How are the body systems examined?

During the systematic examination, each system is examined separately by inspection (looking), palpation (feeling), percussion (tapping) and auscultation (listening with a stethoscope):

  1. Respiratory system:
    • Count the respiratory rate.
    • Listen for cough, wheezing or stridor.
    • Look for signs of respiratory distress (recession, grunting).
    • Percuss for dullness over both lungs, front and back.
    • Auscultate both lungs, front and back.
  2. Cardiovascular system:
    • Count the pulse and note the nature of the pulse (easy or difficult to feel?)
    • Take the blood pressure (not always needed in infants).
    • Look at the shape of chest.
    • Palpate (feel) for the position of the apex beat.
    • Auscultate the heart for heart sounds and murmurs.
  3. Gastrointestinal system:
    • Look for abdominal distension.
    • Look and feel for hernias.
    • Feel for abdominal tenderness.
    • Feel for enlarged organs (liver, spleen, kidneys) or other masses.
    • Listen for bowel sounds.
  4. Genitourinary system:
    • Is the child obviously a boy or girl?
    • If a boy, are the testes descended?
  5. Central nervous system:
    • Assess whether the child is alert and fully conscious. Any convulsions (fits)?
    • Determine the developmental milestones.
    • Can the child see and hear normally?
    • Can the child smile and close eyes tightly?
    • Assess for neck stiffness (meningism).
    • Asses whether the child is able to move all limbs normally.
    • Observe whether the child walks normally (if old enough).
  6. Muscular skeletal system:
    • Look whether the back is straight.
  7. Ears, nose and throat:
    • Examine mouth and throat.
    • Examine ears.

The order of the examination is flexible. Usually the examination of the mouth, throat and ears is done last as it is unpleasant for a young child. Sometimes the heart is examined first so that the heart sounds can be heard before the child becomes upset and cries.

Only the most important aspects of the physical examination are given here. For a more detailed examination see a standard textbook on paediatrics such as Paediatric Primary Health Care by Ireland, Power, Woods and Desai (Oxford University Press, Cape Town 2006).

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