ABDOMEN EXAMINATION OF INFANT OR CHILD

ABDOMEN EXAMINATION OF INFANT OR CHILD

It is helpful to bear in mind the anatomic topography and to examine the abdomen when it is relaxed, i.e. when the infant is taking his feed or sucking at the “sugar tip”, the mother’s lap or shoulder (when the child is struggling and abdomen can be examined from the back) is the best place for abdominal examination. An important tip is to do palpation only when the child breathes and abdomen is relaxed (ballotment method). Not its size and contour , distention, movement with respiration, visible peristalsis, umbilicus,  hernias, local or rebound tenderness, palpable organ, or lump, hyperresonance, shifting dullness, alteration in bowel sounds, etc. Gentle palpation is of greater value than deep, particularly in the case of spleen. Secondary umbilical hernia is common during first 2 years of life and usually regresses spontaneously.

Palpability of liver should be determined in both the midline and the right nipple line. As a rule, liver is normally palpable up to 2 cm below the costal margin until age 4 years. Therefore, rather than just palpability of liver, it is more reliable to measure the liver span (distance between upper margin of liver dullness and lower edge of liver in the midclavicular line). Normal liver span is 4.5-5.0 cm at 1 week. By 12 years, it goes up to 6.0-6.5 cm in girls and 7.0-8.0 cm in boys.

The tip of spleen is palpable far more laterally in infants and young children than in older children. In infants until the age 2-3 months, spleen may be normally palpable. Splenic size may be graded.

Grading of splenic size

Grade 1: Normal, not palpable even on deep inspiration

Grade 2: Palpable just below costal margin, usually on deep inspiration.

Grade 3: Palpable below costal margin but not projected beyond a horizontal line half    way between costal margin and umbilicus. This projection is need to be ascertained along a line dropped vertically from the left nipple

Grade 4: Lowest palpable point approaching the umbilical level but not below a line drawn horizontally through umbilicus.

Grade 5: Lowest palpable point below umbilical level but not projected beyond a horizontal line situated halfway between umbilicus and Symphysis pubis.

Grade 6: Lowest palpable point beyond lower limit of grade 4