Pediatric Nursing Q 201
Which of the following is the best method for performing a physical examination on a toddler?
A. From head to toe
B. Distally to proximally
C. From abdomen to toes, the to head
D. From least to most intrusive
Correct Answer: D. From least to most intrusive
When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Stay at the child’s level as much as possible. Do not tower. Examine painful areas last-get general impression of overall attitude. Be honest. If something is going to hurt, tell them that in a calm fashion.
Option A: Starting at the head or abdomen is intrusive and should be avoided. The last items to perform in the physical exam should always be those things that are most threatening to the child, including looking in the ears and mouth.
Option B: Proceeding from distal to proximal is inappropriate at any age. In general, when evaluating any child, observation is the best initial diagnostic tool. The degree of alertness and interaction, responsiveness to parents, and respiratory status are all valuable measures of illness that may either suggest or eliminate concerns of toxicity.
Option C: After observation, it is important to begin the exam with auscultation of the heart and lungs as this is usually when the child is calm, quiet, and most cooperative. While doing the actual physical exam, try to use the parent’s lap as much as possible as the child is most comfortable there.