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Pediatric Vital Signs and Physical Examination - Coggle Diagram
Pediatric Vital Signs and Physical Examination
Norms (as per KYS)
less than 3 months
RR 60-80 sys
BR - 30-60bpm
SpO2 - 94-100%
HR - 110-150
3 months - 12 months
RR 88-99 sys
BR - 25-50 bpm
SpO2 - 94-100%
HR - 110-150
1-5 years
RR 90-110 sys
BR - 20-40 bpm
SpO2 - 94-100%
HR - 90-120
5-12 years
RR 90-120 sys
BR - 20-30 bpm
SpO2 - 94-100%
HR - 70-110
over 12 years
RR 110-130 sys
BR - 12-16bpm
SpO2 - 94-100%
HR - 60-100
How do we asses vital signs in children and adolescents
Blood pressure cuff sizes - measuring according to arm or leg circumferece
Neonate - 7-13cm
Infant 12-19 cm
Pediatric 18-26 cm
Adult 23-40 cm
BP measurement technique
Have the patient sit in comfortable position - in case of small baby it can lay down or be in one of the parents arms or toddlers can sit on parents lap
Make sure child is well rested
Ensure that the cuff is good size
Place the cuff on child's arm or in some cases baby's lower leg (thigh)
Record the result and repeat after 2 minutes
The pulse can be measured at areas where an artery passes close to the skin. These areas include the:
Back of the knees
Groin
Neck
Temple
Top or inner side of the foot
Wrist
To measure the pulse at the wrist, place the index and middle finger over the underside of the opposite wrist, below the base of the thumb. Press with flat fingers until you feel the pulse.
To measure the pulse on the neck, place the index and middle fingers just to the side of the Adam's apple, in the soft, hollow area. Press gently until you locate the pulse.
SpO2
Saturation probe in babies is placed on the foot
In children and teenagers is placed on a finger
Note: Satuartion in newborns straight after birth may be lower, however it should quickly increase within matters of minute
The NICE guidelines recommend that all children, administered to an acute setting, should have vital signs measured immediately or as soon as the situation permits. The main vs include temp, bp (rr), resp. rate, cap refil, SpO2 and heart rate
Physical examination
Newborn
Obtain information about duration and course of pregnancy, delivery and mother's medical history
Weight, height, head circumference
Assess various organ systems
Whole examination takes 5-10 minutes
Before taking baby's clothes off examine the ABCDE
Examine movement, reflexes and neuro status (PGCS)
Examine skin for possible nutritional status
Palpate the baby's abdomen and examine the genitals
Examine the skeleton and the hips.
Baby alertness clues
Weight and height
Head circumference
Free question: Are we prepared for the skills before internship?
Would it be beneficial to create some guide or skill lab?
Medical History
Infant and young children
Remember that in early childhood, most children have stranger anxiety.
Set a light mood during the physical exam to maximize cooperation.
Explain your next steps (e.g., “Now I'm going to check your ears...”) rather than ask the child for permission (e.g., “Is it ok if I check your ears?”), as the child may say no.
Having toys in the office is useful for distracting children, and small, inexpensive gifts can be handed out after the visit to build rapport.
Perform examinations that the patient is likely to find uncomfortable and may decrease cooperation (e.g., ear exam) towards the end of the physical exam.
https://www.amboss.com/us/knowledge/Pediatrics:_history_and_physical_examination
Older children and teenagers