How to Proceed with Examination of a Child?
The assessment of a child is quite different from that of adults and requires knowledge of normal variations in anatomy and physiology with growth and development. An important part of initial assessment includes triage and recognizing children with emergency signs so that they can be managed at the earliest to prevent death and referred timely to the specialist. After ruling out emergency signs, the children with priority signs require prompt assessment, management and referral to the specialist. In addition to normal history as in adults, prenatal and birth history, developmental history, immunization history, feeding history and social history are important for complete assessment of the child. The approach to physical examination should consider age and developmental level. It is important to make the child comfortable with pleasant surroundings and playful behavior to yield maximum information from the examination. In addition to diagnosing disease, pediatric assessment should involve identification of malnutrition, immunization status, level of development, screening for 4 Ds (Defects at birth, Deficiencies, Diseases and Developmental Delay including Disability), hearing and visual assessment and detection of child abuse. Tanner staging and psychosocial assessment should be done in adolescents.
KeywordsPediatric examination Triage Pediatric emergency signs
SM and PT: Reviewed the topic and involved in designing and writing of this review article. PT will act as guarantor for the paper.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 1.London ML. Pediatric assessment. In: London ML, Ladewig PW, Ball JW, Bindler RC, Cowen KJ, editors. Maternal & Child Nursing Care. 3rd ed. Prentice Hall: Pearson; 2010. p. 961–1022.Google Scholar
- 2.Swash M. Hutchison’s Clinical Methods C. 19th ed. London: Balliere Tindall; 1989.Google Scholar
- 3.Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Pediatrics. Eye examination in infants, children, and young adults by paediatricians. Pediatrics. 2003;111:902–7.CrossRefGoogle Scholar
- 4.Emergency Triage Assessment and Treatment (ETAT) - Manual for Participants. Geneva: World Health Organisation; 2005.Google Scholar
- 5.Facility based IMNCI - Participant Manual. New Delhi: Ministry of Health and Family Welfare, Government of India; 2009.Google Scholar
- 7.Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr. 2004;21:64–90.Google Scholar
- 9.Rashtriya Baal Swasthya Karyakram (RBSK) - Child Health Screening and Early Intervention Services - Participant Manual. New Delhi: Ministry of Health & Family Welfare, Government of India; 2013.Google Scholar
- 10.Facility Based Management of Children with Severe Acute Malnutrition. New Delhi: Ministry of Health & Family Welfare, Government of India; 2011.Google Scholar
- 11.Immunization Handbook for Medical Officers. 3rd ed. New Delhi: Ministry of Health & Family Welfare, Government of India; 2016.Google Scholar
- 12.Rashtriya Baal Swasthya Karyakram (RBSK) - Child Health Screening and Early Intervention Services - Job Aids; New Delhi: Ministry of Health & Family Welfare, Government of India; 2013.Google Scholar
- 16.WHO Child Growth Standards. Geneva: World Health Organisation; 2006.Google Scholar
- 18.Tanner JM. Growth at adolescence. 2nd ed. Oxford: Blackwell Scientific Publications; 1962.Google Scholar
- 19.Seidel HM, Ball JW, Dains J, Benedict GW. Mosby’s guide to physical examination. 5th ed. St. Louis: Mosby; 2003.Google Scholar