The Evidence-Based Physical Examination of the Child and Adolescent Male

 

Blood pressure

Weight for length/BMI

Eyes

Mouth

Neuro

GU

Skin

MSK

Spine

Chest

12 months
 
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15 months
 
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18 months
 
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2 years
 
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2 ½ years
 
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3 years

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4 years

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5–6 years

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7–8 years

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9–10 years

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11–17 years

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18–21 years

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*Bright Futures recommends a comprehensive physical examination, with concentration on key components for specific age groups




Weight for Length/Body Mass Index


One Healthy People 2020 objective seeks to increase the proportion of primary care physicians who regularly measure and interpret the body mass index (BMI) of their patients. Approximately 17 % of children and adolescents aged 2–19 years are considered obese. Obesity is more prevalent in older children and adolescents compared to younger children (8.4 % in 2–5 year olds, 17.7 % in 6–11 year olds, and 20.5 % in 12–19 year olds) [6]. Bright Futures recommends measuring weight, length, and height and plotting the weight-for-length for supine children (generally 2 years of age and under) and BMI for standing children (validated for 2 years of age and older). These parameters should be calculated at every scheduled well visit. Body mass index greater than 85th percentile is considered overweight and greater than 95th percentile, obese [7]. These children and their parents should receive specific and detailed counseling on how to promote healthy lifestyles—centered on healthy diet and daily exercise—in order to decrease risk factors for developing future cardiovascular disease and diabetes mellitus. The USPSTF, AAFP, and American Diabetes Association (ADA) also recommend routine BMI screening. The ADA and Bright Futures recommend that testing for prediabetes should be considered in children and adolescents who are overweight or obese and have two or more risk factors for diabetes. Relevant risk factors include a family history of type 2 diabetes mellitus or gestational diabetes in first-degree relatives, high-risk racial/ethnic group (e.g., African-American, American Indian), signs of insulin resistance (e.g., acanthosis nigricans, hypertension, or dyslipidemia), or prior small-for-gestational age birth weight. Prediabetes testing would include a fasting blood sugar, hemoglobin A1C, total cholesterol, and in some circumstances an oral glucose tolerance test [4, 8].


Blood Pressure


The fourth report of the National High Blood Pressure Education Program (and Bright Futures) recommends routine annual blood pressure screening starting at age 3 years and continuing through childhood and adolescence. Blood pressure percentile charts—based on age, gender, and height—should be used for children and adolescents ages 3–18. Please see Table 5.2 [9].


Table 5.2
Blood pressure norms for boys by age and height percentile [9]









































































































































































































































































































































































































































































































































































































































































































































































Age (year)
BP percentile ↓
Systolic BP (mm Hg)
Diastolic BP (mm Hg)

← Percentile of height →
← Percentile of height →

5th
10th
25th
50th
75th
90th
95th
5th
10th
25th
50th
75th
90th
95th

1
50th
80
81
83
85
87
88
89
34
35
36
37
38
39
39

90th
94
95
97
99
100
102
103
49
50
51
52
53
53
54

95th
98
99
101
103
104
106
106
54
54
55
56
57
58
58

99th
105
106
108
110
112
113
114
61
62
63
64
65
66
66

2
50th
84
85
87
88
90
92
92
39
40
41
42
43
44
44

90th
97
99
100
102
104
105
106
54
55
56
57
58
58
59

95th
101
102
104
106
108
109
110
59
59
60
61
62
63
63

99th
109
110
111
113
115
117
117
66
67
68
69
70
71
71

3
50th
86
87
89
91
93
94
95
44
44
45
46
47
48
48

90th
100
101
103
105
107
108
109
59
59
60
61
62
63
63

95th
104
105
107
109
110
112
113
63
63
64
65
66
67
67

99th
111
112
114
116
118
119
120
71
71
72
73
74
75
75

4
50th
88
89
91
93
95
96
97
47
48
49
50
51
51
52

90th
102
103
105
107
109
110
111
62
63
64
65
66
66
67

95th
106
107
109
111
112
114
115
66
67
68
69
70
71
71

99th
113
114
116
118
120
121
122
74
75
76
77
78
78
79

5
50th
90
91
93
95
96
98
98
50
51
52
53
54
55
55

90th
104
105
106
108
110
111
112
65
66
67
68
69
69
70

95th
108
109
110
112
114
115
116
69
70
71
72
73
74
74

99th
115
116
118
120
121
123
123
77
78
79
80
81
81
82

6
50th
91
92
94
96
98
99
100
53
53
54
55
56
57
57

90th
105
106
108
110
111
113
113
68
68
69
70
71
72
72

95th
109
110
112
114
115
117
117
72
72
73
74
75
76
76

99th
116
117
119
121
123
124
125
80
80
81
82
83
84
84

7
50th
92
94
95
97
99
100
101
55
55
56
57
58
59
59

90th
106
107
109
111
113
114
115
70
70
71
72
73
74
74

95th
110
111
113
115
117
118
119
74
74
75
76
77
78
78

99th
117
118
120
122
124
125
126
82
82
83
84
85
86
86

8
50th
94
95
97
99
100
102
102
56
57
58
59
60
60
61

90th
107
109
110
112
114
115
116
71
72
72
73
74
75
76

95th
111
112
114
116
118
119
120
75
76
77
78
79
79
80

99th
119
120
122
123
125
127
127
83
84
85
86
87
87
88

9
50th
95
96
98
100
102
103
104
57
58
59
60
61
61
62

90th
109
110
112
114
115
117
118
72
73
74
75
76
76
77

95th
113
114
116
118
119
121
121
76
77
78
79
80
81
81

99th
120
121
123
125
127
128
129
84
85
86
87
88
88
89

10
50th
97
98
100
102
103
105
106
58
59
60
61
61
62
63

90th
111
112
114
115
117
119
119
73
73
74
75
76
77
78

95th
115
116
117
119
121
122
123
77
78
79
80
81
81
82

99th
122
123
125
127
128
130
130
85
86
86
88
88
89
90

11
50th
99
100
102
104
105
107
107
59
59
60
61
62
63
63

90th
113
114
115
117
119
120
121
74
74
75
76
77
78
78

95th
117
118
119
121
123
124
125
78
78
79
80
81
82
82

99th

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Jul 30, 2017 | Posted by in ABDOMINAL MEDICINE | Comments Off on The Evidence-Based Physical Examination of the Child and Adolescent Male

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