Topics

• Abdomen
• Pediatric Variations
• Case Example

NDNP 819: Advanced Health Assessment Across the Lifespan

Module: Abdomen

Pediatric Variations

History

Additional history for pediatric patients includes:

• Prenatal care: issues or concerns during prenatal period- health of mother, pregnancy, substance use, tobacco, other issues
• Birth history:
  • Pre-term/Term
  • Delivery complications
  • APGAR scores
  • Feeding problems (at birth or now)
  • Diagnosed with any syndromes (will cover more in depth later lecture)
• Growth and Development: adequate weight gain, and growth, meeting milestones?

Additional ROS questions:

• Infants:
  • Feeding problems?
  • Does baby sweat when he/she eats?
  • Does baby get winded when she/he eats?
  • Does your baby turn blue when he/she cries?
  • Snoring?
  • Exposure to smoke?
• Toddlers:
  • Meeting milestones ?
  • Easily fatigued?
  • Feeding Problems or food reactions?
  • Eczema/skin lesions?
  • Snoring
  • URIs/ episodes of wheezing
  • Immunizations Up to date?
  • Exposure to smoke?

School Age and Adolescent:

May be able to contribute to the history and ROS but will need to verify with parent.

Ask about school performance, missed school due to illness, exposure to smoke and substance use experimentation.

Physical Examination Considerations by Age:

• Your examination may be in a different order, depending upon the child. For example, it would be wise to assess a sleeping infant for CV and lungs before looking in their ears. Warm your hands and stethoscope.
• A toddler may be very interested in your stethoscope and be very happy to “help” or may do better sitting with parent instead of on exam table.
• School aged children usually are willing participants and will be reassured if you can let them help or if you can let them choose “Would you like me to listen to your heart first or your lungs?”
• Adolescents appreciate ensuring their privacy, so be careful to provide drape and reassurance when their exam findings are “Normal” or what you were expecting for someone their age.