Pediatrics : Hair and Scalp / Head and Neck

      • Hair and scalp
        • Hair should be evenly distributed, smooth, and strong
          • Manifestations of nutritional deficiencies include hair that is stringy, dull, brittle, and dry
          • Hair loss or balding spots on infants can indicate the child is spending too much time in the same position
        • Scalp should be clean and absent from any scaliness, infestations, and trauma.
        • Assess children approaching adolescence for the presence of secondary hair growth
      • Head and Neck
        • Head
          • The shape of the head should be symmetric
          • Fontanels should be flat.
            • The posterior fontanel usually closes by 8 weeks of age
            • The anterior fontanel usually closes between 12 and 18 months of age
        • Face
          • Symmetric appearance and movement
          • Proportional features
        • Neck
          • Short in infants
          • No palpable masses
          • Midline trachea
          • Full range of motion present whether assessed actively or passively
        • Eyes
          • Eyebrows
            • Symmetrical and evenly distributed from the inner to the outer canthus
          • Eyelids
            • Close completely and open to allow the lower border and most of the upper portion of the iris to be seen
          • Eyelashes
            • Curve outward and be evenly distributed with no inflammation around any of the hair follicles
          • Conjunctiva
            • Palpebral fissures and conjunctiva are pink
            • Bulbar conjunctiva are transparent
          • Lacrimal apparatus
            • Without excessive tearing, redness, or discharge
          • Sclera
            • Should be white
          • Corneas
            • Should be unclear
          • Pupils
            • Should be:
              • Round
              • Equal in size
              • Reactive to light
              • Accommodating
          • Irises
            • Round with the permanent color manifesting around 6 to 12 months of age
          • Visual acuity
            • Can be difficult to assess in children younger than 3 years of age
            • Visual acuity in infants can be assessed by holding an an object in front of the eyes and checking to see whether the infant is able to fix on the object and follow it
            • Use he tumbling E or HOTV test to check visual acuity of children who are unable to read letters and numbers
            • Older children should be tested using a Snellen chart or symbol charts
          • Peripheral visual fields
            • Should be:
              • Upwards 50°
              • Downward 70°
              • Nasally 60°
              • Temporally 90°
          • Extraocular movements
            • Might not be symmetric in newborns
            • Corneal light reflex should be symmetric
            • Cover/uncover test should demonstrate equal movement of the eyes
            • Six cardinal fields of gaze should demonstrate no nystagmus
          • Color Vision
            • Should be assessed using the Ishihara color test or the Hardy-Rand-Rittler test
            • The child should be able to correctly identify shapes, symbols, or numbers
          • Internal exam
            • Red reflex should be present in infants
            • Arteries, veins, optic discs, and maculae can be visualized in order children and adolescents


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