Case 4 – The Sick Child

You are about to see 7 year old boy named Bobby. His father has brought him in and tells you that he’s been significantly less active in the last two days, and that he’s been running a high fever. Perform a focused physical examination for a child with a fever.

Physical Examination

  • Explains the nature and purpose of the examination to the child and parent
  • Asks parent for assistance while examining the child when needed


  • Comments on overall appearance (looks unwell, diaphoretic)
  • Examines for rashes
  • Examines joints for effusion, erythema


  • Measures heart and respiratory rate
  • Assesses volume status by examining mucus membranes, skin temperature/turgor, capillary refill
  • Takes temperature of patient (hyperthermic)
  • States that orthostatic vitals should be measured
  • States that the weight of the child should be measured as part of the volume assessment

Head and Neck exam

  • Comments on the presence of erythema and exudates in oropharynx
  • Palpates all lymph nodes of the head and neck
  • Comments on the size, texture, mobility, and location of any identified nodes
  • Asks patient/assesses child for tenderness during examination
  • Examines patient’s ears using otoscope, comments on auditory canal and tympanic membrane
  • Checks for neck stiffness


  • Comments on respiratory status: accessory muscle use, nasal flaring, central/peripheral cyanosis
  • Auscultates in all lung fields
  • Comments on findings

Abdominal Exam

  • Examines for abdominal tenderness in all four quadrants
  • Assesses for splenomegaly
  • Assesses for masses in the abdomen
Case 4 – The Sick Child