Other Questions by the Nurse
- Does the child have any urinal challenges like wetting the bed at night? This can help understand the possibility of femur fracture and the possibility of this turning into pica cast (Pediatric Assessment, 2006).
- What safety equipment does the child use when playing, especially when riding a bicycle?
- To the parent, what is the health status of both parents and is there any history of musculoskeletal disorders like arthritis or muscular dystrophy? The two disorders are hereditary (Ganel, Dudkiewicz & Grogan, 2003).
- What is the general state of the playground or space at school and at home?
- Inspection of the arm to check for bending at the point where the bones articulate, assess the possibility of hip dislocation by having the child stand on one leg at a time, check the legs to ensure they are well aligned and lastly, evaluate the possibility of bowed legs by measuring the distance from the first knee to the next when the child has positioned the ankles together (Jarvis, 2016).
First, the child could be examined while on the parent’s lap so that the parent could assist in holding or supporting the child appropriately (Jarvis, 2016). Second, the child should be examined without any clothing except the underpants (the underpants can be removed during genital inspection). Additionally, the preschooler should be allowed to play with items in the office and to increase their levels of cooperation, they can be distracted by asking them to count or describe an interesting event they know or witnessed.
Major differences in assessment
At this age the child is more cooperative to the process and willing to undress for the checkup. Additionally, parts like the valgus have to be re-assessed and normalcy confirmed (Jarvis, 2016). Lastly, the possibility of bending arms, hip dislocation, alignment and bowing of the legs are critical and must be applied in this assessment (Jarvis, 2016).
Things to be included in plan of care
Use of safety gear while playing especially when riding a bicycle. Routine checkup for increasing deformities and reporting of any injuries or pains (“growing pains”) (Jarvis, 2016).
Most likely cause of leg pains
Leg pains are also referred to as “growing pains” at this age and are most likely due to: bruises, broken bones, sprains or strains.
Ganel, A., Dudkiewicz, I., & Grogan, D. P. (2003). Pediatric orthopedic physical examination
of the infant: A 5–minute assessment. Journal of Pdiatric Health Care, 17(1), 39–41.
Jarvis, C. (2016). Physical Examination & Health Assessment. St. Louis, Missouri: Saunders.
Pediatric Assessment (2006): Media Link. Online Source. Available at: http://www.prenhall.com/london2e/pages/london_final_ch35.pdf