PEDIATRIC PHYSICAL ASSESSMENT
The assessment of a child is similar to that of the adult. You want to start your assessment from head to toe in order to get a general overall appearance of the patient. When obtaining a health history, the parents are usually the ones who are going to give you all the information. Explain each step to the parents so they are aware and comfortable, as well. Obtain vital signs and use the FLACC scale to assess pain. In the case of patients who are too young to express how they are feeling, asking the parents the symptoms or the child's usual behavior may help. This is the most difficult part of pediatric nursing: although adults can tell you how they feel, often times children cannot. A thorough assessment is vital in order to diagnose and treat the patient. Remember, the parents' consent is needed at all times. Always obtain a health history before beginning the assessment.
Vital Signs
Vital signs are different for infants, children, and adolescents. You will be tested on knowing the difference.
I. Temperature
An accurate axillary, oral, rectal, or tympanic temperature is obtained. An oral temperature should only be obtained from children who are 4 years of age or older. For patients 1 to 3 years old, temperature is taken tympanically. Rectal temperatures are used for newborns and infants up to a year old. The normal temperature for a child is 98.6°F.
II. Pulse
To obtain the heart rate, the apical pulse is palpated and assessed for a full minute. The brachial pulse can be used on older children. It is important to also document the child's activity level at the time of assessment. Was the child crying, screaming, or running around? The normal range of pulse is:
Birth: 100 to 170 bpm 3 to 6 months: 100 to 120 bpm 6 to 12 months: 80 to 120 bpm 1 to 3 years: 70 to 110 bpm 3 to 6 years: 60 to 110 bpm 6 to 12 years: 60 to 90 bpm 12 years to adult: 60 to 100 bpm
III. Blood Pressure
The blood pressure (BP) is taken with a pediatric cuff. The normal range of blood pressure (systolic/diastolic) is:
Birth to 3 months: 60 to 80 mmHg/40 to 50 mmHg 3 to 6 months: 70 to 90 mmHg/50 to 60 mmHg 6 to 12 months: 80 to 100 mmHg/50 to 60 mmHg 1 to 3 years: 90 to 100 mmHg/60 to 70 mmHg 3 to 6 years: 95 to 110 mmHg/60 to 75 mmHg 6 to 12 years: 100 to 120 mmHg/60 to 80 mmHg 12 years to adult: 110 to 130 mmHg/65 to 85 mmHg
IV. Respirations
Infants have diaphragmatic respirations, so it is important to use the abdomen to assess respiratory rates. Count the respirations for a full minute, and document your findings, also assessing for any complications or changes. The normal respiratory rate is:
Birth to 6 months: 30 to 55 breaths per minute.
6 months to 12 months: 35 to 45 breaths per minute 1 to 3 years: 20 to 30 breaths per minute 3 to 6 years: 20 to 25 breaths per minute 6 to 12 years: 14 to 20 breaths per minute 12 years to adult: 12 to 18 breaths per minute
V. Pain
When assessing for pain, assess the infant's behavioral response. Is the child crying or squirming around? Does the infant's response to pain increase with palpation of the affected area? If the child is old enough to tell you where the pain is, assess the area and treat.
