1. Clinical Learning Guide
Pediatric general examination
STEP/TASK CASES
GETTING READY
1. Pre-exam checklist: WIPE:
a. Wash your hands [thus warming them].
b. Introduce yourself to pt, explain what going to do.
c. Position pt [+/- on parent's knee].
d. Expose area as needed [parent should undress].
2. Examine from the Right side of the patient.
PEDIATRICS: EXAMINATION
General appearance
• Posture, body positions, body shape.
• Hydration.
• Dress, hygiene.
• Alertness, happiness.
• Crying: high-pitched vs. normal.
• Any unusual behavior.
• Parent-child interaction, reaction to someone new walking
entering the room (child abuse).
• Ask if tenderness anywhere, before start touching them.
• If asleep, do the heart, lungs and abdomen first.
Vital signs (see specific learning guide)
• Radial pulse. (Appendix 1)
• Apical Pulse (Appendix 2)
• Femoral pulse and other peripheral pulses. (Appendix 3)
• Respiratory rate (Appendix 4)
• Blood Pressure. (Appendix 5)
• Temperature. (Appendix 6)
Taking Pediatric Vital Signs Reference.
Lymph nodes (appendix 7)
• Palpate lymph nodes in the neck, inguinal, epitrochlear,
supraclavicular, axillary, and posterior occipital regions.
Comment on size in its largest diameter, consistency, adherent
or freely mobile, tender or not, skin overlying. (check
foundation skills)
Head and neck Appendix 8

2. STEP/TASK CASES
• Head circumference, rate of growth.
• Head asymmetry, microcephaly, macrocephaly, other visible
abnormalities.
• Fontanelle, if <18 months:
o Full or flat or depressed.
• Thyroid enlargement, other lumps.
• Neck stiffness.
• Neck lymph nodes: location, size in cm, tenderness,
consistency.
Eyes
• Exam position: mother holds child on lap facing forward, one
arm encircling child's arms, the other hand on child's forehead.
• Pupils: reaction to light, accommodation.
• Strabismus
o Strabismus is normal before 4-6 months.
• Photophobia, proptosis, sclerae, conjunctivae, ptosis, congenital
cataracts.
Ears
• Exam position: same as eye, but child faces the side.
• Discharge, canals, external ear tenderness.
• Test hearing.
Nose
• Nares patency, septum, nasal flaring.
• Discharge, mucous membranes, sinus tenderness.
Mouth (Appendix 9)
Throat
• Breath odor.
• Lips: color, fissures and dryness.
• Tongue.
• Teeth: number, arrangement, dental caries.
• Gums: color, hypertrophy (phenytoin)
• Throat: epiglottis
• Tonsils: size, signs of inflammation.
Height, weight, skull circumference and midarm circumference (Appendices 10-13)
• Measure and plot on appropriate centile chart.
2

3. STEP/TASK CASES
Diaper, genitalia, anus (permission is asked verbally)
• Only perform when indicated.
• Diaper:
o Inspect contents.
o Inspect napkin area
• Male:
o Testes decent, hernias.
o Circumcision, testes, hydrocele.
• Female:
o Vulva, clitoris.
• Both sexes:
o Discharge.
o Abnormalities.
o Tanner stage.
• Anus inspection:
o Hemorrhoids, fissures, prolapse.
o Sphincter tone, tenderness, mass.
o Peri-anal inflammation.
Extremities and Back
• Infants: hip abduction in infants with knees flexed.
• Feet abnormalities, such as rocker-bottom feet.
• Similar signs as seen in hands, nail.
• Spine: deformity, masses, tenderness, limitation of movement,
spina bifida and pilonidal dimple.
Skin
• Rashes, using proper terminology.
• skin color, consistency, and hydration.
• Cyanosis, jaundice, edema, bruises, petechiae, and pallor.
• Note café-au-lait spots, hemangiomas and nevi, their size and
location.
3

4. Appendex1
Clinical Learning Guide
Measuring Radial Pulse
STEP/TASK CASES
Getting Ready:
1. Prepare equipment: Watch or clock with a counter for
seconds.
2. Explain the procedure to the patient.
3. Assist the patient to pronate and slightly fix the forearm.
4. Wash the hands.
Procedure:
1. Locate the radial artery just medial to the distal radius and
proximal to the patient’s wrist on the thumb side. Frequently,
transmitted pulsations can be seen on careful inspection.
2. Place the tips of the index, middle & ring fingers just
proximal to the patient’s wrist on the thumb side, orienting
them over the vessel.
3. Push lightly at first, gradually adding pressure till you feel
the pulse.
Pushing too hard might occlude the vessel and lead to faultily perceiving the
examiners pulse as that of the patient.
Post Procedure:
1. Wash the hands.
2. Discuss the findings with the patient.
3. Record the results as beats / minute and comment on
regularity and volume.
During palpation, note the following:
 Rate: Measure the rate of the pulse (recorded in beats per minute). Count for 30 seconds and multiply by 2. If
the rate is particularly slow or fast, it is probably best to measure for a full 60 seconds in order to minimize the
impact of any error in recording over shorter periods of time.
 Compare to apical pulsations
 Rhythm: Is the time between beats constant? so it may be :
• Regular.
• Regular irregularity (if there are extra beats).
• Irregular irregularity (if there is no discernable pattern as cases of atrial fibrillation).
N.B. if the pulse is irregular; verify the rate by listening over the heart (apical pulse).
 Volume: (i.e. the subjective sense of fullness).
• Normal.
• Big.
• Small
• Variable volume.
 State of the vessel wall:
• Place the tip of the three fingers ( ring , middle , index ) over the radial artery
• Press proximally using the index finger to close the radial artery.
• Press by the ring finger distally to prevent the back flow.
• Palpate the vessel wall by the middle finger.
4

