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- Ears
- During the tympanic membrane exam:
- In infants – Pull pinna down and back
- In children older than 3 – Pull pinna up and back
- The ear canal should be pink with fine hairs
- The tympanic membrane should be pearly pink, or gray
- The light reflex should be visible
- Alignment
- The top of the auricles should meet in an imaginary horizontal line that extends from the outer canthus of the eye
- External ear
- The external ear should be free of lesions and nontender
- The ear canal should be free of foreign bodies or discharge
- Cerumen is an expected finding
- Hearing
- Newborns
- Have intact acoustic blink reflexes to sudden sounds
- Infants
- Turn towards sound
- Older children
- Can be screened by whispering a word from behind to see whether they can identify the word
- Newborns
- During the tympanic membrane exam:
- Nose
- The position should be midline
- Patency should be present for each nostril without excessive flaring
- Smell can be assessed in older children
- Internal structure
- The spectrum is midline and intact
- The mucosa is deep pink in light-skinned clients and various shades of brown or gray in dark-skinned clients
- The mucosa should be moist without evidence of discharge
- Mouth and throat
- Lips
- Darker pigmented than facial skin
- Smooth, soft, moist, and symmetrical
- Gums
- Coral pink in light-skinned clients, and various shades of brown or gray in dark-skinned clients
- Tight against the teeth
- Mucous membranes
- Without lesions
- Moist, smooth, and glistening
- Pink in light-skinned clients and various shades of brown or gray in dark-skinned clients
- Tongue
- Infants can have white coating on their tongues from milk that can easily removed
- Oral candidiasis coating is not easily removed
- Children and adolescents should have pink, symmetric tongues that they are able to move beyond their lips
- Teeth
- Infants should have six to eight teeth by 1 year of age
- Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32 permanent teeth
- Hard and soft palates
- Intact, firm, and concave
- Uvula
- Intact and moves with vocalization
- Tonsils
- Infants: Might not be able to visualize
- Children: Barely visible to prominent, same color as surrounding mucosa
- Voice
- Infants: Strong cry
- Children and adolescents: Clear and articulate
- Atraumatic Care
- Encouraging Opening the Mouth for examination
- Perform the examination in front of a mirror.
- Let the child first examine someone else’s mouth, such as the parent, the nurse, or a puppet, and then examine the child’s mouth.
- Instruct the child to tilt the head back slightly, breathe deeply through the mouth, and hold the breath; this action lowers the tongue to the floor of the mouth without the use of a tongue blade.
- Lightly brushing the palate with a cotton swab also may open the mouth for assessment.
- Encouraging Opening the Mouth for examination
- Lips
- Ears
Working Out to Stay Sharper
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