TeachingInitial Pediatric Assessment Teaching Tool www.luhs.org/emscIllinois Emergency Medical Services for ChildrenInitial Pediatric AssessmentTeaching ToolEmergencies involving children comprise only a small percentage of ambulance runs, affording limitedopportunities for prehospital personnel to develop and practice their skills in pediatric care.
Prehospitalpersonnel typically identify that the patients who generate the greatest level of anxiety for them in thefield are children.
This emphasizes the need for ongoing education in order to refresh one's knowledgeand skill base as well as to ensure clinical consistency with current practice guidelines.Children are not "small adults".
There are a number of significant anatomic and physiological differencesbetween children and adults which impact on assessment and management.
The child is not onlyphysically smaller but also has respiratory and cardiovascular systems that are immature with fewerreserves than those of the adult.
Consequently, the child in respiratory or cardiac distress will likelydecompensate more rapidly than the adult with a comparable illness or injury.A child's psychosocial and communication skills are constantly changing.
Therefore, the child may beunable to convey key information to assist the prehospital provider in their , as well as numerous others, are why prehospital personnel must develop assessment skillsthat address the unique aspects and needs of the child.
This prehospital pediatric initial assessmentteaching tool provides a systematic and comprehensive approach to the initial assessment of the child.This document can be incorporated into prehospital primary and continuing education.I.Action Strategy Overview: AAction sequence is essential.
Regardless of the diagnosis, follow a systematic approachin assessing all patients.Priorities and time frames may vary.BWhile prioritized steps are sequenced in their order of importance for clarity, some arefrequently accomplished simultaneously.
Obtaining patient and event histories mayaccount for 90% of the presumptive diagnosis.C and rule-out the worst possible scenario based on the patient's age andpresenting complaint.Assume that all have a life-threatening event until it is ruled out.II.Review of dispatch information: Anticipate and plan your needed equipment and actions.Scene location may give clues to the type of incident and its possible severity (Bledsoe, 167).III.General Approach to the Stable Pediatric PatientAssessments and interventions must be tailored to each child in terms of age, size, developmentand metabolic status.ASmile if appropriate to the situation.BKeep voice at an even quiet tone, don't yell.Ck slowly; use simple age-appropriate terms.DUse toys or penlight as distractors; make a game of assessment.EKeep children with their caregiver(s); encourage assessment while caregiver is holdingchild.
Whenever appropriate, transport the child & caregiver together.FKneel down to the level of the child if possible.GBe cautious in use of touch.In the stable child, make as many observations as possiblebefore touching (and potentially upsetting) the child or inflicting pain.HEstimate size:
2 x age in years + 10 = weight in kg.or use a length/weight basedmeasuring tape.Illinois Emergency Medical Services for Children (EMSC)Initial Pediatric Assessment - page 2Scene size upAIdentify possible hazards.BAssure safety for patient and responder.If scene is unsafe, do not enter! Call for policeassistance.If a possible crime scene, make efforts to preserve integrity of evidence.DDetermine number of patients and locate all patients.
If number or acuity exceedsresponders' capability, call for assistance.EObserve for mechanism of injury/nature of illness.FNote anything suspicious at the scene, i.e., medications, household chemicals, other illfamily members.GAssess any discrepancies between the history and the patient presentation, ie infant fellon hardwood floor, however floor is carpeted.HInitiate appropriate body substance isolation (BSI) precautions.VInitial InspectionAWhile walking up to the child, observe/inspect the following:General appearance, age-appropriate behavior and level of consciousness,affect, restlessness.Is child looking around, responding with curiosity or fear,playing, sucking on a pacifier or bottle, quiet, eyes open but not moving much oruninterested in environment?2Obvious respiratory distress or extreme pain3Level of consciousness, ie awake versus asleep or unresponsive4Position.
Are the head, neck or arms being held in a position suggestive of spinalinjury? Is the patient sitting up or tripoding?5icant odors6Muscle tone: good or limp7Movement: spontaneous, purposeful, symmetrical8Color: pink, pale, flushed, cyanotic, mottled9Obvious injuries, bleeding, bruising, impaled objects, or gross deformitiesBGeneral Impression of the Patient: first impression which determines priorities of care.Consider the following:1How ill or injured does the patient appear?2The environment3Patient's chief complaint4Associated complaints5 of pain:P:Initial Assessment: assessment should take less than 2 minutesA Detect and resuscitate all clinically evident, immediate life threats.BA = Airway Access/Maintenance; C-Spine Control1Obstruction may be acute, insidious, progressive or recurrent.Maintain highIllinois Emergency Medical Services for Children (EMSC)Initial Pediatric Assessment - page 3index of suspicion.2Expected outcome: patent airwayaVentilations are quiet without stridor or retractions.bPatient speaks or makes appropriate sounds.cChest rises and falls easily with respirations/positive pressureventilations.Foreign material not visible in upper airway.3
Look/listen for signs of airway obstruction
.aIf patient is responsive: are they crying or talking without difficulty?( assess breathing, quality of voice (hoarse or raspy?)( feel for air movementbIf unresponsive: look,
Pediatric Assessment: Focus On Physical Assessment …
Pediatric Assessment: The Major Focus • Major differences between children and adults ... General Assessment: Key Points • Note general appearance (pediatricapta.org)
Assessscreentools2Section on Pediatrics Created by the Practice Committee 05/04 Last revised 06/05 This list of assessment and evaluation tools and measures is NOT exhaustive.The Practice Committee has attempted to compile a list of the tools that are most commonly used by pediatric physical therapists.There are many other tools, as well as many Web sites, with additional information.
