Pediatrics : Ears / Nose / Mouth and Throat

    • 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
    • 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.


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