Examination of children

In Pediatrics use all methods of assessment, which are used in adults (see History in children), but to ensure that the results are correct and reliable, you need to know some special methods the objective of the study children.
The first is the right approach to child, to reassure him. Cry and worry baby make it difficult and even impossible examination. If a child is caught sleeping, you should not Wake, and in questioning the mother, trying during sleep to get through inspection perhaps more data.
Pay attention to the situation of the child. Healthy infant during sleep, lying on his back, pens bent at the elbows, clamped in the jaws.
Older kids certain position during sleep, do not accept.
In some diseases of children observed typical of the disease situation. When meningitis child usually lies on her side, legs bent at the knees, and are drawn to the stomach; in the case of pleural effusion cavity on the sick side; when pancarditis, bronchial asthma child prefers poluciaetsea or sitting position.
Then pay attention to the color of skin of the face and presence of rash. Pale skin with different shades observed in anemia, leukemia, kidney diseases, tuberculosis intoxication, rheumatism. Redness of the skin - with pneumonia, influenza and other fevers. Yellowish colour is visible in daylight. Cyanosis is characteristic of diseases of the heart and lungs. The nature of skin rashes we can assume the existence of a disease (piodermia, exudative diathesis, infectious disease, hemorrhagic diathesis, and so on).
Next, find out the nature of cough and breathing. Frequent "kaysee" breathing swelling of the nose wings, indrawing compliant places of chest, short cough suggest pneumonia.
Calm the child during sleep is the best time to count the pulse and respiration. Slow pulse characteristic of typhoid, meningitis, quickly disappears when the anxiety and the cry of the child. If the child is not sleeping, you should avoid anything that might cause him anxiety. It is not recommended to stare at him, quickly to approach, talk loudly. It is advisable during the inspection to take the child with a toy or a playful conversation.
Before the examination it is necessary to warm and wash hands, as the skin of children, especially infants, easily damaged and prone to purulent infections.
In the future the plan of treatment depends on the age and the sex of the baby. Children under two years of age should strip naked and perform inspection in the crib, changing table or on his mother's lap. Older children undress gradually research. The latter is especially recommended against the girls of school age, especially in the period of pubertybecause of their shame.
We should not forget to explore the legs of the child not to miss such diseases as hemorrhagic vasculitis, erythema nodosum, congenital hip dislocation, like changes bones, etc.
Very stubbornly opposed to the survey children with unstable nervous system. These children are sometimes unexpectedly subject to strict order and only in exceptional cases, they have to hold.
Examination of the throat as the most unpleasant for child procedure is carried out at the end of the study; this should not give in to requests of the child and parents to examine the throat without a spoon or spatula. The child can be calm, saying that spoon or spatula need for examination of the teeth.
Each child requires individual approach, and the success of the survey is completely dependent on experience and skills of the inquirer.

Survey of older children differs little from the survey of the adult. In the examination of children of early age the same research methods should be adapted to the age characteristics of the organism of the child and the findings should be treated with due account for these characteristics. Special approach to the child and partly to his mother, ability to make observations during inspection and obtain the necessary information require pediatrician not only medical but also pedagogical knowledge, great tranquility and patience. History (see) is collected by questioning the mother or caretaker of the child parties. during the conversation, the pediatrician should pay attention to the position of the baby in the crib or in the mother's arms, on his motion, behavior, opinion, etc. that could enable a tentative assumptions about a particular disease. After interviewing the mother of the child should be exposed to a thorough inspection of the entire body. Objective research should begin with such methods, which are less likely to cause discomfort and resistance of the child. Therefore the order of examination of organs and systems in a child other than adults, and often vary not only depending on the type of disease, but also from the behavior of the child in the study. So, the expense of pulse and respiration, very labile children are only performed when a quiet condition or in sleep.
The feeling of the child must be done very carefully washed clean and always a warm hands. Determines the thickness of the subcutaneous layer, elasticity and turgor of the skin and subcutaneous fat layer. Along with the inspection of great importance feeling the bones, taking into account features of the skeleton depending on the age of the child; exposes rachitic changes (softening of the bones or giperostos), fractures, tumors and other
The state of the muscular system is investigated as with feelings, and with the help determine tone during passive movements.
Palpation of the lymph nodes is made by the General rules; in children of early age often felt soft lymph nodes at full health.
In the study of the chest, one should remember that the boundaries and status of different depending on the age even within the first three years. Due to the thinness of the walls and the small size of the chest require especially careful percussion, the younger the child. In infants is not always possible to conduct the percussion in a sitting position, children of the first months of life often percutiebat in the supine position. Cry, strong breath ("rolling up") or exhale change the results percussion, has to check at a calm condition. Crying, accompanied by deep breaths, helps percussion and auscultation, enabling to determine the mobility of the lower border of the lungs or hear the wheezing, not appearing at the surface of breath; so sometimes you have to make the child cry. Auscultation is best done biauriculate stethoscope or directly to the ear through a thin sheet. For children of early age physiologically normal is puerile breath.

The study of the stomach and abdominal organs begin with a tour, and then make palpation, which in young children is difficult because of the scream and the tension of the abdominal wall, frequent flatulence. But the subtlety of the abdominal wall allows for careful palpation warm hands easier than adults to achieve the back wall of the abdominal cavity; thus it is possible to probe and kidneys or hematoma of the adrenal the newborn. Liver and especially spleen should not be taken by strong impressions of the toes; be careful to dip your fingers item, without moving them to wait, when the breath of a child spleen "touch" to the fingers exploring. This technique, N. Speranskii allows to determine the spleen, even when it increased slightly and soft consistency.
The study of the nervous system in children is conducted according to General rules, but the correct assessment of the results in accordance with the degree of development of the nervous system depending on the age of the child.
The study of the mouth, throat, nose and ear must be the last, as is usually the strong resistance of the child, and weep, and then other studies would be difficult. If the resistance of the child these studies have put him on his knees to his mother or sister and good to keep hands and feet; it is better to wrap up his hands in a blanket. The study AEWA should be gently but quickly.
For research tools use the same devices and techniques as adults than only the size of the electrodes, catheters, olive and so on Technique of performance of all of these studies in infants more difficult, than adults, and requires great skill and experience.
Biochemical studies in children should be mainly micro methods, so as to get the blood and the urine of the child in large numbers is difficult. In the evaluation of the received results it is necessary to take into account the age of the child.