Description

Join a discussion about growth and development by Dr. Hands, who presents all that any parent would like to know about any health concern during the first few years of child's life. This video shows what happens in a physical exam for an 8 year old and a

Transcript

What to Expect from a Child's Physical Exam We have three children of different age. We have an eight-year old, a six-year old and we also have an 18-month old. We’re going to demonstrate some of the physical exam. It’s a physical exam characteristic that we try to list each different age group. First, what we’re going to do is the standard height and weight exam. We’re going to have Carl step up in the scale. He can take his shoes off. And my nurse will get height and weight. Now as we talk about height and weight has more meaning today when we relate them to what we call a body mass ratio. So what he would be is entered on a chart which will include body mass ratios which would be followed each year. So the height and weight are done in the usual manner that they are interpreted in a little bit different manner than we used to. What I'm going to have you do is step over here. Let’s get a blood pressure and a pulse on her. In physical examinations, they are after the height and weight is obtained. Vital signs are next. They usually consist of pulse, blood pressure and respiration if necessary. The six-year old and Casey is having her blood pressure taken, important this cap sized and the physician will use the right cap size for the child. We have larger caps for older kids and we have smaller caps to younger. This is important and as parents you find that you're getting some abnormal blood pressure at school and other places, it may be they are not using a proper cap size. Another thing is the pulse can be taken. Now the pulse is still important because it’s a hint of arrhythmias and it’s a hint of cardiac problems. It can also be a hint in disease related to different types of pulses whether it is tachycardia or bradycardia means slow pulse. Tachycardia being a rapid pulse and it’s still an important measurement. Respirations we really do in the office. We do them only if the patient has abnormal respiratory signs or complains of respiratory symptoms. Now there are some other things that we do. On the young man here, if we’re doing an evaluation for nutrition and for weight, we often do a mid-circumference of the arm which helps a lot in assessing nutrition. More significant however, is what we call skin fold measurements. And these are often done with calipers and they can be done in four locations. We do them here, in the biceps. We do it here, triceps. And we do two more, one in the back, one above his hip. These can tell us the body fat content and they are very important especially in our youngster who are heavy or are very thin in assessing their nutrition and how they are doing. Head circumference is very important. Head shape is very important. More important though in the younger kids and we've talked about general appearance. We've talked about skin. We will look at nails. Dermatoglyphics is important where we look at the hands and we look at the pattern of the skin folds and the ridging in the hands. Abnormal patterns have seen in certain inherited diseases, the one that’s best known is what we call Simian crease which is across the palm which is seen in Down syndrome and can be helpful. Again, in children you come in and have complaints and we’re trying to see if there's some underlying neurologic or neurogenetic type of problem. The rest of the exam on the bigger kids is the same as adult exam. We ask the youngster to usually get undress, but in this case for the purpose of the DVD and this young lady will just demonstrate superficially. Abdominal exam is best on trying to get the patient to relax. We always put the legs up and get them relax this way. And sometimes if we’re having trouble, we have the youngster actually palpate or on top of us. We do the abdominal exam. We check they’re get examine both boys and girls. We listen to the heart, the lung. We do ear checks, throat checks and we look in the eyes as part of the exam. What also important are other aspects of the exam. We always check the back and I’ll use the young man here to demonstrate that. We have him bend and touch your toes. This is known as scoliosis check. And we check the back to make sure the back is straight. The other thing is we check thyroid evaluation. We palpate his neck from behind. We ask him to swallow and it tells us if his thyroid gland is enlarged or not. And all the kids we watch their gait. We make sure that their gait is normal and not disturbed. And that also is part of the exam. We do some other inderal-muscular exams if the youngster is getting ready to play sports and we’re going to have them participate. One exam that’s become quite popular and we try to do on the kids is we measure their arm span a lot. Now the arm span which is from tip to tip is important because if their arm span is greater than your height, it maybe a tip off of what we call Marfan syndrome which can have certain negative aspects in competitive sports. So this is a very important screen device as part of our physical. Again, use more often in our sport physical but we do this in general. As we mentioned in the talk for nutrition, I talked about nails, hair. We talked about lips or mucus membranes—. And then there the eye exams and the eye exams are important. Across the whole, we have eye machines to test eye and ear exams. They are done in most offices and are very important to be done. We've also check the eye anatomy. We check for sties. We check for various abnormalities in the lids. And we also, always look still in youngsters at the cornea, and the front eye, and do a complete eye exam on them as part of the exams. What we’re going to do now is switch gears to an 18-month old who needs a check up and we’re going to demonstrate what's required there. But before we do because once we start that, 18-month old is being what they are. It would be -- we’ll reach a point where I'm sure that she will get a little upset with the exam be hard to talk. So I just want to make immunizations. Immunizations, we give are basically, started at birth. We have quite a few mandatory immunizations. There are hepatitis, chicken pox, measles, mumps and rubella, diphtheria, whooping cough and tetanus. There are HIB which is hemophilus influenza type B. There are Pneumococcal vaccine. These are all right now mandatory vaccines. There is in the making the possibility of the ptosis vaccine being given to older kids and a second varicella vaccine. Ptosis is whooping cough. A whooping cough is believed to be spread by the adult population who would no longer immune from the child toward immunizations. And therefore, infecting our teenagers and older kids and vaccine is therefore should be carried to an older age. And I think there also a lot of vaccines in the horizon for adolescence that I think people would be seeing in the next couple of years including human papilloma virus vaccine which will probably be administered and as well as I mentioned the P in the DPT will renew in that age group. The meningitis vaccine for the meningococcal meningitis is being encouraged more and more in the 11-year old, older age group. We certainly give it college kids now. That’s certainly on the horizon, it will be given. The big controversies with immunization are always acclaims that they lead to some complication or problem. And although it’s an extensive discussion, the truth of the matter is the problems that led people to worry about measles, mumps and rubella with autism have been essentially refuted. There has been—all the concerns originally with DPT has been somewhat circumvented by the new —or DPT with very much reaction rate and really no problems related to it. There are reactions however possible to the shots that are more minor related to fever and local reactions even allergic reactions can occur to them. And they need to consult their doctor at the time having the vaccines. They need to be given advice as to what any risks are of these more minor reactions and they need instructions as to what to do. If they see the reaction and what can be given preventatively. We will be giving vaccines to the younger child, but basically, the vaccine technique is given as the same in each. They are given as intramuscular or subcutaneous injections to the kids. I think now what we’ll do is proceed with looking at the 18-month old and do that exam for you.