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BINAL JOSHI

PEDIATRIC NURSING

M SC NURSING

SUBJECT: PEDIATRIC NURSING

TOPIC: TODDLER ASSESSMENT FORM

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BIO DATA:

NAME: AGE: YEAR/MONTH:

SEX: WARD:

DATE OF ADMISSION: DATE OF DISCHARGE:-- OPD NUMBER: IPD NUMBER: BIRTH DATE: BLOOD GROUP: ADDRESS: DR: UNIT: RELIGION: NATIONALITY: FATHER: MOTHER: FAMILY INCOME: FOOD TYPE: HABITS:

HISTORY

Birth history

Diet history Personal history Socio economic status

ANTHROPOMETRIC MEASUREMENTS

Biological Measurement:No Measurement Child value Normal value Remark

1 Height2 Weight

3 Head circumference

4 Chest circumference

5 Arm circumference

6 Vital sign :

Temp

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3/7

Pulse

Respiration

B.P

Percentage of malnutrition: actual weight100/ideal weight

:

:

PEM GRADE:

DEVELOPMENTAL HISTORY

NORMAL OBSERVATION CHILDS

OBSERVATION INFERENCE

Gross motor :

Fine motor:

Psychological:

Psychosexual:

Spiritual:

Intellectual or cognitive

Moral:

LANGUAGE:

Receptive language:

Expressive language:

Play stimulation:

EXAMINATION OF THE CHILD:

General appearance

Nourishment:

Body Build

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Activity:

Mental Status:

Movement:

1. Skin Color:

Texture:

Lesions:

Temperature:

Birthmarks

2. Head

Size:

Shape:

Hairs:

Distribution:Color:

Texture:

3. Scalp

Fontanel:

Hair:

4. Face:

Eyes:

Location:

Eyebrows:

Eyelids:

Eyeballs:

Conjunctiva:

Sclera:

Pupil:

Reaction to light:

Ears:

Location:

Hearing:

Discharge:

Nose:

External nares:

Nostril:

Mouth and Pharynx:

Lips:

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Odor from the mouth:

Teeth:

Tongue:

Mucus membrane:

Throatand pharynx:

5. Neck: Skin folds:

Lymph node:

6. Chest:

Size:

Shape:

Breath sounds:

Respiratory rate:

Respiratory rhythm:

4. Heart:

Heart Sound:

Heart Rate:5. Abdomen:

Distension:

Palpable Mass:

Bowel Sounds:

6. Umbilical cord

Number of vessels at birth

Appearance

7. Extrimities:

A.Hands:

Length

Movements

Muscle tone

Fingers

B.Legs:

AppearanceLength

Movement

Alignment

Muscle tone

Toes

Number

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Webbing

Position

8. Nails:

Clubbing:

Flattened:

Capillary Refilling:

9. Back

10. Genital

FEMALE

1. Labia

Size

Appearance

2. Vaginal discharge (In Pre Term)

Color

Type

MALES

Testes in scrotum

Urethral meatus at end of penis

Circumcised

VOIDINGS

Amount

Frequency

11. Rectum:

a. Patency

b. Stools

1. Color

2. Consistency

3. Frequency

12. IMMUNIZATION STATUS:

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13. REACTION TOWARDS HOSPITALIZATION:

14. PARENT-INFANT INTERACTION:

15. EATING-SLEEPING PATTERNS:

17. BEHAVIOURAL PROBLEMS:

16. CHILDS RESPONSE DURING ASSESSMENT: