IV - Pediatric Physical Exam
Derm review
Color and integrity of skin, signs of infection (bacterial and fungal), look for eruptions (eczema, psoriasis,
could limit the child's movements, or flexor surfaces can limit knee motion), dimples, sinuses, or hairy
tufts - spina bifida.
Vasc review
Color - digits for appropriate color. Cap fill time to the extremities. Comparative temperature - running
your hands on the backs of both legs.
Chilblains
Localized erythema with subq swelling from cold exposure usually involving the hands, feet, ears, and
face in children.
Raynaud's
Intermittent B/L attacks of ischemia to extremities brought on by cold due to underlying Vasospastic
condition in the vasculature.
Under 1 yo heart rate
2-5 yo
5-12 yo
110-160 bpm
95-140 bpm
80-129 bpm
,Patient has a fever 3 yo and pulse is 130 bpm or what is expected pulse rate?
Yes; 95-140 bpm
Myelinization
Maturation of neurological system once the neuro system closes. Head to toe, head lag progression
(newborn; 6 wks; 6 months). Starts at second trimester and goes to the 2nd decade.
Neural development
Neural plate forms and closes dorsally forming the CNS. Neural crest cells proliferate and differentiate
into dorsal root; sensory and motor nerves, autonomic ganglia, Schwann cells making up the PNS. Two
areas fuse at the medulla and progress superiorly until 7 wks - anencephaly and myelomeningocele.
Between wks 8-16 - neural proliferation occur (teratogens and infection blocks). Between weeks 12-22 -
cells migrate to specific sites creating nerve tracts. Neurons organize at week 20, align and develop
synapses - failure can result in MR and Down syndrome.
Myelinization
Start at the second trimester. Myelinization of cerebrum and cerebellar hemispheres starts after delivery
and continues for 1st 2 decades. Fine MOTOR and SENSORY control, balance, coordination, reasoning
and intelligence. Control of posture and movement. Voluntary movements - initiated from the cerebral
cortex.
Head control raising head from the bed happens in what month?
6
Rolling over occurs at what month?
6 mo
, Sitting occurs at what month?
6
Crawling occurs at what month?
7-9 months - reciprocal limb control
Standing occurs at what month?
12 mo center of gravity
Independently walking occurs at what month?
1 yr - 18 months
Bowel and Bladder control occurs at what month?
2 yrs
At 3 months neuro landmarks
Vigorous movements; hands open, head bobs when upright, hold a toy, smile, vocalize, and follow an
object.
At 6 months neuro landmarks
When supine can lift up head, roll from supine to prone; maintain head and chest up in prone. Support
self in standing; transfer toys in hands, recognize people and voices.
Derm review
Color and integrity of skin, signs of infection (bacterial and fungal), look for eruptions (eczema, psoriasis,
could limit the child's movements, or flexor surfaces can limit knee motion), dimples, sinuses, or hairy
tufts - spina bifida.
Vasc review
Color - digits for appropriate color. Cap fill time to the extremities. Comparative temperature - running
your hands on the backs of both legs.
Chilblains
Localized erythema with subq swelling from cold exposure usually involving the hands, feet, ears, and
face in children.
Raynaud's
Intermittent B/L attacks of ischemia to extremities brought on by cold due to underlying Vasospastic
condition in the vasculature.
Under 1 yo heart rate
2-5 yo
5-12 yo
110-160 bpm
95-140 bpm
80-129 bpm
,Patient has a fever 3 yo and pulse is 130 bpm or what is expected pulse rate?
Yes; 95-140 bpm
Myelinization
Maturation of neurological system once the neuro system closes. Head to toe, head lag progression
(newborn; 6 wks; 6 months). Starts at second trimester and goes to the 2nd decade.
Neural development
Neural plate forms and closes dorsally forming the CNS. Neural crest cells proliferate and differentiate
into dorsal root; sensory and motor nerves, autonomic ganglia, Schwann cells making up the PNS. Two
areas fuse at the medulla and progress superiorly until 7 wks - anencephaly and myelomeningocele.
Between wks 8-16 - neural proliferation occur (teratogens and infection blocks). Between weeks 12-22 -
cells migrate to specific sites creating nerve tracts. Neurons organize at week 20, align and develop
synapses - failure can result in MR and Down syndrome.
Myelinization
Start at the second trimester. Myelinization of cerebrum and cerebellar hemispheres starts after delivery
and continues for 1st 2 decades. Fine MOTOR and SENSORY control, balance, coordination, reasoning
and intelligence. Control of posture and movement. Voluntary movements - initiated from the cerebral
cortex.
Head control raising head from the bed happens in what month?
6
Rolling over occurs at what month?
6 mo
, Sitting occurs at what month?
6
Crawling occurs at what month?
7-9 months - reciprocal limb control
Standing occurs at what month?
12 mo center of gravity
Independently walking occurs at what month?
1 yr - 18 months
Bowel and Bladder control occurs at what month?
2 yrs
At 3 months neuro landmarks
Vigorous movements; hands open, head bobs when upright, hold a toy, smile, vocalize, and follow an
object.
At 6 months neuro landmarks
When supine can lift up head, roll from supine to prone; maintain head and chest up in prone. Support
self in standing; transfer toys in hands, recognize people and voices.
