Chapter 4
Communication and Physical
Assessment of the Child and Family
Guidelines for Communication
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Interviewing is goal-directed communication
Introduction
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Introduce self
Ask names of family members and how to address
Include children in interaction
Privacy and confidentiality
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Minimize distractions
Confidentiality
Communicating with Parents
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Encourage talking; use open-ended questions
Direct the focus
Listening and cultural awareness
Use silence and empathy
Provide anticipatory guidance
Use professional interpreters if the family speaks
another langue
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Do not use children as interpreters
Communicating with Children
(1 of 2)
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Be developmentally appropriate
Use simple terms, questions and instructions
Get on the child’s eye level
Approach the child gently and quietly while
involving the parent or caregiver
Always be truthful
Give the child choices as appropriate
Include play, including role-play when possible
Communicating with Children
(2 of 2)
Developmentally Appropriate
Communication
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Infants: primarily nonverbal
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Early childhood: focus on the child
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Allow children to touch medical equipment
Repeat information in simple, consistent terms
School-age: focus on concrete explanations
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Crying, smiling and vocalizing
Encourage child to touch and practice with equipment
Adolescents: be honest, and explain thoroughly
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Be aware of privacy, potential for regression
Play
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Play is a child’s “work”; the universal language
Play is a child’s “developmental workshop”
Play can serve as a
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Therapeutic intervention
Stress reliever for the child and family
Pain reliever and distracter
Barometer of illness
History Taking
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Chief complaint (CC)
History of present illness (HPI)
Family history (FH) and structure
Psychosocial history
Review of Systems
Nutritional assessment
Approaches to Examining a Child
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Pediatric assessment sequencing is altered from
the typical head-to-toe sequence used in adults
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Alter sequence to accommodate developmental
needs
Often from least invasive/distressing to most
Use communication techniques, play, and parental
assistance to complete the examination
Minimize the stress and anxiety associated with
the assessment of various body parts
Maximize the accuracy of assessment findings
Preparation of the Child (1 of 2)
Preparation of the Child (2 of 2)
Examination of Growth
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Infants through 36 months
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After 36 months
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Recumbent length, weight and head circumference
Standing height, weight, body mass index (BMI) after
Plot measurements on proper growth chart
Important to note the TREND of growth, not the
individual measurements
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Ethnic and gender differences
Expected growth rate varies by age
Physiologic Measurements
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Physiologic measurements are indicators of overall
physical status
Comparison with normal-range values for each age
group
Often assessed from least to most invasive
Vital sign assessment (often in this order):
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Respiratory rate (RR)
Heart rate (HR): apical
Blood pressure (BP)
Temperature (T)
Pain
Blood Pressure Measurement
Physical Assessment (1 of 2)
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General appearance
Skin
Hair, nails, hygiene
Lymph nodes
Head and neck
Eyes, ears, nose, and throat (EENT)
Physical Assessment (2 of 2)
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Chest
Lungs
Heart
Abdomen
Genitalia
Back and extremities
Neurologic assessment