36. The child

The physical examination of children presents various challenges, as each age requires a different approach and a different communication style. Children need to be taken seriously and addressed on a level that is suitable for their age. Observation starts in the waiting room, with the aim of gaining a good impression of such things as motor and psychosocial development. The child’s situation or age will often determine the order in which the physical examination is conducted, and flexibility and humour can be extremely useful here. It is important to be familiar with the normal ranges of vital signs in children, and also the consequences of any abnormal results: respiratory insufficiency, for instance, is more likely to occur in children because of their build and more limited compensation mechanisms. Examination of the abdomen, heart, lungs and ear, nose and throat area is important in all children. Further investigation on indication may be necessary, such as a neurological evaluation or assessment of secondary sexual characteristics.