] NURS 629 PEDS EXAM
Proportional changes in infants: weight, height, head, nervous system, chest -
ANSWER Weight increases 6-8lbs, up to 20lbs in the 1st year of life
Posterior fontanelle closes by - ANSWER 2 months of age
Infant eye alignment - ANSWER Some children get cross eyed at times, but usually
resolve close to 4 months
Red reflex should be symmetrical
When do infant abdominal muscles close? - ANSWER By 3 months of age
Normal development for boys: - ANSWER Both testicles are descended by 6
months
Note any hydrocele
Normal development for girls: - ANSWER Assess for labial adhesions
Normal infant musculoskeletal development - ANSWER Leg fold symmetry
Hip abduction: To make sure there are no hip clicks. Barlow maneuver and Ortolani
maneuver will assess for hip click
Foot shape and flexibility
Skin: rashes - ANSWER Common - infantile eczema
Lesions
Bruising or burns: Mongolian spots are normal
Feeding difficulties - ANSWER Regurgitation and spitting-up
○ Acid reflux is prevalent d/t sphincters are not mature
○ Encourage parents to break up feeding after ~15mL. burp the child and then return
to feeding
○ Spitting up can be large amount and it is normal for it to come out of the nose
Colic
○ Common during newborn period, usually resolves by 6 months of life
Normal Toddler growth and development - ANSWER -Weight gain 4-6lbs per year
-Height: 3 inches per year
-Visual acuity 20/40
-Brain growth is 75% completed
,-Respiratory tract is rapidly developing closer to that of an adult, but still anatomically
is much smaller.
-Immune system is weakened, increased risk for any kind of complications
-Measurements: height, weight, head circumference up until 2 years of age
-Physical exam
Normal toddler HEENT - ANSWER Anterior fontanel - make sure it is getting
smaller and closing
● It usually closes by 18 months - 2 years
Screen for strabismus
Look for tooth eruption and/or dental decay
● If by 18 months they do not have a first tooth eruption, order x-ray
Normal toddler musculoskeletal - ANSWER Assess for hip dysplasia, gait, out-
toeing, bowlegged
Normal toddler neurological - ANSWER Deep tendon reflex
Babinski
Normal preschool growth and development - ANSWER -Weight gain 5 lbs/year
-Height 2-3 inches/year
-Head circumference, no needed since the anterior fontanelle should have closed 18
months - 2 years
-Screening: vision and hearing
Normal school aged growth and development - ANSWER Slow but steady growth:
● Height: increases 2 in/year
● Weight: 4 ½ - 6 ½ lbs/year
● Skeletal lengthening & fat diminution
● Strength increases yet muscles remain functionally immature
● Start to lose those primary teeth and develop their permanent teeth
● GI system, cardiovascular system becomes that of an adult
● Bladder capacity increases
● Immune system improves
● Bones become hard and they are not as pliable as it was in the early ages
● Prepubescent
Vital signs: approaching adult values by the end of the school age:
● Blood pressure
● Vision screening
● Hearing screening
Normal adolescent growth and development - ANSWER Extremities grow faster
than trunk and head
Facial proportions change
● Nose and chin enlarge first
Figure changes
● Pelvis enlarges in females
, ● Shoulders enlarge in male
Subcutaneous fat increases
Increased function of sweat glands
Increased function of sebaceous glands
Puberty begins - ANSWER Girls: 9-13 years
Boys: 11-14 years
Puberty changes in girls - ANSWER -Breast enlargement begins 8-13 years
-Axillary hair develops 11-13 years
-Pubic hair develops 10-12 years
-Menarche begins 10-16 years
Puberty changes in boys - ANSWER -Genital enlargement begins 9-13 years
-Axillary hair begins 12-14 years
-Facial hair develops 11-14 years
-Pubic hair develops 12-15 years
Normal adolescent physical exam findings - ANSWER Obtain vitals, height &
weight with BMI
Head to toe examinations
○ Acne
○ Athletic teens may have lower heart rate
○ Changes related to puberty - including Tanner staging
Neonate normal milestones vs red flags - ANSWER Normal
Strong reflexes. Minimum of 6-8 bowel movements per day. Urinates 8 times a day
Abnormal
Jaundice at birth (hemolysis). High-pitched cry. Irritable. "Floppy" (hypotonic). Poor
reflexes
3rd month normal milestones vs red flags - ANSWER Normal
Smiles. Able to coo. Makes gurgling sounds. Can hold head up. Starts to recognize
parents. Crawls.
Abnormal
Inability to hold head up. Avoids eye contact. Floppy.
6th month normal milestones vs red flags - ANSWER Normal
Sits up without support. Rolls in both directions (front to back, back to front). Says
single-syllable sounds "ba, da, ma." Tries to get things out of reach by "raking" (uses
palms to reach).
