16.3 General Assessment of Body Systems

This section discusses a wide range of childhood disorders that affect various body systems, including the gastrointestinal, integumentary, neurological, cardiovascular, and musculoskeletal systems, as well as the eyes and ears. When a nurse is assessing a disorder originating in a specific body system, manifestations may be found across other body systems as well. A synopsis of possible abnormal findings that may be found on assessment is discussed in this section. View information on assessment of the respiratory system in the “Focused Assessment for Respiratory Disorders” section of the “Childhood Respiratory Disorders” chapter.

Gastrointestinal System

Table 16.3a describes abnormal findings across body systems that may be found during assessment of a child with a gastrointestinal disorder.

Life Span Considerations

When assessing a pediatric client, there are some key differences to consider regarding the gastrointestinal system^[2]:

• Eating and elimination patterns of infants require special consideration based on the stage of development. Ask parents about feeding habits. Is the baby being breastfed or formula fed? If formula fed, how does the child tolerate the formula?
• To assess for urine output in infants and toddlers, assess the frequency of wet diapers and the daily number of wet diapers. In hospitalized infants and toddlers, the diapers may be weighed for precise measurements of urine output. Urine output can be used to assess hydration status.
• Note that the expected abdominal contour of an infant is called protuberant, which means bulging. The expected abdominal contour of a child is protuberant until about the age of four.
• Assess the umbilical cord of the neonate; it should dry and fall off on its own within two weeks of life.
• Respiratory movement can be observed in the abdomen of the infant.
• Children often cannot provide additional information other than “My stomach hurts.” Other reported symptoms by children or their parents/caregivers may include decreased school attendance due to abdominal discomfort.

Integumentary System

Table 16.3b describes abnormal findings across body systems that may be found during assessment of a child with a disorder affecting the integumentary system.

Life Span Considerations

Please keep the following in mind when assessing the integumentary system of a pediatric client^[5],[6]:

• When assessing the skin of an infant, some may have acne similar to that of a teenage client.
• Upon assessment, the skin of a neonate may feel rougher than the skin of older infants.

Neurological System

Table 16.3d describes abnormal findings across body systems that may be found during assessment of a child with a disorder affecting the nervous system.

Life Span Considerations

In regard to assessment of the nervous system, there are some key differences in the pediatric population that must be considered^[9]:

• The anterior fontanel of an infant remains open until 12-18 months of age. The posterior fontanelle of an infant closes between two to three months of age.
• Motor and sensory functions in the infant continue to develop in the first year of life so this must be taken into consideration when assessing clients less than one year of age.
• The nurse must be aware of reflexes that are specific to newborns, as well as the timing for when they should disappear.

Cardiovascular System

Table 16.3e describes abnormal findings across body systems that may be found during assessment of a child with a cardiovascular disorder.

Life Span Considerations

Here are some differences that may be noted in the assessment of the cardiovascular system of a pediatric client^[11]:

• Until the ductus arteriosus closes, a murmur may be heard in newborn clients for the first few days of life.
• The apical pulse should be used to assess heart rate in children. Once the pediatric client reaches adolescence, a radial pulse can be used.
• Heart rate steadily decreases with age, reaching levels similar to adults after six years of age.

Eyes & Ears

Table 16.3f describes abnormal findings that may be found during assessment of a child with an eye or ear disorder.

Life Span Considerations

When performing an eye and ear assessment on a pediatric client there are some key differences to consider^[14],[15]:

• A Snellen chart is typically used to assess for visual impairment in adults and children who can read. However, other methods may be necessary for children who cannot yet read.
• When assessing the ear of a younger child, the ear should be pulled back and down to inspect the auditory canal and eardrum. In an older child, the ear should be brought up and back to adequately examine the auditory canal and eardrum.

Musculoskeletal System

Table 16.3g describes abnormal findings that may be found during assessment of a child with a musculoskeletal disorder.

Life Span Considerations

When the musculoskeletal system of a pediatric client is assessed, there are some key differences to consider^[17],[18]:

• Infants should be assessed for the presence of a “click” in their hips, as this can indicate issues within the hip joint.
• Although kyphosis is abnormal for adults, it is considered normal in an infant’s spine.
• When compared to adults, infants have increased external rotation of the hips.
• The knees of infants are bow-legged, and the knees of toddlers are knock-kneed.