🔍 Pediatric Assessment Cram
Chapter 32 · highest-yield points
1The mindset — judge by age
Assessment starts BEFORE touching
Every finding vs. age expectations
Observe behavior, activity, caregiver interaction first. Get history from child AND caregiver. HR 130 = normal infant, tachycardic school-ager.
2Exam sequence
Least threatening first
Uncomfortable procedures LAST
Flexible order — ears/throat at the end. Warmth, privacy, caregiver support throughout. General appearance (alertness, color, breathing effort) comes before hands-on.
3Communication by age
Toddler: caregiver's lap · play · limited choices
Preschooler: simple + literal · demonstrate
Teen: direct · privacy · HEADSSS
HEADSSS = Home, Education, Activities, Drugs, Sexuality, Suicide/depression, Safety — the teen psychosocial screen.
4Vital sign ranges — HR / RR
Infant 80–150 / 25–55
Toddler 70–120 / 20–30
Preschool 65–110 / 20–25
School-age 60–100 / 14–26
Teen 55–95 / 12–20
Rates fall with age. Count a full minute in young kids. Crying/fever/anxiety inflate numbers — measure calm.
5BP rules
Routine screening starts age 3
Cuff width ≈ 40% of arm
Cuff length 80–100% of arm
Arm at heart level, child calm, pediatric reference values — never adult cutoffs. Small cuff = falsely high.
6Growth — trends beat numbers
Weight-for-length: under 2 yr
BMI-for-age: 2 yr and up
Worry when: crossing percentiles downward, poor gain/weight loss, head circumference jumps, lost skills. One low point on its own curve = fine.
7Respiratory distress
Tachypnea · nasal flaring · retractions
Grunting · accessory muscles
Deterioration: less responsive, exhaustion (effort drops!), central cyanosis, apnea, bradycardia. Abdominal breathing in an infant = normal.
8Perfusion + shock — the trap
Early: tachycardia · cool limbs · slow refill
Hypotension = LATE sign
Kids compensate — BP stays normal while shock develops. Also watch: less urine, behavior change. Don't wait for the BP to fall.
9Eyes + ears traps
White/absent red reflex = URGENT referral
Otoscope: under 3 → pinna DOWN + back
Over 3 → pinna UP + back. Brief eye misalignment in early infancy = normal; persistent strabismus = evaluate.
10Normal variants vs. red flags
Normal: bowlegs (toddler) · knock-knees (preschool)
Normal: Babinski in infancy · sinus arrhythmia
Red flags: bruising a non-mobile baby can't explain · petechiae/purpura · weak femoral pulses (congenital heart disease) · abdomen: listen BEFORE palpating.