The pediatric physical examination: General principles and standard measurements
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Sophisticated technologic advances in medicine have proved to be remarkably beneficial in the diagnostic process, yet the well-performed history and the physical examination remain the clinician's most important tools. They are venerated elements of the art of medicine, the best series of diagnostic tests we have .
A relatively complete physical examination should be performed on each patient, regardless of the reason for the visit. Numerous medical anecdotes relate instances in which the examination revealed findings unrelated to and unexpected from the patient's chief complaint and major concerns. On occasion, a limited or inadequate examination may miss a significant condition, mass lesion, or potentially life-threatening condition.
The general principles, standard measurements, and overall approach to the pediatric patient are discussed here. Examination of specific organ systems is discussed separately. (See "The pediatric physical examination: HEENT" and "The pediatric physical examination: Chest and abdomen" and "The pediatric physical examination: Back, extremities, nervous system, skin, and lymph nodes" and "The pediatric physical examination: The perineum".)
The approach — After years of experience, seasoned examiners become aware of potential avoidable pitfalls often encountered upon entering a patient's room. Before entering the room, the clinician should review the patient's chart and confirm the identity of the patient and others in the room. Most clinicians have experienced the discomfort of walking into a room and greeting the patient, parent, or caregiver by the wrong name or of having the correct name but the wrong medical record.
To avoid a potentially embarrassing situation, the examiner should always knock on the door and await a response before entering. Small children standing on the other side can be injured easily by the door handle or by the door's impact as it is being opened.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Sackett DL, Rennie D. The science of the art of the clinical examination. JAMA 1992; 267:2650.
- Committee on Practice and Ambulatory Medicine. Use of chaperones during the physical examination of the pediatric patient. Pediatrics 2011; 127:991.
- Committee on Psychosocial Aspects of Child and Family Health 1995-1996. Guidelines for health supervision III, American Academy of Pediatrics, Elk Grove Village, IL 1997.
- Rios A. Microcephaly. Pediatr Rev 1996; 17:386.
- Nellhaus G. Head circumference from birth to eighteen years. Practical composite international and interracial graphs. Pediatrics 1968; 41:106.
- Roche AF, Mukherjee D, Guo SM, Moore WM. Head circumference reference data: birth to 18 years. Pediatrics 1987; 79:706.
- Rollins JD, Collins JS, Holden KR. United States head circumference growth reference charts: birth to 21 years. J Pediatr 2010; 156:907.
- Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC). Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep 2010; 59:1.
- Bushby KM, Cole T, Matthews JN, Goodship JA. Centiles for adult head circumference. Arch Dis Child 1992; 67:1286.
- Natale V, Rajagopalan A. Worldwide variation in human growth and the World Health Organization growth standards: a systematic review. BMJ Open 2014; 4:e003735.
- American Academy of Pediatrics Committee on Nutrition. Failure to thrive. In: Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.663.
- Wright CM, Williams AF, Elliman D, et al. Using the new UK-WHO growth charts. BMJ 2010; 340:c1140.
- Niven DJ, Gaudet JE, Laupland KB, et al. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis. Ann Intern Med 2015; 163:768.
- Anagnostakis D, Matsaniotis N, Grafakos S, Sarafidou E. Rectal-axillary temperature difference in febrile and afebrile infants and children. Clin Pediatr (Phila) 1993; 32:268.
- Bates B. A Guide to Physical Examination and History Taking, 6th ed, Lippincott, Philadelphia 1995.
- Rowe PC. Pediatric procedures. In: Principles and Practice of Pediatrics, Oski FA, DeAngelis CD, Feigin RD, Warshaw JB (Eds), Lippincott, Philadelphia 1990. p.2010.
- Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA 1998; 279:308.
- Simoes EA, Roark R, Berman S, et al. Respiratory rate: measurement of variability over time and accuracy at different counting periods. Arch Dis Child 1991; 66:1199.
- Gadomski AM, Khallaf N, el Ansary S, Black RE. Assessment of respiratory rate and chest indrawing in children with ARI by primary care physicians in Egypt. Bull World Health Organ 1993; 71:523.
- Berman S, Simoes EA, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child 1991; 66:81.
- Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377:1011.
- Gadomski AM, Permutt T, Stanton B. Correcting respiratory rate for the presence of fever. J Clin Epidemiol 1994; 47:1043.
- Veith I (translator). The Yellow Emperor's Classic of Internal Medicine, University of California Press, Berkeley, CA 2002.
- Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 1996; 98:649.