428 Unit 4 | Common Illnesses or Disorders in Childhood and Home Care
● Estimate of gestational age ● Complications of pregnancy or delivery
Review of Systems ● Basic head-to-toe physical assessment of normal versus abnor- mal findings Weight ● Infant weight without diaper on infant scale ● Minimal clothing for other children ● Scales should be calibrated for accuracy before weighing Height ● Supine measurement for infants until age 24 months ● Children older than 24 months should be measured using a stadiometer (scales with measuring arms not recommended). ● While using a stadiometer, take the child’s shoes off and make sure the child is standing with feet together, heels against the wall, and standing straight with the hands down to the side. Children with ponytails should take their hair down (Escobar & Perez, 2021). Head Circumference ● Obtained using a measuring tape until age 36 months unless otherwise indicated by physician ● Level of fontanels should be assessed in infants Height and Weight Calculations ● Careful and accurate plotting of height, weight, and head circumference on growth chart (Richmond & Rogol, 2021) ● Body surface area (BSA; refer to Chapter 10) ● Midparental height (MPH) or target height (TH) (Escobar & Perez-Garcia, 2021) ● For boys: Mother’s height (cm) + father’s height (cm) + 6.5 cm ● For girls: Mother’s height (cm) + father’s height (cm) divided by 2 – 6.5 cm ● Body mass index (BMI) (Malhotra, 2021) (Weight in kg) OR (Weight in kg) (Height in cm divided by 100) 2 (Height in meters) 2 ● Height velocity (Escobar & Perez-Garcia, 2021) ● Number of centimeters (cm) or inches (in) in growth per year Vital Signs ● See vital sign parameters in Chapter 7. Tanner Stages of Puberty ● Refer to the Tanner staging chart in Chapter 10. ● Assess for signs of ambiguous genitalia and abnormal advance- ment in puberty (Chan & Levitsky, 2021; Horner, 2007). Skin ● Assess skin for unusual areas of discoloration or areas of increased pigmentation. Body Odor ● Assess for unusual smells (e.g., musty, cheesy, sweet).
● Parental substance abuse ● Neonatal complications
Hospitalizations ● Overnight stays ● Surgeries—type and recovery time ● Accidents or injuries Current Medications ● Prescribed ● Over the counter ● Dietary supplements ● Alternative/natural remedies
Allergies ● Medications ● Seasonal ● Foods/other
Immunizations ● Current, missed doses, and/or due dates
Family History ● Endocrine disorders ● Extreme short stature
● Parental heights/sibling heights ● History of other chronic disease Developmental History ● Age of developmental milestones ● School performance ● History of behavioral problems
Nutrition ● Type of infant feeding (breast or formula)
● Types of food preferred ● Diet history—2 to 3 days ● Eating patterns ● Type and frequency of fast-food consumption ● Amount of milk consumed per day ● Any eating-related vomiting/GI distress ● Problems with chewing, swallowing, eating, or drinking Activities ● Daily activities—type, quantity, how often ● Physical activity in school/team sports ● Number of TV/computer/video game hours per day Physical Examination A physical examination for endocrine conditions should include the following aspects.
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