Sequence of examination
- Infant
- Before able to sit alone — supine or prone, preferably in parent’s lap; before 4 to 6 months, can place on examining table
- After able to sit alone — sitting in parent’s lap whenever possible; if on table, place with parent in full view
- If quiet, auscultate heart, lungs, and abdomen.
- Record heart and respiratory rates.
- Palpate and percuss same areas.
- Proceed in usual head-to-toe direction.
- Perform traumatic procedures last (eyes, ears, mouth [while crying]).
- Elicit reflexes as body part is examined.
- Elicit Moro reflex last.
- Completely undress if room temperature permits.
- Leave diaper on male infant.
- Gain cooperation with distraction, bright objects, rattles, talking.
- Smile at infant; use soft, gentle voice.
- Pacify with bottle of sugar water or feeding.
- Enlist parent’s aid for restraining to examine ears, mouth.
- Avoid abrupt, jerky movements.
- Toddler
- Sitting or standing on or near parent
- Prone or supine in parent’s lap
- Inspect body area through play: “Count fingers,” “tickle toes.”
- Use minimum physical contact initially.
- Introduce equipment slowly.
- Auscultate, percuss, palpate whenever quiet.
- Perform traumatic procedures last (same as for infant).
- Have parent remove outer clothing.
- Remove underwear as body part is examined.
- Allow toddler to inspect equipment; demonstrating use of equipment is usually ineffective.
- If uncooperative, perform procedures quickly.
- Use restraint when appropriate, request parent’s assistance.
- Talk about examination if cooperative; use short phrases.
- Praise for cooperative behavior.
- School-Age Child
- Prefer sitting
- Cooperative in most positions
- Younger child prefers parent’s presence
- Older child may prefer privacy
- Proceed in head-to-toe direction.
- May examine genitalia last in older child
- Respect need for privacy.
- Request self-undressing.
- Allow to wear underpants.
- Give gown to wear.
- Explain purpose of equipment and significance of procedure, such as otoscope to see eardrum, which is necessary for hearing.
- Teach about body function and care.
- Adolescent
- Same as for school-age child
- Offer option of parent’s presence
- Same as older school-age child.
- May examine genitalia last
- Allow to undress in private.
- Give gown.
- Expose only area to be examined.
- Respect need for privacy.
- Explain findings during examination e.g., “Your muscles are firm and strong”).
- Matter-of-factly comment about sexual development (e.g., “Your breasts are developing as they should be”).
- Emphasize normalcy of development.
- Examine genitalia as any other body part; may leave to end.
- Goal of assessment
- Minimize anxiety and foster trust
- Preserve security of parent-child relationship
- Prep child as much as possible
