What are the key components of a physical exam in a 13-month-old child?

Key Components of a Physical Exam in a 13-Month-Old Child

A comprehensive physical exam for a 13-month-old child should include assessment of growth parameters, vital signs, complete systems examination with special attention to developmental milestones and neurological status.

Growth Parameters

• Length/Height: Measure recumbent length (for children up to 24 months)

  • Use infant stature board with fixed headboard and moveable footboard
  • Requires two people: one to hold the head, another to measure
  • Record to nearest 0.1 cm 1

• Weight:

  • Use infant scale with child undressed completely
  • Record to nearest 0.1 kg 1

• Head Circumference:

  • Use firm non-stretchable measuring tape
  • Measure around the head just above the supraorbital ridges
  • Plot on growth charts (should be measured in children up to 36 months) 2
  • Compare with standard growth curves 1

Vital Signs

• Temperature, pulse, respiratory rate, blood pressure, oxygen saturation 1

General Appearance

• Overall body habitus
• Level of alertness and responsiveness
• Interaction with caregiver and examiner

Skin Examination

• Look for rashes, lesions, bruising
• Assess for signs of injury or abuse 1

Head and Neck

• Head: Shape, fontanelles (may be closed or closing at this age), bruising
• Eyes:
  • Red reflex examination to detect abnormalities
  • Pupillary examination (size, shape, symmetry, response to light)
  • Fixation testing using developmentally appropriate targets
  • Corneal light reflex assessment 1
• Ears: Examine tympanic membranes
• Nose and Mouth: Check for congestion, blood in nares/oropharynx, evidence of trauma
• Neck: Mobility, lymphadenopathy 1

Cardiopulmonary

• Chest: Auscultation, palpation for rib tenderness or irregularities
• Heart: Rhythm, rate, murmurs
• Lungs: Air entry, adventitious sounds 1

Abdomen

• Organomegaly, masses, distention
• Tenderness 1

Genitourinary

• Examine for abnormalities
• Check for signs of diaper rash or irritation 1

Musculoskeletal

• Muscle tone and strength
• Symmetry of movement
• Joint range of motion
• Spine alignment 1

Neurological Assessment

• Motor Development:

  • Assess gross motor skills: Should be pulling to stand, cruising, possibly walking independently
  • Fine motor skills: Pincer grasp, ability to hold small objects
  • Look for "red flags" such as asymmetry of movement or tone 1

• Reflexes:

  • Deep tendon reflexes
  • Symmetry of reflexes 1

Developmental Assessment

• Gross Motor: Walking with or without support
• Fine Motor: Pincer grasp, puts objects in container
• Language: 1-3 words with meaning, follows simple commands
• Social: Plays interactive games (peek-a-boo), imitates actions

Special Considerations

• Behavioral Observation:

  • Separation anxiety
  • Interaction with caregiver
  • Response to examiner

• Screening for Developmental Delay:

  • Assess for signs of developmental delay or disability 3
  • Consider standardized screening tools appropriate for age

Practical Approach

1. Begin with non-threatening components (observing behavior, growth measurements)
2. Proceed to auscultation before palpation
3. Leave potentially uncomfortable examinations (ears, mouth) for last
4. Make the child comfortable with pleasant surroundings and playful behavior 3

Common Pitfalls to Avoid

• Failing to measure and plot growth parameters correctly
• Not comparing growth measurements to standardized charts
• Overlooking subtle neurological signs
• Rushing the exam and missing important observations
• Not accounting for the child's developmental level when assessing behavior and cooperation

Remember that the physical examination should be performed in a systematic way, using the cephalocaudal approach, and should be adapted to the child's comfort level and developmental stage to yield maximum information 3.