Cranial Nerves I—Olfactory Nerve Olfactory mucosa of nasal cavity (Smell) With eyes closed, have child identify odors, such as coffee, alcohol from a swab, or

Musculoskeletal system Length, position, and size of extremities are symmetric Joints Stable and symmetric with full range of motion and no crepitus or redness Spine

Abdomen Without tenderness, no guarding. Peristaltic waves can be visible in thinner children. Shape: Symmetric and without protrusions are around the umbilicus Infants and toddlers

Circulatory System Heart Inspection Precordial activity Shape and symmetry Heave: an obvious lifting of the chest wall during contraction, may indicate an enlarged heart Palpation

Chest and Lungs Chest shape Infants: Shape is almost circular with anteroposterior diameter equaling the transverse or lateral diameter Children and adolescents: The transverse diameter

Ears During the tympanic membrane exam: In infants – Pull pinna down and back In children older than 3 – Pull pinna up and back

Hair and scalp Hair should be evenly distributed, smooth, and strong Manifestations of nutritional deficiencies include hair that is stringy, dull, brittle, and dry Hair

General Appearance Appears undistressed, clean, well-kept, and without body odors Muscle tone: Erect head posture is expected in infants after 4 months of age Make

Pulse Rate Grading of Pulses Grade Description 0 Not palpable +1 Difficult to palpate, thready, weak, easily obliterated with pressure +2 Difficult to palpate, may

Temperature measurement in pediatrics Ask the Question PICOT Question: In infants and children, what is the most accurate method for measuring temperature in febrile children?

Physical Assessment Anthropometric Measurements Height, weight, and circumference Weigh the child, taking two measurements and averaging them Calculate BMI BMI under the 5th percentile indicated

Performing Pediatric Physical Examination Perform the examination in an appropriate, nonthreatening area: Have room well-lit and decorated with neutral colors. Have room temperature comfortably warm.