This list should serve as a starting point for anyone seeking information on assessment and evaluation tools and measures.The Practice Committee suggests the following Web site as one source of additional information: you have additional tools or measures that you believe should be added to this list, please complete the form at the end of this document and submit it to the Section on Pediatrics at INDEX Author: Simeonsson, R.J., Bailey, D., Smith, T., Buyssee, V.(1995).
Publisher: Young children with disabilities: Functional assessment by teachers.Journal of Developmental Physical Disabilities, 7, 267-284.characteristics of childhood disability.Has potential to identify discrete profiles of functional characteristics Areas Tested: Index of 9 domains: audition, behavior, intelligence, limbs, intentional communication, tonicity, integrity of health, eyes, and structure.AGES & STAGES QUESTIONNAIRES (ASQ)
Second Edition Authors: Diane Bricker, Jane Squires, & Linda Mounts Publisher:
Brookes Publishing Co., PO Box 10624, Baltimore, MD 21285-0624 level of a child through parent report Age Range: Four to sixty months (4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, 60) Areas Tested: 19 questionnaires each containing thirty items covering five areas of development: -Communication Gross motor, Fine motor, Problem solving, Personal-social AGES & STAGES QUESTIONNAIRES: Authors: Jane Squires, Diane Bricker, and Elizabeth Twombly Purpose: To help identify young children at risk for social emotional difficulties.Age Range: six to sixty months (6, 12, 18, 24, 30, 36, 48, and 60) Area Tested: Social and emotional behavior ALBERTA INFANT MOTOR SCALE (AIMS) Author:
Piper and Johanna Darrah WB Saunders Co., The Curtis Center, Independence Mall West, Philadelphia, PA 19106 Purpose: To identify infants and toddlers with gross motor delay and to evaluate gross motor skill maturation over time Areas Tested: Fifty-eight gross motor skill items divided among four positions: prone, supine, sitting, standing Each item observed for the components of: weight bearing, posture, and anti-gravity movement ASSESSMENT, EVALUATION, AND PROGRAMMING SYSTEM FOR INFANTS AND CHILDREN (AEPS) Volume 1:
Measurement for Birth to Three Years Author: Diane Bricker Publisher:
Paul H.Brookes Publishing Co., PO Box 10624, Baltimore, MD 21285-0624 Purpose: To determine level of skill attainment, assist in the development of programmatic outcomes, goals and objectives, and monitor progress toward attainment of outcomes over time Age Range: Developmental skill range from one to 36 months of age Areas Tested: Two hundred twenty-eight items divided among six domains which are further divided into strands: Fine motor: reach, grasp, release, functional use; Gross motor: movement in prone and supine, balance in sitting, standing and walking, and play; Adaptive: feeding, hygiene, undressing; Cognitive: sensory causality, problem-solving, pre-academic interaction with objects; Social: interactlinguistic, expressive, receptive Each strand is further divided into goals and objectives.
Goals and objectives are assessed and are arranged BATTELLE DEVELOPMENTAL INVENTORY
(BDI) Authors: Newborg J, Stock JR, Wnek L., Guidubaldi J, Svinicki Publishing Co., 8420 Bryn Mawr Avenue, Chicago, IL
60631 Purpose: Judgment or performance based measure administered through structured format, interviews with caregivers or naturalistic observations.Norm referenced Age Range: Birth to 8 years
Areas Tested: GM, FM personal-social, language and cognitive skills,
BAYLEY INFANT NEURODEVELOPMENTAL SCREENER (BINS) Purpose: To identify infants who are at risk for delays or neurological impairments Areas Tested: Seventy-two items divided among six age sets (3, 6, 9, 12, 18, 24 months) each containing 11-13 items.
Items are categorized into four conceptual areas of ability: Basic neurological functions/intactness: tone, reflexes, and abnormal signs: Receptive functions: visual, auditory, verbal: Expressive functions: gross motor, fine motor, vocalizations: Cognitive processes; memory, problem solving, object permanence, attention BAYLEY SCALES OF INFANT DEVELOPMENT-II Author:
Nancy Bayley Purpose: To identify developmental delay and to monitor a child's developmental progress Age Range: One to 42 months Areas Tested: Consists of three scales: Mental: cognition, object permanence, memory, manipulation, problem solving, verbal communication, and comprehension; Motor: gross and fine motor development/ skill acquisition; Behavior: qualitative aspects of child's behavior during administration of mental and motor scale
BERG BALANCE TEST
Purpose: Measures balance during movement activities Areas Tested: 14 items including common movement activities such as picking an object up from the floor, walking and BRIGANCE INVENTORY OF EARLY DEVELOPMENT, REVISED EDITION (BDIED-R) Publisher: Curriculum Associates, 5 Esquire Road, North Billerica, MA
01862-2589 Purpose: Commonly used assessment in early intervention and preschool programs to determine developmental delay in several domains and for program planning.Areas Tested: Criterion-referenced test of: psychomotor, self-help, speech and language, general knowledge and comprehension, early academic skills and social-emotional development.BRUININKS-OSERETSKY TEST OF MOTOR PROFICIENCY (BOTMP) Author: Robert Bruininks, ----Oseretsky
Bldg., PO Box 99, Circle Pines, MN
55014-1796 Age Range:
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