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Vitals. Adapted from Mosby’s Guide to Physical Examination, 5 th Ed. Ch. 3 . Vitals . Pulse Respiration Blood pressure Temp Height & weight (infants and children). Pulse. Apical pulse 5 th intercostal space in the midclavicular line Femoral pulse

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vitals

Vitals

Adapted from Mosby’s Guide to Physical Examination, 5th Ed.

Ch. 3

vitals1
Vitals
  • Pulse
  • Respiration
  • Blood pressure
  • Temp
  • Height & weight (infants and children)
pulse
Pulse
  • Apical pulse
    • 5th intercostal space in the midclavicular line
  • Femoral pulse
    • use a point halfway from the pubic tubercle to ASIS as a guide
respiration
Respiration
  • Infants – rise and fall of the abdomen facilitates counting
    • Rate
    • Regularity and rhythm
    • Depth
    • Difficulty; use of accessory muscles
blood pressure
Blood Pressure
  • Cuff size (children)
    • Width should cover ~2/3 of the upper arm or thigh

Too wide - underestimate BP

Too narrow - artificially high BP

http://store.datascope.com/Assets/product_images/0998-00-0003-21,22_s164_jpg.jpg

temperature
Temperature
  • Tympanic thermometers are becoming increasingly popular
    • Accuracy depends on correct technique
      • Must read tympanic membrane which shares blood supply with the hypothalamus
temperature young infants
Temperature – Young Infants
  • Traditional routes may be more accurate

NOTE: axillary temp correlates well with core temp of newborns

    • due to the infant’s small body mass and uniform skin blood flow
height infant
Height - Infant

Infant measuring mat

OR

Mark on a sheet of headrest paper

height child
Height - Child

“Stature measuring device”

(or height chart)

  • child is able to stand without support
  • approx. 24 months old
weight
Weight
  • Infant platform scale
    • More accurate

(ounces or grams)

    • Child may sit or lie
    • Place paper or blanket under the child
      • “weigh it out”
growth and measurement

Growth and Measurement

Adapted from Mosby’s Guide to Physical Examination, 5th Ed. Ch. 5

MacGregor, 2000

newborn
Newborn
  • Most babies born to the same parents weigh within 6oz of each other at birth
    • Lower birth weight: consider an undisclosed congenital abnormality or intrauterine growth retardation
slide15
Average Weight
  • 5 lb, 8 oz – 8 lb, 13oz (term newborn)

Expected growth

  • Double birth weight by 4-5 months
  • Triple birth weight by 12 months

NOTE: on average formula-fed babies are heavier after the 1st 6 months than breast-fed babies

slide16
Average Length
  • 18-22 in (45-55cm) long at birth

Expected Growth

  • Length increases by 50%in the 1st year of life
growth
Growth
  • Infancy
    • Growth of the trunk predominates
    • Fat increases until 9 months of age
      • What happens at 9 months?
  • Childhood
    • Legs are the fastest growing body part
    • Weight is gained at a steady rate
    • Fat increases slowly until 7 yrs of age when a prepubertal fat spurt occurs before the true growth spurt
growth1
Growth
  • Adolescence
    • Trunk and legs elongate
    • About 50% of the ideal weight is gained
    • Skeletal mass and organ systems double in size
measurement
Measurement

Infant

  • Length
  • Weight
  • Head circumference
  • Chest circumference

Child

  • Height
  • Weight
recumbent length
Recumbent Length
  • Measurement of choice for infants birth to 24-36 months
recumbent length1
Recumbent Length
  • Tear a length of headrest paper
  • Lay the child on top of the paper
  • Mark the top of the child’s head
  • Ask mother to hold child in place
  • Extend leg and mark under the heel (foot dorsiflexed)
recumbent length2
Recumbent Length
  • Measure to the nearest 0.5 cm or ¼ in.
  • Chart on appropriate growth curve for sex and age
    • Identify the infant’s percentile
    • Note any change or variation from the population standard or the child’s norm
standing height
Standing Height
  • Child stands erect
    • Heels, buttocks and shoulders against the wall
    • Looking straight ahead
      • Outer canthus of the eye should line up with the external auditory canal
  • Slide the headpiece onto the crown
standing height1
Standing Height
  • Use once the child is walking well
  • Usually about 24-36 months
  • Stature is recorded to the nearest ¼ in (0.5 cm)
infant scale oz or g
Infant scale (oz or g)
  • Distract the infant and balance the scale
  • Read the weight to the nearest ½ oz (10g) when the infant is most still
  • Chart on appropriate growth curve for sex and age
    • Identify the infant’s percentile
    • Note any change or variation from the population standard or the child’s norm
head circumference
Head Circumference
  • Measure the infant’s head at every “health visit” until 2 years of age
    • Yearly from 2-6 years of age

Newborn: 13-14 in (33-35 cm)

NOTE: By 2, the head is 2/3 its adult size

head circumference1
Head Circumference
  • Measure the largest circumference with the tape snug
    • Occipital protuberance to the supraorbital prominence
head circumference2
Head Circumference
  • Nearest 1/4 in (0.5 cm)
  • Repeat to check the accuracy of your measurement
  • Chart on appropriate growth curve for sex and age
    • Identify the infant’s percentile
    • Note any change or variation from the population standard or the child’s norm
what if
What if…?
  • Head circumference increases rapidly
    • Rises above percentile curves

~> Increased intracranial pressure

  • Head circumference grows slowly
    • Falls off percentile curves

~> Microcephaly

chest circumference
Chest Circumference
  • Measure around the nipple line to the nearest 1/4 in (0.5 cm)
    • Firmly but not tight

enough to cause

an indentation in the skin

head vs chest circumference
Head vs. Chest Circumference

Newborn to 5 months

  • Head may be equal or exceed the chest by 2 cm

5 months to 2 years

  • Chest should closely approximate the head circumference

2 years +

  • Chest should exceed head circumference
growth development abnormalities
Growth/ Development Abnormalities

What might you detect by recording height, weight, head & chest circumference?

  • Failure to thrive
  • Craniosynostosis
  • Hydrocephalus
  • Turner’s syndrome etc.
failure to thrive
Failure to Thrive
  • Failure of an infant to grow at “normal rates”
  • May be related to:
    • Chronic disease
    • Congenital disorder (brain, heart, kidney)
    • Inadequate calories and protein
    • Improper feeding methods
    • Intrauterine growth retardation
    • Emotional deprivation
failure to thrive1
Failure to Thrive
  • An emotionally deprived infant will not grow
    • Growth hormone levels will be low

Once the child is given attention, growth hormone will be produced and the child will grow.

craniosynostosis
Craniosynostosis

www.emedicine.com/neuro/topic80.htm

Early closure of suture(s)

Associated with:

  • small head circumference (microcephaly)
  • rigid sutures

www.emedicine.com/neuro/topic80.htm

hydrocephalus
Hydrocephalus

Excess CSF accumulates between the brain and the dura or within the ventricular system

Resultant increased ICP leads to:

  • head enlargement
  • widening of sutures and fontanels
  • lethargy, irritability, weakness
  • “setting sun eyes”
turner syndrome
Turner Syndrome
  • Abnormality of sex chromosomes
  • Characteristics include:
    • Short stature
    • Absence of sexual development
    • Webbed neck
    • Shield-shaped chest
    • Hypoplastic axillary nipples
    • Increased carrying angle
    • Congenital abnormalities or heart or urinary tract
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