Nursing Health Assessment: Toddler & Preschooler

Front 1

Weigh, height, head & chest circumference.

Back 1

Toddlers: gain 4-6 lbs & Grow 3 inches in height yearly. Head & chest circumferences are equal at 2 yrs old.
Preschoolers: gain 5 lb & grow 2 1/2 to 3 inches in Height yearly.

Front 2

Vital signs

Back 2

Gradual & slight increase in blood pressure & slight decrease in temperture, pulse, and respirations.

Front 3

General Health Survey:
Inspect overall appearence, Noting: appropriate growth & development for the child's age.

Back 3

Toddler's General Appearence: "Pot belly" & wide base of support are normal.
Preschooler: loses pot belly & becomes taller & leaner.
Detect any delays or premature maturation.
Note any obvious weight prolems.

Front 4

Integumentary:
Inspect skin for lesions.

Back 4

Lesions, such as tinea capitis or (ringworm), need treatment.

Front 5

Inspect hair & scalp for lice.

Back 5

Pediculosis common among preschoolers.

Front 6

HEENT
Head & Face:
Inspect head and face.

Back 6

Size of head slows to 1 inch yearly until age 2, then slows to 1/2 inch yearly until age 5.

Front 7

Head & Face:
Palpate anterior fontanel.

Back 7

Closes by 18 months.

Front 8

Eyes:
Test visual acuity.

Back 8

Visual acuity is 20/40 during toddler years.
Vision screening between 3 to 4 yrs old.
Visual deficits warrant follow-up.

Front 9

Eyes:
Test for "Lazy eye" (Strabismus) with corneal light reflex or cover-uncover test.

Back 9

Referral needed for strabismus to prevent amblyopia (reduction or dimness in vision).

Front 10

Ears:
Test hearing with pure tone audiometer.

Back 10

Hearing deficits warrent follow-up.

Front 11

Ears:
Inspect external ear canal & typanic membrane.

Back 11

Hearing should be tested between 3 to 4 yrs old.

Front 12

Ears:
Otoscopic exam (leave until last part of the physical assessment).

Back 12

High incidence of otitis media.

Front 13

Nose:
Inspect the nasal septum & mucosa.

Back 13

Chronic rhinorrhea can result from allergic rhinitis. (Boogy, bluish-purple, or gray turbinates)

Front 14

When inspecting the nares or the external ear canal,be award of...

Back 14

Foreign objects.

Front 15

Mouth:
Inspect oral mucosa & pharynx.

Back 15

Tonsils are generally large.

Front 16

Mouth:
Inspect number & condition of teeth.

Back 16

Eruption of primary teeth completed by 2 1/2 yrs old.
Note: any nursing/baby-bottle caries.
Review dental hygiene with parent & child.

Front 17

Neck:
Palpate the neck for lymph nodes.

Back 17

Enlarged lymph nodes may be associated with an infection or lymphoma.

Front 18

Respiratory:
Inspect & measure size & shape of chest.

Back 18

anteroposterior: lateral diameter 1:2 by end of 2nd year.

Front 19

Cardiovascular:
Ausculate heart; Note: rate & rhythm.

Back 19

Children often have a sinus arrhythmia & a split second heart sound. Both the arrhythmia & the split second sound change with respiration. This is a normal variation. Systiolic innocent murmurs & venous hum are common findings.
If murmur is detected, refer for follow-up to rule out pathology.

Front 20

Gastrointestinal:
Inspect, ausculate, & palpate abdomen.

Back 20

A pot belly is normal for a toddler; the condition disappears as the abdominal muscles strengthen.

Front 21

Musculosketetal:
Inspect gait.

Back 21

Toddlers walk alone by 12 to 13 months. Balance is unsteady with wide base of support. Genu valgus or varus may be present.
Preschool's gait more balanced, smaller base of support; walks, jumps, climbs by 3 yrs old.

Front 22

Musculoskeletal:
Test muscle strength.

Back 22

Strength increases during preschool years.

Front 23

Neurologic:
Test balance, coordination, & accuracy of movements.

Back 23

Balance & coordination improve, with refinement of fine motor skills.