Auscultation: note any wheezing(asthma, viral-induced wheeze), crepitations (secretions, bronchiolitis, infection), or bronchial breathing (pneumonia). If the child is crying, try to listen during inspirations. Listen anteriorly and posteriorly.
Pupils: check with torch if very unwell(sluggish response = post-ictal or drug toxicity; changing sizes = seizure; asymmetrical = SOL, e.g. sub-/extradural; gaze may be abnormal after a seizure)
Limb tone and movement (also check for joint swelling)
Rash (inspect everywhere) and check for neck stiffness
Capillary glucose: measure if decreased alertness
Normal paediatric observations
Ensure you tell the parent what you need to do and give clear instructions.
Ears: the child must be stable and held tight, sitting sideways on parent’s lap. The parent should keep one hand on the child’s head and the other encircling their arms and body. Use your free hand to hold the head in against the parent’s chest. NB: healthy eardrums often pink.
Throat: position the child facing you on parent’s lap. They should use one arm to hold the child’s forehead back and the other to encircle their arms. You may need to use a tongue depressor. NB: children often have large red tonsils.
Measuretemperature (axilla recommended in babies)
Feel – best if lying flat but child can be examined in parent’s lap
Ask child to point to pain with finger (start away from painful areas)
Palpate gently first, then deeper
Check for organomegaly (liver, spleen, kidneys)
Check inguinal region and umbilicus for hernias
Auscultate for bowel sounds
Produced using NICE ‘CG160 fever in under 5s: assessment and initial management’ 2013