Pediatrics : Abdomen / Genitalia

    • 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.
    • 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
      • 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

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