Physical Exam Key Points

1. Growth parameters. Plot height (if age > 2 years) or recumbent length (if < 2 years), weight, and head circumference on a standard growth chart (see Appendix G, p. 766).

2. Overall appearance and behavior. Assess for eye contact, interaction, inappropriate behaviors, dysmorphic features, signs of endocrine or metabolic disease, psychosocial neglect, or emotional abuse.

3. Signs of malnutrition. Loss of subcutaneous fat, muscle wasting, sparse hair or alopecia, cheilosis, hydration.

4. Signs of maltreatment or neglect. Cutaneous injuries (eg, bruises, burns, unusual marks) or poor hygiene.

5. HEENT. Fontanelle, funduscopic exam, neck masses, dental disease, tonsillar or sinus disease, cleft palate or lip.

6. Cardiopulmonary system. Abnormal chest wall, evidence of reactive airway disease, atypical murmur or abnormal heart sounds, digital clubbing.

7. Abdomen. Protuberance, organomegaly.

8. Neurologic exam. Abnormal muscle tone and strength, coordination, deep tendon reflexes.

B. Laboratory Data. Initial laboratory tests to consider in severe cases include CBC, electrolytes, BUN and creatinine, total CO2 or HCO3, urine culture, HIV, and PPD. Order other tests as dictated by history and exam findings.

C. Radiographic and Other Studies. These tests have minimal yield if not suggested by history or exam findings. Perform skeletal survey, if maltreatment is suspected.

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