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Observe body characteristics
and check body mass index, or BMI.
Note facial expression and the presence or absence of distress.
Observe hygiene, grooming, and dress.
Check for any odors.
Evaluate affect (bright, pleasant, anxious, apprehensive, depressed, angry, hostile).
Measure weight, height, head circumference, and body mass index.
or light-skinned infants, the overall color of the skin should be pink. Skin folds may appear red or irritated, though, since these areas
are often moist. Infants, especially during the newborn period, might have tiny white papules called milia on the cheeks, forehead, nose, and chin. Let the parents know that milia will go away on their own, and encourage them not to rub vigorously or break the intact skin. Another irregularity you might note on the forehead or the back of the neck is a "stork bite," a telangiectatic nevi that is irregularly shaped and red or pink. This type of lesion typically fades during the first year.
Lastly, note the condition of the peri-anal skin in the diaper area for any redness, rashes, or open lesions.
dark-skinned or Asian may have Mongolian spots. Assess for these bluish-gray macular areas on the sacrum or buttocks. These spots usually fade over the first year. Normal capillary refill time is less than 2 seconds. Delayed capillary refill indicates poor blood flow.
3+ adult auricle UP/back
peds auricle DOWN/back
Tympanic membrane:
translucent, shiny, light gray, taut, say "ah"=intact/vibrates
Hearing: whisper, Weber (bone conduction=top of head), Rinne (sound conduction=mastoid bone)
Geriatrics: ear lobes pendulous, presbycusis at 50, slowly progressive
A normal tympanic membrane is shiny and pearly gray, with a cone of reflected light on the nasal aspect. In other words, the cone of light should be visible at "7 o'clock" in the left ear and "5 o'clock" in the right ear. You might be able to see landmarks created
by the tiny bones behind the tympanic membrane as well. Take care to withdraw the otoscope as carefully as you inserted it to avoid damaging the delicate ear canal.