Bates’ Visual Guide to Physical Examination

Volume 3: 3.2 General Survey and Somatic Growth Video Transcript

Narrator: With the patient’s health history in mind and after good hand hygiene, you are ready for the physical examination.

Begin with a general survey, inspecting the patient closely literally from head to toe in order to form impressions for your later written assessment. During the general survey, you will observe for a wide range of abnormalities including:

• Behavioral problems such as poor parent-child interactions.
• Sibling rivalry.
• Inappropriate parental discipline.
• Overall intense temperament.

When engaging the child and age-appropriate conversation, look for signs of developmental delay in areas such as cognitive abilities, language, social and emotional tasks as well as gross and fine motor skills. This developmental assessment also becomes a key part of the neurological exam. Observe for signs of social or environmental problems including parental difficulties such as stress or depression and risk for abuse or neglect.

Somatic growth is one of the most important indicators of a child’s health. The deviation from normal may be an early sign of an underlying problem. The most important tools for assessing somatic growth our growth charts. Growth charts display a series of lines that enable you to establish percentile rankings for your patience, indicating their growth relative to other children of the same chronologic age. To assess trends, plot the patient’s growth parameters over time. Measure standing height or stature. You will obtain optimum results using an accurate wall-mounted stadiometer. Have the child stand with the heels back and the head against the wall or the back of the stadiometer. If using a wall with a marked ruler, make sure to place a board or other flat surface across the top of the child’s head at a right angle to the ruler. Please note that standup weight scales with height attachments are relatively inaccurate.

Weigh children in their underpants or gown on a standup scale. Use the same scales across successive visits to optimize comparability. In general, head circumference is measured until the child reaches 24 months. Afterward, this measurement may be helpful if you suspect a genetic or central nervous system disorder. Age and sex-specific charts are now available to assess body mass index for age. BMI measurements are helpful for early detection of obesity in children older than 2 years old. It is helpful to give parents their child’s BMI results together with information about the impact of healthy eating and physical activity.