manner in which it is going to be conducted is clearly understood by all concerned. It
is best to:
- explain in advance how the child is to be positioned,
- ask parents for their active help,
- give reassurance that the child is not going to be hurt in any way.
In the most controlled approach, the child is laid across the parent's knees with his or
her head on those of the operator (Fig. 3.1). The parent is able to hold the child's arms
though a dental nurse may need to restrain the child's legs. It may be easier to
examine bigger children who have special needs while they are restrained in their own
wheelchair, the dental nurse supporting the child's head during the examination. (See
also Chapter 17 page 419.)
Fig. 3.1 Controlled examination of a young boy laid across his mother's knee.3.4.3 Extraoral examination
General examination
Before carrying out a detailed examination of the craniofacial structures, a more
general physical assessment should be undertaken. Valuable information about a
child's overall health, development, or even habits can often be determined by noting:
- height⎯is the child very tall or very small for their age? In a few cases, it may be
appropriate to take an accurate height measurement (Fig. 3.2) and plot data on a
standard growth chart (Fig. 3.3). Children whose height lies below the third centile,
above the ninety-seventh centile, or who exhibit less than 3-5 cm growth per year
should be referred to a paediatrician for further investigation; - weight⎯could there be an underlying eating disorder? Is general anaesthesia
contraindicated due to the child's obesity? Is there an underlying endocrine problem? - skin⎯look for any notable bruising or injury on exposed arms or legs (Fig. 3.4);
- hands⎯assess for evidence of digit sucking or nail biting, warts, finger clubbing,
abnormal nail, or finger morphology (Fig. 3.5).
The head and neck
During the examination of the head and neck, the following structures should be