The physical assessment of a child differs from that of an adult due to differences in cognitive, psychosocial, and physical development. In terms of similarity, the general steps in assessment for children and adults are the same – inspection, palpation, percussion and auscultation (except for the abdomen, in which auscultation comes before palpation) (AAP, n.d.). In both groups, history taking precedes examination and the taking of the vital signs and data including height and weight is done before examining the systems. However, depending on age, some children cannot effectively partake in history taking by accurately answering assessment questions. While many adults have the control of giving their own history, not all children can do that. Caregivers or parents may thus help to answer history questions during a child’s physical assessment.
Furthermore, some younger children including toddlers and preschoolers may be afraid of strangers based on their psychosocial developmental stage, and it would thus be appropriate for the nurse to adopt strategies such as letting the child play with the stethoscope to allay their anxiety and build some trust before proceeding with the physical assessment (ODPHP, 2017). To communicate and engage with the child, the nurse may apply role play, distraction with toys, or use popular stories and characters to try and captivate the child’s attention and trust depending on their age and developmental stage. According to the American Academy of Pediatrics (n.d.), the nurse should physically stoop down to maintain their eye at the level of the child’s to avoid intimidating the child.
American Academy of Pediatrics [AAP]. (n.d.). Preparticipation physical evaluation. Retrieved from https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Council-on-sports-medicine-and-fitness/Pages/PPE.aspx
Office of Disease Prevention and Health Promotion [ODPHP]. (2017). Early and middle childhood. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/early-and-middle-childhood