development items test whether you can select age-appropriate tools, interpret numbers against age-specific norms, and recognize the compensating child before decompensation becomes obvious.
Assessment sequence
- Start with the Pediatric Assessment Triangle - appearance, work of breathing, circulation to skin. It takes seconds and sets urgency before you touch the child.
- Obtain history from the caregiver while observing; perform painful or intrusive parts of the exam last in infants and toddlers.
- Normal values are age-specific: a respiratory rate of 40/min is normal in a newborn and tachypnea in a school-age child.
Growth
- Plot on WHO charts from birth to 2 years and CDC charts from 2 to 20 years.
- Measure recumbent length until 2 years, then standing height; head circumference until 36 months.
- Crossing two major percentile lines in either direction signals a problem (endocrine, gastrointestinal, psychosocial) and warrants referral.
Development
- Anterior fontanel closes at 12–18 months; posterior at 6–8 weeks.
- Red flags: no social smile by 2 months, poor head control by 4 months, not sitting by 9 months, not walking by 18 months, fewer than two words by 24 months.
Pain tools
- Neonates and preverbal infants: NIPS or PIPP; toddlers: FLACC; 4 years and older: Wong-Baker FACES or a numeric rating.
Worked example
A 9-month-old weighs 8.2 kg. Maintenance fluids by the 4-2-1 rule: 4 mL/kg/h for the first 10 kg = 8.2 × 4 = 32.8 mL/h. Had the child weighed 14 kg, you would use 40 mL/h for the first 10 kg plus 2 mL/kg/h for the remaining 4 kg (8 mL/h) = 48 mL/h.
Traps that cost marks
- Applying adult vital sign ranges to infants.
- Using FACES with a 3-month-old.
- Measuring standing height in a child under 2 years.
- Calling a single low percentile abnormal without looking at the trend.