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- 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 have rounded abdomens
- Children and adolescents should have flat abdomens
- Bowel sounds should be heard every 5 to 30 seconds
- The sections are named:
- Left upper quadrant
- Left lower quadrant
- Right upper quadrant
- Right lower quadrant
- Atraumatic Care
- Promoting relaxation during abdominal palpation
- Position the child comfortably, such as in a semi reclining position in the parent’s lap, with knees flexed.
- Warm your hands before touching the skin.
- Use distraction, such as telling stories or talking to the child.
- Teach the child to use deep breathing and to concentrate on an object.
- Give an infant a bottle or pacifier.
- Begin with light, superficial palpation, and gradually progress to deeper palpation.
- Palpate any tender or painful areas last.
- Have the child hold the parent’s hand and squeeze it if palpation is uncomfortable.
- Use the non-palpating hand to comfort the child, such as placing the free hand on the child’s shoulder while palpating the abdomen.
- To minimize the sensation of tickling during palpation:
- Have the child “help” with palpation by placing a hand over the palpating hand.
- Have the child place a hand on the abdomen with the fingers spread wide apart and palpate between his or her fingers.
- Promoting relaxation during abdominal palpation
- Genitalia
- Anus
- Surrounding skin should be intact with sphincter tightening noted if the anus is touched.
- Routine rectal exams are not done with the pediatric population
- Male:
- Hair distribution is diamond shaped after puberty in adolescent males.
- No public hair is noted in infants and small children
- Penis
- Should appear straight
- Urethral meatus should be at the tip of the penis.
- Foreskin might not be retractable in infants and small children
- Enlargement of the penis occurs during adolescence
- The penis can look disproportionately small in males who are obese because of skin folds partially covering the base
- Scrotum
- Hangs separately from the penis
- The skin on the scrotum has a rugose appearance and is loose
- The left testicle hangs slightly lower than the right
- The inguinal canal should be absent of swelling
- During puberty, the testes and scrotum enlarge with darker scrotal skin
- Penis
- Female
- Hair distribution over the mons pubis should be documented in terms of amount and location during puberty.
- Hair should appear in an inverted triangle.
- No pubic hair should be noted in infants or small children
- Labia
- Symmetric, without lesions, moist on the inner aspects
- Clitoris
- Small, without bruising or edema
- Urethral meatus
- Slit-like in appearance with no discharge
- Vaginal orifice
- The hymen can be absent, or it can completely or partially cover the vaginal opening prior to sexual intercourse
- Labia
- Anus
- Abdomen
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