Clinical Signs of General Health and Nutrition
General appearance
Healthy
Alert, responsive, cheerful
Unhealthy
Listless, apathetic, cachexic, crying in pain
Respiratory
Breathing slowly, relaxed, quiet
Hair
Shiny, lustrous, healthy scalp, no scratching
Skin (face & neck)
Smooth, slightly moist, pink, warm, no
enlargements
Eyes, nose, ears
Bright, clear, no fatigue circles, nose clean, ears
clean
Lips
Good color, moist
Tongue
Pink, surface papillae present, no lesions
Teeth/Gums
Straight, no crowding, clean, no discoloration,
pink gums, no lesions.
Skin (general)
Slightly moist, good color, smooth, good turgor
Abdomen
Flat
Cough, rapid or difficult breathing, flaring
nostrils, wheezing
Stringy, dull, brittle, dry, depigmented,
scratching at scalp.
Greasy, discolored, scaly, hot or cold, clammy,
skin sores, swelling, pale, grey or yellow,
enlarged thyroid
Dryness, signs of infection (swelling, red,
crusty), glassiness, thickened conjunctiva, runny
nose, pulling at ears, ears draining
Dry, scaly, swollen, angular lesions (stomatitis),
breath smells foul or fruity
Papillary atrophy, smooth appearance, swollen,
red, beefy (glossitis)
Unfilled caries, absent teeth, worn surfaces,
mottled, malpositioned, red swollen gums,
receding
Rough, dry, scaly, pale, pigmented, irritated,
petechiae, bruises, poor turgor
Distended
Legs & feet
Skeleton
No tenderness, weakness, or swelling
No malformation
Weight
Normal for height, age, body build
Posture
Erect. Arms and legs straight, abdomen in, chest
out
Well developed, firm
Good attention span for age, does not cry easily,
not irritable or restless, coordinated
Sagging shoulders, sunken chest, humped back
Good appetite and digestion, normal regular
elimination
Good endurance, energetic, sleeps well at night
Anorexia, indigestion, vomiting, constipation,
diarrhea, stool odor
Easily fatigued, no energy, falls asleep in school,
looks tired, apathetic
Muscles
Nervous control
GI function/appetite
General vitality
Edema, tender calf, tingling, weakness
Bowlegs, knock-knees, chest deformity at
diaphragm, beaded ribs, prominent scapulae
Overweight or underweight
Flaccid, poor tone, undeveloped, tender
Inattentive, irritable
Example for Preschool paper
Alert, cheerful, but slow to respond due to
language barrier
Normal respirations
Shiny dark brown hair, thick and healthy
No enlargements of lymph nodes or thyroid.
Facial skin smooth, warm and pink.
Bright, clear, brown eyes. No fatigue circles
Lips were pink and moist. No sores.
Her tongue was pink with papillae. No obvious
sores.
Gums healthy pink with no bleeding or sores.
She would not let me look in her mouth but her
front teeth were clean, white and straight.
Warm, dry, and smooth. Good turgor.
Soft and slightly round. No distention, just baby
fat.
No tenderness or weakness. Pink in color.
No obvious malformations of the skeleton.
She was in the 50th percentile for height and 65th
percentile for weight.
She walked upright with her chest out and legs
spread shoulder width apart.
Well developed and firm.
Attention span of 2-3 minutes. No temper
tantrums or crying. Calm and observant. Used
fork at lunch.
Potty trained. Voided only once all day. Ate 80%
of lunch. Chews well before swallowing.
High energy level and good endurance. Did not
take naps. Mom says she sleeps well at night.