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Differences from adult in physical examination

Differences from adult in physical examination

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Differences from adult in physical examination

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  1. Differences from adult in physical examination • Comfort, confidence of the baby FIRST • OBSERVATION! • Unstructured • Intimidating examinations last • Variation from 1 Kg to 45, HR from 140 to 72 • Tools of the trade vary from toys to measuring tapes to different sizes of stethescope & BP cuffs. • Congenital malformations, dysmorphic features • Anthropometry:weight, height,HC, MAC, (span, US:LS ratio) • Developomental assessment • Nutritional status

  2. Physiological variations • Ant. Fontanel • Tonsils • Dentition • Apex beat; functional murmers • Respiratory: puerile breath sounds • Abdomen:palpable liver & spleen • Genitalia:hydrocoel in NB, phimosis in infant • umbilical hernia • Bow legs & flat feet up to 2 years • Upgoing plantars up to 2 years

  3. SOME MEMORY-AIDS INPAED.PHYSICAL EXAMINATION

  4. A ROUGH ESTIMATE OF WEIGHT • After initial wt. loss, wt.gain starts at about 10 days of age, at approx. 30 gms./day for first 3 months. • 5 months of age=BWx2 (3x2 =6Kg) • 12 months BW x3 (3x3=9Kg) • 2 yrs. BWx4 (3x4=12kg) • 3yrs. BWx5 (3x5=15Kg) • 10 yrs. Bwx10 (3x10=30kg)

  5. A rough estimate of length • (recumbent) length upto 2 yrs.of age • (standing) height after 2 yrs.of age • At birth: 50cm. • 1 year : 75cm (50% increase) • 2 years: 87.5cm ) • 4years; 100cm. • Then 5cm. /year till 10 years • (2 to 12 years…age in yrs. X6 +77cm)

  6. Head circumference • At birth: ~ 35cms. • At 12 months 47cm. (ie 12cm. increase in 12 months, but not at the rate of 1 cm./ month,but: • 2cm/mth.x3months, • 1cm/mth.xnext 3months • 0.5 cm/month x next 6 months!) • HC is approx. 3cm.> CC at birth. • HC = CC at 1 year, after which CC is > HC