SKIN EXAMINATION OF INFANT OR CHILD

SKIN EXAMINATION OF INFANT OR CHILD

Note infant’s color for cyanosis, jaundice, pallor and caroteinemia.

Cyanosis

Definition: Bluish discoloration of skin and mucous membrane.

Peripheral: Present only in the periphery, i.e. limbs as a result of exposure to excessive cold, Raynaud’s phenomenon, arterial thrombosis, superior vena cava syndrome or traumatic compartment syndrome.

Central: Present in central regions as a result of pulmonary (cyanotle congenital heart disease), pulmonary (RDS, congenital diaphragmatic hernia, persistent fetal circulation, pneumonia, etc.), hematologic (polycythemia, hypercoagulability, methemoglobinemia, etc)or neurologic (encephalitis, encephalopathy, etc) disease.

Look for pigmentation. Localized bluish spots, usually on the buttocks and the back, are the so-called “monogolian spots”. They are self-limited, having no clinical significance. “Café-au-lait spots” may be associated with phakomatosis. Reticular pigmentation may be a feature of megaloblastic anemia or infantile tremor syndrome. In Addison disease, the pigmentation usually gives the skin dirty brown color and may also be present at the gum margins and cheeks.

Skin turgor is lost in dehydration and marasmus. In order to elicit pitting edema, greater pressure requires to be applied in children than in adults.

Presence of rashes, petechiae, ecchymosesor specific diseases should also be observed.

While examining skin, it is appropriate to look for subcutaneous nodules over bony prominences in suspected cases of rheumatic fever or rheumatoid arthritis.

Types of fever

Continuous fever: Present throughout the day with fluctuation < 1 degree C in 24 hours.

Examples: Pneumonia, UTI, infective endocarditis

Remittent Fever : Present throughout the day with fluctuation of > 1 degree C in 24 hours.

Intermittent fever: Present only during certain periods of the day. In between, temperature is normal. Examples: Malaria, kala-azar, juvenile rheumatoid arthritis.

Qutodian fever: Intermittent fever occurring daily

Tertian Fever: Intermittent fever occurring on alternate days

Quartan Fever: Intermittent fever occurring at 2 days interval

Fever with Rigors/Chills: It is encountered in infectious processes such as malaria, UTI, septicemia, etc.