Physical Growth Should Be Carefully Monitored in Infants and Young Children. Standard Growth

Ch24 Summary

Physical growth should be carefully monitored in infants and young children. Standard growth charts are used to compare the child’s physical growth with national standards. This information helps identify children who are experiencing delayed growth. Normally, an infant will double his or her birth weight in the first 6 months of life, and triple it in the first 12 months. An infant’s height increases at the rate of 1 inch per month for the first 6 months of life and at a rate of 1/2 inch per month for the next 6 months.

Infants younger than 6 months of age are unable to shiver in response to lower ambient temperatures and thus have difficulty regulating their body temperature. By age 4 years, the child’s temperature parameters are comparable to those of an adult. Heart and respiratory rates are elevated in infants and young children and decrease as the child becomes older. By preadolescence the heart and respiratory rates are comparable to those of an adult. Normally, blood pressure is lower in infants and children than it is in adults. The following formula, normal systolic BP = 80 + (2 × [mult. “x”]age in years), may be used to determine a child’s blood pressure. Diastolic blood pressure is normally two-thirds the systolic pressure.

The approach to performing a physical assessment on a child is different from that for an adult. Although the strategies employed are based on the developmental age of the child, some strategies apply universally, such as the importance of maintaining a warm, comfortable environment during the exam. Implement techniques to decrease anxiety and promote a sense of security in the child and caregiver. Younger children respond well to game playing, distraction, and the demonstration of procedures on dolls or stuffed animals first. Older children respond better to truthful explanations of the procedures and being told whether or not they will experience pain. Always maintain privacy and protect the child’s modesty as much as possible. It is recommended to interview older children separately from their caregiver, as they may have concerns they might not feel comfortable expressing in front of their caregiver. It is usually best to save uncomfortable procedures for the end of the examination, after you have built a trusting relationship with the child and caregiver.

The technique for auscultating heart sounds in a child differs from that for an adult. To auscultate heart sounds in a young child, follow a Z pattern that moves from left to right. Auscultate for the presence of additional heart sounds or murmurs. Fifty percent of children will have innocent heart murmurs at some point in their lives. These murmurs are exacerbated in high cardiac output states such as fever. Auscultation should occur with the child in two positions, seated and lying down. An innocent murmur is heard best in early systole at the second or third intercostal space at the left sternal border. Innocent murmurs have a musical quality that disappears when the child lies down.