What is the appropriate head‑to‑toe physical examination for a 15‑month‑old male infant?

Head-to-Toe Physical Examination for a 15-Month-Old Boy

A systematic head-to-toe examination of a 15-month-old should prioritize growth parameters, developmental dysplasia of the hip screening (using Ortolani and Barlow maneuvers with attention to hip abduction and thigh fold symmetry), cardiovascular auscultation, and developmental milestone assessment appropriate for this age.

Growth Parameters and Vital Signs

• Measure and plot weight, length, and head circumference on CDC or WHO growth charts to identify percentiles and detect microcephaly, macrocephaly, or growth impairments 1, 2
• Document temperature, heart rate, respiratory rate, and oxygen saturation 1

Head and Neurological Examination

• Examine fontanelles for size, tension, and any bulging or depression (the anterior fontanelle typically closes between 12-18 months) 1, 2
• Assess overall head shape and symmetry 2
• Evaluate tone and posture through observation of spontaneous movements and interaction 1, 2
• At 15 months, primitive reflexes should have resolved; assess for age-appropriate motor skills instead 1

Eye Examination

• Perform red reflex testing bilaterally to detect cataracts, retinoblastoma, or other ocular media abnormalities 1, 2
• Conduct the binocular red reflex (Brückner) test to assess symmetry 1, 2
• Assess fixation and following behavior 2
• Examine external ocular and periocular structures 2

Ear, Nose, and Throat

• Examine tympanic membranes for signs of infection or fluid 2
• Assess nares for patency and any discharge 1, 2
• Examine the oral cavity, including palate integrity, tongue position, dentition (should have several teeth erupted by this age), and frenulum 1, 2

Cardiovascular System

• Auscultate the heart for rate, rhythm, and presence of murmurs in multiple positions 1, 2
• Many innocent murmurs present in infancy, but pathologic murmurs require further evaluation 1
• Assess perfusion and skin color 2

Respiratory System

• Auscultate lungs for air entry and any abnormal sounds 2
• Assess respiratory rate and pattern (normal rate at this age is approximately 20-30 breaths per minute) 1, 2

Abdominal Examination

• Palpate for organomegaly, masses, or tenderness 2
• The umbilical site should be completely healed by this age 1

Genitourinary Examination

• In males, examine external genitalia including assessment for descended testes bilaterally, hypospadias, hydrocele, or inguinal hernia 1, 2
• Assess urinary stream if history suggests concerns 2

Musculoskeletal and Hip Examination

Critical Hip Screening at 15 Months

• Perform hip examination with attention to limitation of hip abduction and asymmetric thigh folds, as these are the most useful clinical signs of developmental dysplasia of the hip (DDH) in children over 3 months of age 3
• At 15 months, Ortolani and Barlow tests are less likely to be positive compared to younger infants 3
• Observe gait pattern if the child is walking; look for limping or toe-walking on the affected side 3
• If both hips are dislocated, look for increased lumbar lordosis, prominent buttocks, and waddling gait 3

Common Pitfall: Ortolani and Barlow maneuvers become less sensitive after 3 months of age; relying solely on these tests in a 15-month-old may miss DDH 3. Instead, focus on hip abduction limitation and thigh fold asymmetry.

Neuromotor and Developmental Assessment

• Assess postural tone and coordination through observation of spontaneous activity 1, 2
• Evaluate age-appropriate motor milestones: by 15 months, most children can walk independently, stoop and recover, and may be attempting to run 1, 2
• Assess fine motor skills and hand preference 2
• Observe social interaction and language development 2

Skin Examination

• Assess skin color, perfusion, and presence of any rashes, lesions, or bruising 2
• Any bruising in unusual locations (e.g., ears, neck, torso, buttocks) or multiple bruises of different ages should raise concern for non-accidental trauma, particularly in a child this age 3, 4

Critical Safety Consideration: Femoral fractures in children who are not yet walking independently and unexplained humeral fractures in children under 15 months should be considered highly suspicious for abuse 3, 4. Multiple fractures in any location without clear accidental trauma are strongly associated with abusive injury 3, 4.

Special Considerations for Premature Infants

• If the child was born prematurely, correct for gestational age when assessing developmental milestones by subtracting the number of weeks born early from chronological age 1, 2
• Age correction should be applied through at least 24 months for developmental assessments 2