Abnormal
Proportional changes in infants: weight, height, head, nervous system, chest -
ANSWER Weight increases 6-8lbs, up to 20lbs in the 1st year of life
Posterior fontanelle closes by - ANSWER 2 months of age
Infant eye alignment - ANSWER Some children get cross eyed at times, but usually
resolve close to 4 months
Red reflex should be symmetrical
When do infant abdominal muscles close? - ANSWER By 3 months of age
Normal development for boys: - ANSWER Both testicles are descended by 6
months
Note any hydrocele
Normal development for girls: - ANSWER Assess for labial adhesions
Normal infant musculoskeletal development - ANSWER Leg fold symmetry
Hip abduction: To make sure there are no hip clicks. Barlow maneuver and Ortolani
maneuver will assess for hip click
Foot shape and flexibility
Skin: rashes - ANSWER Common - infantile eczema
Lesions
Bruising or burns: Mongolian spots are normal
Feeding difficulties - ANSWER Regurgitation and spitting-up
○ Acid reflux is prevalent d/t sphincters are not mature
○ Encourage parents to break up feeding after ~15mL. burp the child and then return
to feeding
○ Spitting up can be large amount and it is normal for it to come out of the nose
Colic
○ Common during newborn period, usually resolves by 6 months of life
Normal Toddler growth and development - ANSWER -Weight gain 4-6lbs per year
-Height: 3 inches per year
-Visual acuity 20/40
-Brain growth is 75% completed
,-Respiratory tract is rapidly developing closer to that of an adult, but still anatomically
is much smaller.
-Immune system is weakened, increased risk for any kind of complications
-Measurements: height, weight, head circumference up until 2 years of age
-Physical exam
Normal toddler HEENT - ANSWER Anterior fontanel - make sure it is getting
smaller and closing
● It usually closes by 18 months - 2 years
Screen for strabismus
Look for tooth eruption and/or dental decay
● If by 18 months they do not have a first tooth eruption, order x-ray
Normal toddler musculoskeletal - ANSWER Assess for hip dysplasia, gait, out-
toeing, bowlegged
Normal toddler neurological - ANSWER Deep tendon reflex
Babinski
Normal preschool growth and development - ANSWER -Weight gain 5 lbs/year
-Height 2-3 inches/year
-Head circumference, no needed since the anterior fontanelle should have closed 18
months - 2 years
-Screening: vision and hearing
Normal school aged growth and development - ANSWER Slow but steady growth:
● Height: increases 2 in/year
● Weight: 4 ½ - 6 ½ lbs/year
● Skeletal lengthening & fat diminution
● Strength increases yet muscles remain functionally immature
● Start to lose those primary teeth and develop their permanent teeth
● GI system, cardiovascular system becomes that of an adult
● Bladder capacity increases
● Immune system improves
● Bones become hard and they are not as pliable as it was in the early ages
● Prepubescent
Vital signs: approaching adult values by the end of the school age:
● Blood pressure
● Vision screening
● Hearing screening
Normal adolescent growth and development - ANSWER Extremities grow faster
than trunk and head
Facial proportions change
● Nose and chin enlarge first
Figure changes
● Pelvis enlarges in females
, ● Shoulders enlarge in male
Subcutaneous fat increases
Increased function of sweat glands
Increased function of sebaceous glands
Puberty begins - ANSWER Girls: 9-13 years
Boys: 11-14 years
Puberty changes in girls - ANSWER -Breast enlargement begins 8-13 years
-Axillary hair develops 11-13 years
-Pubic hair develops 10-12 years
-Menarche begins 10-16 years
Puberty changes in boys - ANSWER -Genital enlargement begins 9-13 years
-Axillary hair begins 12-14 years
-Facial hair develops 11-14 years
-Pubic hair develops 12-15 years
Normal adolescent physical exam findings - ANSWER Obtain vitals, height &
weight with BMI
Head to toe examinations
○ Acne
○ Athletic teens may have lower heart rate
○ Changes related to puberty - including Tanner staging
Neonate normal milestones vs red flags - ANSWER Normal
Strong reflexes. Minimum of 6-8 bowel movements per day. Urinates 8 times a day
Abnormal
Jaundice at birth (hemolysis). High-pitched cry. Irritable. "Floppy" (hypotonic). Poor
reflexes
3rd month normal milestones vs red flags - ANSWER Normal
Smiles. Able to coo. Makes gurgling sounds. Can hold head up. Starts to recognize
parents. Crawls.
Abnormal
Inability to hold head up. Avoids eye contact. Floppy.
6th month normal milestones vs red flags - ANSWER Normal
Sits up without support. Rolls in both directions (front to back, back to front). Says
single-syllable sounds "ba, da, ma." Tries to get things out of reach by "raking" (uses
palms to reach).
Abnormal
