briefly assessed:
- head⎯note size, shape (abnormalities may be seen in certain syndromes), and any
facial asymmetry (Fig. 3.6); - hair⎯note if sparse (look out for head lice!);
- eyes⎯is there any visual impairment or abnormality of the sclera?
- ears⎯record any abnormal morphology or presence of hearing aids;
- skin⎯document any scars, bruising, lacerations, pallor, birthmarks (Fig. 3.7) and be
aware of contagious infections, such as impetigo; - temporomandibular joint⎯is there any pain, crepitus, deviation, or restricted
opening? - lymph nodes⎯palpate for enlarged submandibular or cervical lymph nodes (bear in
mind that lymphadenopathy is not uncommon in children, due to frequent viral
infections) (Fig. 3.8); - lips⎯note the presence of cold sores, swelling, or abnormal colouring (Fig. 3.9).
Any positive findings should be recorded carefully. Clinical photographs or annotated
sketches (Fig. 3.10) may be very helpful for future reference, particularly with respect
to medico-legal purposes, or in cases of suspected child physical abuse (see Chapter
12 ). Obviously, when the child presents with a specific problem, such as a facial
swelling, a more thorough examination of the presenting condition is needed (see
Chapter 15).