Head and Neck

Observe the head for shape and symmetry. Palpate the skull, assessing for any lesions, fractures, or swelling. Palpate the anterior and posterior fontanels. The anterior fontanel closes at 12 to 18 months. In older children, the posterior fontanel is assessed.

Place the child in a sitting position to assess the neck. Assess ROM (moving the neck side to side). Assess for any lesions, skin folds, or swelling. Palpate the trachea. Document any findings.

Eyes and Ear Assessment

Inspect the eyes and lids for symmetry. Inspect the conjunctiva, which should appear pink and glossy. Inspect the sclera, which should appear white and clear. A yellow tint of the sclera can signify jaundice. If the child can follow directions, assess the extraocular movement by evaluating the cardinal fields of gaze.

Inspect the ears for symmetry. Note if there are any abnormalities, pain, or drainage. Observe the tympanic membrane. Palpate the mastoid for tenderness. Assess for signs of an ear infection. To assess hearing acuity for infants, clap to elicit a response. For school-age children, a whisper test is conducted. Document any findings.

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