Allow child to examine mouth of nurse, parent, or doll/puppet to
decrease anxiety.
Report any flaring of the nostrils, which could indicate respiratory distress.
Note any bleeding, swelling, discharge, dryness, or blockage of nasal
passages that could indicate trauma, irritation, or infection such as a cold.
Mouth and throat may reveal lesions of mouth or lips, redness, or
drainage indicating infection.
Fissures, stomatitis, or glossitis may indicate fluid and nutritional
deficits.
White patches in infants or children may indicate candidiasis; herpes
simplex or a syphilitic chancre may be noted with adolescents.
Tonsil enlargement, redness, white patches, or drainage in throat could
indicate tonsillitis or pharyngitis.
Inspect teeth for dental caries that could indicate poor hygiene and nutri-
tional deficits, and also note malocclusion (poor biting relationship of
teeth and poor teeth alignment) that could result in feeding problems
and loss of teeth, self-image problems.
Palpate head and neck for lymph nodes and report swollen, tender, or
warm nodes that may indicate the presence of infection.Chest (heart, neck vessels, pulses, and blood pressure)
Note chest shape, symmetry, and movement. Report significant retrac-
tion of chest muscles, which could indicate respiratory distress.
Note nipples for symmetry; breast development usually occurs from 10
to 14 years of age.
Listen to heart with child in sitting and supine position; note heart mur-
murs and record the location and volume intensity.
Note history of congenital heart disease or hypertension.
Neck vein distention could indicate congestive heart failure.
Report if child reports experiencing chest pain, infant becomes fatigued
or short of breath during feeding because these are signs of decreased cir-
culation or cardiac function.
Resting pulse rates according to the age of the child are as follows:- Infants >3 months: pulse rate 100 to 200 beats/minute
- 4 months to 2 years of age: 80 to 150 beats/minute
- 2 years to 10 years: 70 to 110 beats/minute
- 10 years to adulthood: 55 to 90 beats/minute
Blood pressure also varies according to age (systolic: age + 90; diastolic:
1 to 5 years, 56, and 6 to 18 years, age + 52). Average blood pressure
2 years: 95/58 mm Hg
- 2 to 5 years: 101/57 mm Hg
- 6 to 10 years: 112/75 mm Hg
- 11 to 18 years: 120/80 mm Hg
CHAPTER 3/ Pediatric Assessment^41