ASSESSMENT OF SPECIAL GROUPS
Common hair problems
CHILDREN AND ADOLESCENTS
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SKIN, HAIR & NAILS
Early childhood
Skin develops a tighter bond with the dermis
Skin color appears pink and evenly distributed and may
include normal variation such as freckles Texture is
smooth and hair is less coarse than adult
TODDLER
Scalp hair grows coarser, thicker, and darker
Fine hair becomes visible on the distal portions of the
upper and lower extremities
Dirty matted hair
Balding hair
Lice & nits
Hair tuft at the back: Spina bifida Occulta (only
not related to nutrition)
Common nail problems
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Color: cyanosis, jaundice
Short, ragged nails
Nail Clubbing
Macerated Thumb
Paronychia (inflamed nails)
Koilonychia (spoon nails; IDA)
HEAD AND NECK
Infancy
JAUNDICE
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MAY BE CAUSED BY LIVER PROBLEMS OR BY
CAROTENEMIA
LIVER PROBLEMS- EXTEND TO THE SCLERA
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Head grows proportionately to body size
Toddler
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Nasal bridge Low
Mandible and maxilla are small
School Age
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Face grows proportionately faster than the rest
of the cranium
Secondary teeth appear too large for the face
Adolescence
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Common Skin problems
Poor skin turgor
Skin allergies
Skin eczema
Russel signs
Nose and Thyroid cartilage enlarge in boys
NECK RELEVANT FINDINGS
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Short, webbed neck
Distended neck veins
Palpable masses (thyroid, tumor)
Shift in tracheal position
MOUTH, THROAT, NOSE & SINUS
Children
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20 deciduous teeth, which are lost between the
ages 6 and 12 years
Permanent teeth begin forming in the jaw by
age 6 months and begin to replace temporary
teeth at age 6 years, usually starting with the
central incisors.
Nasal cartilage grows during adolescence
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Frontal sinuses develop around age 7 to 8 years,
and the sphenoid sinuses develop after puberty
Tonsils and adenoids rapidly grow, reaching
maximum development by age 10 to 12 years
or about twice their adult size.
NOSE RELEVANT FINDINGS
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Cleft lip &/or palate
Nasal polyps
Deviated septum
Koplik’s spots
Children
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TEETH RELEVANT FINDINGS
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Dental caries
Bottle caries syndrome
EYES
The lungs continue to develop after birth and
new alveoli form until about 8 years of age
The child will have 300 million alveoli by
adolescence
The chest wall is thin with very little
musculature
The ribs are soft and pliable with the xiphoid
process movable
The airways of children are also smaller and
narrower than in adults
A child’s respiratory rate is much faster than an
adult’s rate
Children younger than 7 years old tend to be
abdominal breathers
Children between 8 and 10 years old,
respiratory rates lower and breathing becomes
thoracic like the adult’s.
Childhood
LUNGS RELEVANT FINDINGS
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Eyes are less spherical than adult eyes
Farsighted until age 6 or 7 years
20/200
EYES RELEVANT FINDINGS
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Jaundice
Blue Sclera (ostogenesis imperfect)
Conjunctivitis
Hypertelorism
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BREASTS (THELARCHE- ONSET OF BREAST
DEVELOPMENT DURING PUBERTY)
EARS
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Older Children
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Eustachian tube lengthens but it may become
occluded from growth of lymphatic tissue,
specifically the adenoids
The canal shortens and straightens as the child
ages, and the pinna can be pulled up and back
as in adult
EARS RELEVANT FINDINGS
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Skin tags and/ or sinuses
Ear Discharge
Low-set ears
THORAX & LUNGS
Retractions (suprasternal. Sternal, substernal,
intercostal) and grunting suggest increased
inspiratory effort, which may be due to asthma,
atelectasis, pneumonia, or airway obstruction.
Diminished breath sounds suggest respiratory
disorders such as pneumonia or atelectasis.
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In girls, breast growth is stimulated by estrogen
at the onset of puberty
Between 8 and 13 years of age, thelarche may
occur
Tenderness and asymmetric development are
common, and anticipatory guidance and
reassurance are needed.
