Pediatrics : General Appearance

    • General Appearance
      • Appears undistressed, clean, well-kept, and without body odors
      • Muscle tone: Erect head posture is expected in infants after 4 months of age
      • Make eye contact when addressed (expect infants)
      • Follows simple commands as age-appropriate
      • Uses speech, language, and motor skills spontaneously
    • Skin
      • Assess skin for color, texture, temperature, moisture, turgor, lesions, acne, and rashes. 
      • Examination of the skin and its accessory organs primarily involves inspection and palpation. 
      • Touch allows the nurse to assess the texture, turgor, and temperature of the skin. 
      • The normal color in light-skinned children varies from a milky white and rose to a deeply hued pink. 
      • Dark-skinned children, such as those of Native American, Hispanic, or African descent, have inherited various brown, red, yellow, olive green, and bluish tones in their skin. 
      • Asian persons have skin that is normally of a yellow tone. Several variations in skin color can occur, some of which warrant further investigation
      • Difference in color changes of racial group
Description Appearance in Light Skin Appearance in Dark Skin
Cyanosis: bluish tone through skin; reflects reduced (deoxygenated) hemoglobin
  • Bluish tinge, especially in palpebral conjunctiva (lower eyelid), nail beds, earlobes, lips, oral membranes, soles, and palms
  • Ashen gray lips and tongue
Pallor: paleness; may be sign of anemia, chronic disease, edema, or shock
  • Loss of rosy glow in skin, especially face
  • Ashen gray appearance in black skin
  • More yellowish-brown color in brown skin
Erythema: redness; may be result of increased blood flow from climatic conditions, local inflammation, infection, skin irritation, allergy, or other dermatoses or may be caused by increased numbers of red blood cells as compensatory response to chronic hypoxia
  • Redness easily seen anywhere on body
  • Much more difficult to assess; rely on palpation for warmth or edema
Ecchymosis: large, diffuse areas, usually black and blue, caused by hemorrhage of blood into skin; typically result of injuries
  • Purplish to yellow-green areas; may be seen anywhere on skin
  • Very difficult to see unless in mouth or conjunctiva
Petechiae: same as ecchymosis except for size: small, distinct, pinpoint hemorrhages ≤2 mm in size; can denote some type of blood disorder, such as leukemia
  • Purplish pinpoints most easily seen on buttocks, abdomen, and inner surfaces of arms or legs
  • Usually invisible except in oral mucosa, conjunctiva of eyelids, and conjunctiva covering eyeball
Jaundice: yellow staining of skin usually caused by bile pigments
  • Yellow staining seen in sclerae of eyes, skin, fingernails, soles, palms, and oral mucosa
  • Most reliably assessed in sclerae, hard palate, palms, and soles


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