Pediatric Physical Exam Terms

Blood Pressure:
Take the BP as early as the child will cooperate, usually by 3-4 years. Play around with the "balloon" so the child will not be frightened. Blood pressure in younger infants will be facilitated by use of the "Doppler" if the stethoscope is inadequate. Take the BP in any age child for at least these indications:

• Non-functional heart murmor
• Renal infection or disease
• Non-palpabe femoral pulses (Also BP in legs)
• Abdominal mass
• Headaches

EOMs:
Follows to midline. See Denver Developmental Screening Test (DDST).
Follow to 180 degrees: See DDST.
Cardinal movements: the 4.5 to 6-month old infant will follow an otoscope light through the cardinal movements.

Vision:
General impression: The infant's visual acuity cannot be tested accurately in a pediatric clinic setting. Grossly adequate acuity can be inferred if the infant performs well on the visual items in the DDST.
E-Chart: When the child is old enough to cooperate, about 3-4 years, he may be tested with the E-chart. This chart works like the standard alphabet chart, except that the child is asked to indicate which way the "E" points.
Red Reflex: Look for the red reflex of the retina to screen for cataracts or the very rare retinoblastoma.
Fundascopic Examination: Do a funduscopic examination yearly as early as the child will cooperate, usually around 3-4 years. No dilation is required if the room is dark. Perform fundascopic examination for at least the following indications:

• Premature birth, to look for retrolental fibroplasia
• Developmental retardation, microcephaly, macrocephaly (to look for systemic effects)
• Headaches, seizures, altered mental state, other CNS signs(to look for papilledema)
• Suspected subdural hematoma or other head injury (to look for hemorrhages).

Voice:
Vocalize: see DDST
Coos or Babbles: Repetitive sounds with consonants
Speech Development by Denver Items: see DDST
Articulation: The child should have normal speech by 5-7 years. If a 7-year-old has faulty articulation, or if you suspect a younger child is not developing his speech normally, a speech and hearing clinic can pursue further evaluation.

Teeth:
Appearance: First incisor: 7 ± 2 months.
Dental Referral: The child should be seen by a dentist at 2-3 years of age.
Caries and Malocclusion: A child with caries or malocclusion should be referred to a dentist.

Femoral Pulses:
Feel the femoral pulses for adequate strength; if any doubt persists, compare the BP in the legs (cuff placed on thigh, auscultation done over the popliteal fossa) to the BP in the arms. Since you are looking for congenital disease, the femorals need only be examined on the initial appointment unless they are abnormal. However, the femoral pulses are easy and quikck to examine and should be checed at each visit.

Testes:
The testes should be in the scrotom or in the inguinal canals and capable of being pushed into the scrotum by a "milking" motion. Best position for examining doubtful cases is during squatting.

Genitalia (Male)
Position of urethra: The urethra should be at the tip of the glans.
Retractable foreskin: The foreskin of an uncircumcised penis should be retractable from the glans. Otherwise, there may be difficulty attributable to poor hygiene or obstructed urine flow.

Genitalia (Female)
Vulva: Look for the state of hygiene. Labial fusion is occasionally seen as a result of poor hygiene. Not spotting on panties.
Clitoris: Look for the size and appearance.
Imperforate vaginal opening: Look to see that the vaginal opening is present. Examine gently, explaining procedure where necessary.

Onset of Puberty (see also Tanner Staging System)
The criteria given are the normal range of onset of these signs of puberty, not the time for full development. The data are from European and North American children. There are variations between ethnic groups. People of African ancestry tent to begin 1-2 years earlier.

• Male

• Testes (10-13½ years): Scrotum and testes slightly enlarged.  Scrotal skin reddened, roughened and changed in texture.
• Pubic hairs (10-15) Sparse growth of long, slightly pigmented downy hair, straight or slightly curled, chiefly at the base of the penis.
• Height spurt (10½-16 years): An accelerated rate of growth.
• Penis (11-14½) Slightly enlarged, beginning first with increased length.
• Voice: Change.
• Female
• Breast bud (8-13 years): Elevation of the breast and the papilla as a small mound. Alveolar diameter enlarged slightly.
• Pubic hair (8-14 years): Sparse growth of long, slightly pigmented downy hair, straight or slightly curled, chiefly along the labia. Also axillary hair.
• Height spurt (9½-14½ years): An accelerated growth rate.
• Menarche (10-16½ years): Onset of menstruation.

• Congenital dislocation of the hip
• Asymmetry of the inguinal or gluteal folds
• Apparent shortness of one lower extremity
• Limitation of abduction of the affected extremity to less than 80° when the thighs are first flexed. Sometimes this maneuver will relocate the hip joint causing a palpable click. Differentiate between true dislocation and subluxation.
• Metatarsus adductus (fixed, not mobile type)
• This is a toe-in deformity caused by a medical deviation of the metatarsal bones. If they can be passively stretched back to normal, no therapy is required.
• Tibial torsion, external
• With the legs together and the patellae pointed anteriorly, or with the legs hung over the edge of the table and the infant or child lying down, the feet should be parallel.
• Bow legs, when persisting after 3 years of age
• Knock knees, when persisting after 8-10 years of age
• Scoliosis