Assessment of the Infant, Child, and Adolescent

Assessment of the infant, child, and adolescent involves a variety of techniques depending on the patient's age and development. As the nurse, you'll collect subjective and objective data, while keeping in mind age-specific techniques and variations.

During your assessment, keep in mind the techniques you'll use based on your patient's age and developmental stage. Infants are typically examined on their caregiver's lap during the quiet parts of the exam like cardiac and respiratory auscultation; then, you'll complete the rest of the exam with the infant on the examination table. Remember that stranger anxiety begins around six to nine months of age, so you'll need to build trust before starting your assessment by taking time to let the infant adjust to their new surroundings and by speaking to them softly before touching them.

When examining a toddler, you'll want to keep them on their caregiver's lap for the duration of the exam and encourage them to hold a security object like a stuffed toy or blanket during the exam. Also, remember that most toddlers and preschoolers are learning to gain independence, so offer them choices when possible, such as asking them which ear you should look at first. They also enjoy playing games and pretending, so you can use a doll to demonstrate what to expect during the exam.

When examining school-aged patients and adolescents, promote relaxation by asking about school or hobbies, and explaining how the body works as you examine each system. Adolescents are often ready to receive health teaching regarding how they can stay safe and healthy, so you can teach as you examine them. Also, be sure to give your adolescent patient a choice to speak to you without their caregiver in the room to ensure confidentiality about specific problems like sexual activity, substance use, or mental health issues.

Begin your examination by collecting subjective data, or information your patient or their caregiver shares. For patients up to age 2, obtain a perinatal history from their caregiver, which includes health during pregnancy, the length of labor, type of delivery, and problems related to pregnancy or delivery. You'll also collect information about your patient's progress in reaching developmental milestones like walking, talking, or turning a page in a book. In addition, collect data about their past medical history, including allergies, chronic disorders, and immunization status. Other subjective data includes sleeping and eating patterns, amount of screen time, and the use of safety measures, like car seats and helmets when biking, skateboarding, or using a scooter.

Next, gather objective data, or information you observe. During your examination, you'll observe your patient's general appearance, motor skills, and speech patterns, as well as their interactions with you and their caregiver. As with an adult, you'll complete a comprehensive assessment, but the pediatric assessment sequence is generally conducted from the least invasive to most invasive, instead of head-to-toe. For example, when assessing infants, toddlers, and preschoolers, you'll typically examine their ears and mouth last, whereas in school-age patients and adolescents, the genitalia are assessed last.

When measuring height and weight, measure the recumbent length of infants and children under 2 years old using a tape measure or measuring board, and measure their weight using an infant balance scale. Also remember to measure head circumference for patients under 2 years old. Once the child can stand safely on their own, height and weight can be measured using a stadiometer. Body measurements of pediatric patients are typically plotted on a growth chart to allow for tracking and comparison to patients of the same age and sex over time, and body mass index, or BMI, is calculated beginning at age two.

Next, measure your patient's vital signs. When measuring the vital signs of infants, remember they tend to breathe using their diaphragm and their respirations are typically irregular, so count their abdominal movements for a full minute. Blood pressure isn't regularly assessed in patients under three years old. For the temperature of patients less than five years old, you'll measure an axillary, temporal, or tympanic temperature, rather than oral.

Now, there are some specific assessments you'll do, depending on your patient's age. For instance, you'll assess the primitive reflexes in newborns like the Moro reflex or rooting reflex, and for older children, you'll check reflexes like the patellar and Achilles reflexes.

When assessing the ears of young children, have them sit facing their caregiver on their lap while the caregiver helps keep the child's head turned sideways. Then, to straighten the ear canal, pull the pinna down and back for patients under three years old, and pull the pinna up and back for patients three years old and older. Lastly, for adolescents, you'll screen for scoliosis, which is an S-shaped curvature of the spine.

Alright, as a quick recap…Assessment of the infant, child, and adolescent involves a variety of techniques depending on your patient's age and development. As the nurse, you'll prepare your patient for the assessment and then collect subjective and objective data, while keeping in mind age-specific techniques and variations.