Becky Ollerenshaw - Paediatrics Society
18.04.15
Introduction
To Mum/Dad and to child
If parents are on your side things are easier!
Explain what you're going to do
General Inspection
Observe
Observe!
Observe!!!
General inspection
Well or ill?
Appearance
Nutritional status
Behaviour
Cannulae, creon, inhalers, wiggly bags (cartoon
bags for central lines),walking aids etc.
Rapport
Depends on age of child
Get mum/dad involved
Explain with detail
appropriate to age of child
Positioning
On parent’s lap for wiggly/scared toddlers and
small children
Hands
Leukonychia, Koilonychia,
Clubbing – Crohn’s, UC, coeliac’s
Beau’s lines – horizontal white lines –
caused by any acute severe illness – grow out in 12 weeks
Asterixis – realistically only in older
children
Hands
Pulse, perfusion (cap refill on
sternum)
Colour, skin
Single palmar crease - thyroid
problems, small bowel obstruction
Bruising – liver failure / vitamin K
deficiency (in neonates)
Face
Sunken fontanelle - dehydration
Yellow sclera - jaundice
Pale conjunctiva - anaemia
Keyser-Fleischer rings
– Wilson’s disease (mean age of presentation 6-20)
Face
Ulceration – Crohn’s, Angular stomatitis,
Glossitis
Gum hypertrophy – leukaemia, anti-epileptics
(phenytoin)
Candida – immunodeficiency (AIDs, leukaemia)
Freckling around the mouth –
Putz-Jehger’s syndrome
– associated with polyps in the bowel. High risk of cancer / obstruction
Warm hands!
And
stethoscopes!!!
Tummy!
Can be tickley
Get down to their level
Get them to move before you
touch- Puff out tummy = rebound
tenderness
Pain less localised than in adults
(abdo pain can be pneumonia!)
Normal to be rounded Normal to be rounded
and feel up to 2 finger widths of liver and spleen in babies and
toddlers.
Abdomen
Inspection - peristalsis, 4 Fs (not 5!),
bruises, scars, etc. Pyloric stenosis – visible peristalsis
Palpate as for adult in older child
Check for pain and distension in babies
(& toddlers if unco-operative)
Hydration status (skin pinch)
Percussion and auscultation technique
as for adult
Abdomen
Listen for cornflakes!!!
Don't forget!!
Dipstick the urine
Plot a growth chart
PR not routinely done
Case 1
Creon by bed, small for age, patient comfortable
at rest.
Old laporotomy scar
No tenderness, no organomegaly
Cystic Fibrosis
Creon by bed – exocrine pancreatic
insufficiency
Small for age - malabsorption
Old laporotomy scar – may be due to
neonatal complicated meconium ileus
No tenderness, no organomegaly
Case 2
Young child of afro-caribbean ethnicity, patient
comfortable at rest.
No jaundice, some conjunctival pallor
No scars
No tenderness, splenomegaly
Early Sickle cell/
Thalassaemia
Young child of afro-carribean ethnicity – not
likely spherocytosis/eliptocytosis
No jaundice, some conjunctival pallor Anaemia
No tenderness, splenomegaly – Late SC
anaemia spleen would be infarcted (not
palpable)
Congenital Abnormalities
requiring surgery
Congenital abnormalities which require abdominal surgery
but leave the child well:
Omphalacele,
Gastroschisis,
Meconium ileus,
NEC (necrotising enterocolitis – usually premies),
Malformations of gut (eg duodenal atresia, biliary atresialivertransplant etc.)
It’s worth making a short list of what you would expect to find – don’t spend too much time
doing this though (they don’t expect you to be paediatrician just yet!!)