Gynecomastia, enlargement of breast tissue in
boys, may be noted in some male adolescents
Peristaltic waves may be visible
in thin children, they may also
indicative of a disease or disorder
The tip of the right kidney may
be felt in young children, especially
during inspiration
In small children, the liver is
palpable at 1 to 2 cm below the right
costal margin
The spleen may be palpable
below the left costal margin at 1 to 2
cm. often in older children, these
structures are not palpable
HEART & PERIPHERAL VASCULAR SYSTEM
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Heart is positioned more horizontally in the
chest
Apical impulse is felt at the fourth intercostal
space left of the midclavicular line
Apical pulse can be heard at the 5th ICS by age
of 7
Heart sounds are louder, higher pitched, and of
shorter duration
Physiologic splitting of the second sound, which
widens with inspiration, may be heard in the
second left intercostal space
A third heart sound (S3) may be heard at the
apex and is present in one-third of all children
Sinus arrhythmia is normal and reaches its
greatest degree during adolescence
Some may have physiologic murmurs that do
not indicate disease
Heart rate decreases as the child gets older,
usually dropping to about 85 beats/min by 8
years of age
Athletic adolescents may have even lower
heart rates
ABDOMEN
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In children, cylindrical, prominent in the
standing position, and flat when supine
The abdomen of toddler appears prominent
and gives the child what is popularly called a
pot-belly appearance
The contours of the abdomen change to adult
during adolescents may have even lower heart
rates
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ABDOMEN RELEVANT FINDINGS
Diastasis recti
UMBILICAL HERNIA
MALE GENITALIA
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Generally, develop over a 2 to 5-year period,
beginning from preadolescence to adulthood
In the adolescent male enlargement of the
testes is an early sign of puberty, occurring
between the ages 9.5 and 13.5 years
Pubic hair signifies the onset of puberty
Pubic hair development and penile enlargement
are concurrent with testicular growth
The onset of spontaneous nocturnal emission of
seminal fluid is a sign of puberty similar to
menarche in girls
Prostate gland grows rapidly to twice its
prepubertal size under the influence of
androgens
MUSCULOSKELETAL SYSTEM
PENILE/ SCROTAL RELEVANT FINDINGS
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Hypospadias
Cryptorchidism
Phimosis
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FEMALE GENITALIA
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Adolescent’s puberty is the time that estrogen
stimulates the development of the reproductive
tract and secondary sex characteristics
The external genitalia increase in size and
sensitivity, whereas the internal reproductive
organs increase in weight and mass
Pubic hair begins growing early in puberty (2 to
6 months after thelarche)
Menarche takes place in the latter half of the
puberty after breast and pubic hair begin to
develop
Menarche typically begins 2.5 years after the
onset of puberty
The menstrual cycle is usually irregular during
the first 2 years because of physiologic
anovulation
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The skeleton of small children is made chiefly of
cartilage
Bone formation occurs by ossification,
beginning during the gestational period and
continuing throughout childhood
As children grow into adolescence, they will
experience a skeletal growth spurt, usually seen
in correlation with Tanner’s stage 2 for girls and
Tanner’s stage 3 for boys
Bone and muscle development is influenced by
use of the extremities
Muscle growth peaks at 12 years for girls and 14
years in boys
MUSCULOSKELETAL SYSTEM
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VAGINAL/LABIAL RELEVANT FINDINGS
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Labial adhesions
Imperforate hymen
Talipes varus is adduction of the forefoot and
inversion of the entire foot
Talipes equinovarus (clubfoot) is indicated if
foot is fixed in the following position: adduction
of the forefoot, inversion of the entire foot,
with the foot pointing downward
Talipes equinus (pointing downwar) position of
the entire foot.
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Polydactyly (extra digits) and syndactyly
(webbing) are sometimes found in children with
mental retardation
Palmar simian crease may indicate down
syndrome
Kyphosis may result from poor posture or from
pathologic conditions
Scoliosis usually is idiopathic and is more
common in adolescent girls
Abnormal posture suggests neuromuscular
disorders such as cerebral palsy
Extremities that are asymmetric in size, shape,
and movement indicate scoliosis or hip disease.
NEUROLOGIC FUNCTIONING CEREBRAL FUNCTION
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The child should be alert and active, respond
appropriately, and relate well to the parent and
the nurse. Increased independence will be
demonstrated with age.
By age 3 years, speech should be easily
understood.
NEUROLOGIC FUNCTIONING DEEP TENDON AND
SUPERFICIAL REFLEXES
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MUSCULOSKELETAL SYSTEM
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Toddlers display lordotic posture
Findings in older children and adolescents are
similar to those in adults
The same as for adults,
Babinski response is normal in children younger
than 2 years (this response usually disappear
between 2 and 24 months)
Triceps reflex is absent until age 6
School- age children and adolescents should be
able to perform most balance and coordination
tests.
Sensitivity to touch and discrimination should
be present. The thresholds of touch, pain, and
temperature are higher in older children.
Gross and fine motor skills should be
appropriate for the child’s developmental age.
Hand preference is developed during the
preschool years