Prepared by physiotherapist: suad Radwan AL NASSR Pediatric Hospital

Sick

vs Not Sick

Assessment

Desired state

why?

Present state

 Identify and treat life-threatening or traumatic problems.

Guide the therapist to the proper way.

Determine the priority of care. Obtain signs on which to reassess the effectiveness of

treatment.

 pulse Auscultation of the heart

Weight, Length
Organomegally Dysmorphic features Laboratory

Karyo type

{Immunity, Metabolic screen}

The 2 major components of examination are:

Subjective Assessment

Objective Assessment

 Symptoms [location, types & behavior, severity, time]. Previous history of the condition.(prolonged labor,

premature, Seizures ).

Related history as medication, radiological studies,

surgical intervention, environment.

Inspection

Palpation
Percussion

General Observation patient's state on entering ; Conscious, irritable, posture, gait.

Symmetrical or not.

Congenital anomalies 3-5% of infants

Syndromes

Respiration

Type

Inspection
General comfort and breathing pattern of the patient. Do they appear : * distressed, * diaphoretic, * labored? * Are the breaths regular and deep? Tachypnea / shallow

 Using

of

accessory nasal

muscles flaring,

of this

breathing signifies

(sternomastoids),

respiratory difficulty.

Color of the patient,. Obviously, blue is bad!

Cyanosis [Heart OR Lung disease? ]

Monitor oxygen; keep O2 sat >75%

Observe color
Color of skin

Nail clubbing =when view fingernail from side,

angle of base of nail is >160.

Clubbing
Cyanotic heart diseases.
Lung ds: hypoxia, bronchiectasis, CF.

U Colitis, Crohns disease.

Biliary cirrhosis. Birth defect . Infective Endocarditis . Neoplasm [esp. Hodgkin] GI mal-absorption .

 Pigeon chest{Pectus Carinatum}.

Funnel chest.

Scoliosis & Kyphosis.

Pectus Excavatum

Barrel chest.

Are they symmetrical, i.e. the same on both sides, or

* Is there a difference ? * Is there any lag or impairment of respiratory

movement ?

Subcostal or intercostal retractions are common signs of pulmonary pathology.

Any audible noises associated with breathing as

wheezing, stridor(upper airway obstruction).

Inspection

Scaphoid abdomen; diaphragmatic hernia

* The fact that striking a surface which covers an air-filled

structure (e.g. normal lung) will produce a resonant

note, while repeating the same maneuver over a fluid

generates a relatively dull sound.

pneumo-thorax emphysema

Normal Large Bulging Sunken Closed

Skin & subcutaneous tissue scars. Muscle Tone {type & degree}.

Temperature, edema,

Joint

mobility, effusion, tenderness.

Tactile of crepitation indicate chest secretions.

Tenderness of chest indicates abscess, rib fracture.

Consciousness, orientation.

Head size.
Dysmorphism (face eyes, (pupils, irises)

ears, neck).
Eyes nystagmus.

Strange movements as Clonus.

Skin-Abdominal mass

Severe positional deformation and contractures indicate arthrogryposis.

1. Neurological examination
Absence of expected movements. Presence of abnormal activity (convulsions)

Sensation 2. Developmental assessment

Absence of expected functions. Motor milestones. Presence of abnormal activity (primitive reflexes)

Reflexes within the developmental stage.

Labyrinthine head righting

Primitive reflexes
When primitive reflexes persist longer than they should, the baby may have a Neurodevelopmental problem.
Reflex Normally disappeared by

Stepping
Placing

6 weeks
6 weeks

Moro
Rooting / sucking Palmar grasp Tonic neck reflex (appears at 2mth) Plantar grasp

3 -4mths
4months awake, 7mths asleep 6 months 6 months 10 months

Functional neurology; what can the baby DO?

History questions (can your baby do ?)

Examination observation can the baby can do specific things ?

HOW?
Systematic process Assess key milestones in all 4 areas of development (GM, FM, Language, Social) Know what is normal

Shape of joint. Color, temperature. Any Asymmetrically. ROM. Muscle power. proprioception. Reflexes; knee jerk.

Tumor

Thrombocytopenia.

X Ray
CT SCAN MRI ULTRA SOUND

Nelson textbook of paediatric (2008). Tidy,s physiotherapy (13 edition). http://newborns.stanford.edu/PhotoGallery/StepReflex1.html