Pediatric Assessment
Teaessa D. Chism RN, MN, CCRN.
Objectives:
Verbalize the difference between adult
and pediatric assessment.
 Discuss the influence pediatric
development plays in assessment.
 Identify nursing interventions to address
development needs when performing an
assessment.
 Verbalize and demonstrate how to
perform a pediatric head to assessment
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Pediatrics vs. Adults:
How is a pediatric assessment similar to
an adult assessment?
 How is different?
 What challenges to do your foresee in
performing pediatric assessment?
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Pediatric Assessment
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“I am ready for my assessment and
vitals.”
Pediatric Assessment
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“Oh, wait is it your first day??”
Differences
 Children
may not always be cooperative
 The sequence in your head/toe
assessment may need to change to
accommodate needs.
 Child may interpret assessment as threat
to security, well being or privacy,
depending on development.
Pediatric Assessment: Differences
 Families
play an important role in
pediatrics assessment. Family centered:
Treating parents as part of the team
rather than a visitor or non caregiver.
 Involving family: Obtaining detailed
history, educating on medications,
updating on progress.
 Treating family & patient.
Pediatric Assessment:
Differences
London, M., Ladwig, P., Ball, J. ,
Bindeler, R. Cowen, K. (2011)
Similarities
Still think about a complete assessment
covering all systems.
 Neuro-Respirtaory-CV-GI-GU-Skin
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Pediatric Assessment:
Step 1 Preparing
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How will I interact with this patient based upon
development?
Refer to developmental hand out.
Think Erickson/Pigaet: “What is this child
trying to accomplish?”
“How will this influence how I perform my
assessment?”
Is this child meeting developmental
milestones? (handout)
Nursing Interventions to address
development:
What will you do?
 Infant:
 Toddler:
 School Age:
 Adolescent:
Nursing Interventions to address
development:

Infant: Keep bundled, help to feel secure,
have parents hold.
 Toddler: Use toys to keep distracted, allow
parents to be present. Explore equipment.
 School Age: Allow them to feel productive
(hold thermometer), play with equipment, keep
scary items (needles) out of sight. Heightened
sense of bodily harm.
 Adolescent: Allow for privacy, provide
choices.
Pediatrics
General Tips when interacting:
Make commutation developmentally appropriate.
 Talk to child at child’s eye level.
 Be gentle and quiet.
 Always be truthful.
 Give child choices.
 Avoid analogies and metaphors.
 Give clear and positive instructions
 Avoid long sentences and medical jargon
 Allow older child opportunity to discuss feeling and problems
without parents present.
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Pediatric Assessment: Step 2
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Rapid Visual assessment before actual
assessment. (Refer to handout)
How does child look?
Playing or lethargic?
Distressed or comfortable?
Sick or not sick?
Being aware of where emergency equipment
is at. (Bag, appropriate size mask, suction,
oxygen).
If in hospital setting check alarm limits if on
monitors.
Pediatric Assessment: Step 3
 Head
to Toe
 Before you disturb infant-listen first. In
school age and older child you may not
need to alter sequence.
 Think Systems to ensure you cover all of
assessment if sequence altered.
 Look, listen, feel for infant.
Pediatric Assessment: Cardiac
 Listen
for one full minute to apical pulse
if less than 2 years old for heart rate.
 Normal heart sound. S1 and S2.
Cardiac
Cardiac
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S1 heard best at apex mitral and tricupsid area
S2 heard best at aortic and pulmonic
Cardiac: Abnormal Sounds
S3 associated with fluid overload
 S4 atrial gallop
 Murmur: sound produced in heart
chambers from vibration of blood
going back and forth. Ex: ASD, VSD,
PDA not closed
 Persistent murmurs after 2-3 days of
birth need evaluation.
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Listening: Lungs
Lungs
Count RR
 Listen for inhalation and exhalation.
 Assessing for abnormal counds such as
rhonchi, crackles, wheezes.
 Absent or diminished breath sounds
abnormal. Could be from fluid, air, or
mass. Needs further evaluation.
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Listening: Bowel Sounds
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Hyper or hypoactiveBowel sounds?
If not present further evaluation for illeus
Pediatric Assessment:
At this point you have listened to heart
tones, got your apical heart rate, listened
to respirations, have your RR, and
listened to bowel sounds.
 I generally will now get a BP then a
temperature on the infant because
usually they get upset during
assessment.
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Correct BP size
Temperature Tips:
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If baby feels warmer than what axially, ear
temp is reading after retaking you may
consider taking rectal (when no other route
can be used)
 Be sure to use correct technique with
rectal. (1 inch into rectum) hold secure.
 Risk of perforation greatest with infant
under 3 months.
 NO RECTAL temps with recent rectal
surgery or Oncology patients.
Head to Toe: In hospital
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Head/Neurological:
Symmetry of ears and eyes? Placement of ear canal
Pupils Equal Reactive
LOC (Level of conscious), GCS (Glasgow Coma Score)
Fontanel open or closed in neonate? P. 940
Sutures mobile?
Head circumference less than 24 months
Nares and mouth patent
Pain/ Comfort (to go over in detail Ch. 42)
Lymph nodes: non swollen and non tender?
Reflexes: Babinski usually not present after 2 years of age
Gait, extremity strength
Ear/Eye Placement
Head to Toe:
 Chest/Respiratory
 Look
at chest: Retractions noted, if so
describe (substrenal, intercostal,
subclavicular).
 Is the chest barrel shape
 If older child and did not listen first, listen
now for respirations.
Head to Toe:
Cardiovascular
 Listen to heart tones now if older child
 On upper and lower extremities comapre
bilateral pulses, cap refilll, and warmth.
 Cool, weak pulses, delayed cap refill
indicates poor cardiac perfusion and
needs to be evaluated.
 Assess for edema or liver enlargement
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Pulses
Head to Toe:
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GI/Abdomen (Look, listen, feel)
Does abdomen look distended?
Listen for bowel sounds if have not done so
Rigid of soft
Abdominal girth
Do they have a feeding tube? If so where? Check
placement.
Salem sump? Is it patent? If so note output
amount and color.
Consider diet and if Pt NPO
Rigid, tense, abdomen, hypoactive BS needs
evaluation for illeus or obstruction.
Anantomy Review
Head to Toe
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GU/Abdomen
Any abnormalities with genitalia?
Any Hernias noted
Foley
Up to BR?
What does urine look like? Clear? Dark? Cloudy? Sediment?
How much are they voiding?
Check q 4/ Should be 1cc/kg/hr to indicates adequate kidney
perfusion
Stoma assessment if present. (note color and output)
Stools: Foul smelling? Bloody? Consistency?
Fluid balance for shift how much have they had in verses out?
Children sensitive to fluid overload.
Hernia
Head to Toe:
Skin
 Any breakdown noted?
 Pressure points?
 Wounds? Dressing care?
 IV site assessment
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Measurements
Measurements
Height & Weight
 Look at growth curve to ensure gaining
weight, accurate growth and early
intervention.
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References
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London, M., Ladwig, P., Ball, J., Bindler,
R. Cowen, K. ( 2017). Maternal and child
nursing care (4th). Upsaddle, NJ:
Pearson.