What observations should be noted during the emergent physical exam of pediatric patients with fever?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Answer

The infant's or child's interactions with the parent or caregiver are easily observed while the history is obtained. The following observations should be noted:

  • What is the quality of the cry? Is it abnormal, high pitched, or weak in effort?

  • Does the child appear fearful of the examiner? Beyond infancy, healthy young children should fear strangers; the child who lies on the examination table without much interaction or who is not disturbed by an examination may be more likely to have a more serious illness

  • What is the skin color? Are there areas of cyanosis or jaundice? Are there any rashes present?

  • What is the degree of hydration? Are tears present during crying? Is there moisture on the oral mucosa/lips or tongue? For the neonate, a gentle palpation of the anterior fontanelle may give a general indication to the fluid status; a sunken fontanelle indicates possible hypovolemia/dehydration

  • What is the response to social overtures? Does the baby smile at the examiner? Does the baby smile or appear interested in a small toy or other shiny object? Checking for a social smile is a helpful component of the examination because it remains one of the better predictors of well babies [30]


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