Texture, dryness or moisture, temperature, hair growth or lack of, could
indicate fluid or nutritional deficits.
Blanching/capillary refill(pallor followed by return of flush after pressure;
<3 seconds indicates circulatory adequacy).
Birthmarks or other skin color deviations (nonpathologic) may be noted.
Ecchymosis(blue/black areas or bruises often from trauma) or abrasions
(indicating trauma, accidental or intentional), or petechiae,small
pinpoint hemorrhages, could indicate a bleeding disorder due to lack of
platelets.Hair
Note color, distribution, quality, texture, elasticity, and cleanliness.
Cultural variations in coarseness or curliness of hair may be noted, but
hair and scalp should be clean without lesions.
Hair loss or dry, thin, and brittle hair can indicate nutritional deficits or
a side effect from medication/cancer treatment.
Unusual hair distribution on face, arms, trunk, or legs could indicate
pathology.
Presence or absence of hair in underarm or pubic regions could indicate
premature or delayed pubertal changes or hormonal dysfunction. Bald-
ing in an infant could suggest need for more frequent position changes
for sleep.
Inspect for scalp itching, which could indicate seborrhea, ringworm, or
scalp infection or infestation, for example, lice (gray flakes from nits/ova
adhering to hair, particularly in school-aged child who could be exposed
from other children).Safety alertUse gloves or a tongue blade during inspection for lice to avoid
self-infestation. Also check scalp for ticks (smooth, oval, gray or brown bodies)Nails
Should be smooth and flexible.
If dry and brittle or ridges are noted, nutritional deficits may be present.
Clubbed (bulged and slightly cyanotic) fingertips may indicate respiratory
or cardiac dysfunction.Head and Neck
Head control should be noted by 4 months of age.
Shape and symmetry: Report extreme asymmetry for further evaluation.
Fontanels should be closed by 18 months of age.
Note reports of headaches, swollen neck glands, neck stiffness, or decreased
range of motion.CHAPTER 3/ Pediatric Assessment^39