Infant and Child Assessment
Infant and Child Assessment
Infant and Child Assessment
Weight
• Weigh an infant on a platform-type balance scale.
• Weigh to the nearest 10 g ( 1 2 oz) for infants and 100 g (14 lb) for toddlers.
• By age 2 or 3 years use the upright scale. Leave underpants on the child. Some
young children are fearful of the rickety standing platform and may prefer sitting
on the infant scale. Use the upright scale with preschool- ers and school-age
children, main- taining modesty with light clothing.
Length
• Until age 2 years measure the infant’s body length supine with a horizontal
measuring board. Hold the head in the midline. Because the infant normally has
flexed legs, extend them momentarily by holding the knees together and pushing them
down until the legs are flat on the table. Avoid using a tape measure along the
infant’s length because this is inaccurate.
• By age 2 or 3 years measure the child’s height by standing him or her against the
pole on the platform scale or against a flat ruler taped to the wall. Encourage the
child to stand straight and tall and look straight ahead without tilting the head.
The shoulders, buttocks, and heels should touch the wall. Hold a book or flat board
onthe child’s head at a right angle to the wall. Mark just under the book or board,
noting the measure to the nearest 1 mm ( 1 8 inch).
Head Circumference
• Measure the infant’s head circumference at birth and at each well-child visit up
to age 2 years and then annually up to age 6 years. Circle the tape around the head
at the prominent frontal and occipital bones; the widest span is correct. Plot the
measurement on standardized growth charts. Compare the infant’s head size with that
expected for age. A series of measurements is more valuable than a single figure to
show the rate of head growth.
• A newborn’s head measures about 32 to 38 cm (average about 34 cm) and is about 2
cm larger than the chest circumference. The chest grows at a faster rate than the
cranium; at some time between 6 months and 2 years both measurements are about the
same; after age 2 the chest circumference is greater than the head circumference.
• Measurement of the chest circumference is valuable as a comparison with the head
circumference but is not necessarily valuable by itself. Circle the tape around the
chest at the nipple line. It should be snug but not so tight as to leave a mark.
Pain
• Infants have the same capacity for pain as adults. Preverbal infants are at high
risk for undertreatment of pain because of persistent myths and beliefs that
infants do not remember pain. Because infants are “preverbal and incapable of self-
report,” pain assessment depends on behavioral and physiologic clues.
• Children 2 years of age can report pain and point to its location. They cannot
rate pain intensity at this developmental level. It is helpful to ask the parent
which words his or her child uses to report pain (e.g., boo-boo, owie).
• Some children will try to be “grown-up and brave” and often deny having pain in
the presence of a stranger or if they are fearful of receiving a “shot.”
• Rating scales can be introduced at 4 or 5 years of age. The Faces Pain Scale–
Revised is one example; the child is asked to choose a face that shows “how much
hurt you have now.”
• Similarly the Oucher Scale has six photographs of young boys’ faces with
different expressions of pain, ranked on a 0-to-5 scale of increasing intensity.
The child is asked to point at the face that best matches his hurt/pain.