5.  Special character:
 Comment if there is a special character .
 Compare to the other radial pulse .
5

6. Appendex2
Clinical Learning Guide
Measuring Apical Pulse
STEP/TASK CASES
Getting Ready:
1. Prepare equipment: Watch or clock with a counter for
seconds.
2. Explain the procedure to the patient.
3. Assist the patient to a comfortable position: supine or semi-
sitting position.
4. Stand to the right of the patient.
5. Expose chest well.
6. Wash the hands
Procedure:
1. By inspection: look tangentially, from the side of the patient
for apical pulsation.
2. Palpate the apex by palmer surface of the hand.
3. Localize the apex (the lowermost outermost powerful
pulsation) with the tip of your index finger.
4. Auscultate the apex with the bell of the stethoscope.
Post Procedure:
1. Discuss the findings with the patient.
2. Wash your hands.
3. Record the results as beats / minute
6

7. Clinical Learning Guide
Appendex 3
Clinical Learning Guide
Measuring Apical Pulse
Measuring Peripheral pulses
STEP/TASK CASES
Getting Ready
1. Greet the patient respectfully and with Kindness.
2. Tell the patient you are going to examine the neck.
3. Ask the patient to sit on the examining table with arms at
sides.
4. Wash hands thoroughly and dry them
5. Put on new examination or high-level disinfected surgical
gloves on both hands.
6. Exposure: Instruct the patient to remove all clothing
covering the examination areas
Measuring Peripheral Arterial pulses:
1. Femoral artery:
Ask the patient to:
 Lay supine
 Partially flex the knee
 Abduct and externally rotate the hip
 Using the tips of your fingers
 Feel the pulse below the mid-inguinal point
 Compare both sides.
2. Popliteal artery:
Ask the patient to lie supine and partially flex the knees
 Feel the pulse with the fingers encircling and
supporting the knee from both sides.
Alternate method:
 Ask the patient to lie prone
 Using the tips of your fingers with the tips of the
thumbs of both hands pressing against the femur
 Feel along the line of the artery
 Compare both sides.
3. Posterior tibial artery:
7

8. Ask the patient to lie supine
 Using the tips of your fingers
 Feel the pulse in the groove midway between the
medial malleolus and the heel( tendo-achilles)
 Compare both sides.
4. Dorsalis pedis artery:
 Using the tips of your fingers
 Feel the pulse lateral to the extensor hallucis longus
tendon and proximal to the first metatarsal space.
 Compare both sides.
5. Brachial artery:
 Partially flex the elbow
 Using the thumb
 Feel the pulse over the elbow just medial to the
biceps tendon.
6. Radial artery: See specific learning guide
8

9. Appendix 4
Clinical Learning Guide
Measuring the Respiratory Rate
STEP/TASK CASES
Getting Ready:
1. Prepare equipment: Watch or clock with a counter for
seconds.
2. Assist the patient to a comfortable semi-sitting position
3. Wash the hands.
Procedure:
1. Do not explain the procedure to the patient,* pretend you are
measuring the radial pulse, while inspecting and counting
the elevations of the chest wall in 30 seconds.
2. If you could not count the respiratory rate easily because of
clothes or any other reason, let the patient lie flat and pretend
that you are measuring the apical pulse or performing
cardiac examination while counting the respiratory rate in 30
seconds.
Post Procedure:
1. Wash your hands.
2. Record the results as breathes/ minute and comment on
regularity and difficulty.
* If the patient becomes aware that the respiratory rate is being counted, s/he may voluntarily alter the rate of breathing.
9

10. Appendex5
Clinical Learning Guide
Measuring Blood Pressure
STEP/TASK CASES
Getting ready:
1. Greet the child and parents.
2. Explain the procedure and attempt to gain the child’s and
parent’s confidence before approaching the child.
3. Explain that the procedure will not hurt.
4. Put the patient in a supine or sitting position with back
supported for 5 minutes and legs uncrossed, feet flat on the
floor and patient relaxed. The patient must not eat.
5. Prepare equipment (stethoscope and mercury or
aneroid sphygmomanometer)
6. Determine if the pulses are equal, use right arm; if unequal,
use arm with the strongest pulse).
7. Take off the sleeve of the identified arm.
8. Arm should be abducted, supinated and at the level of the
heart (if sitting, use arm support).
1. Choose the correct size of the width of the cuff. The bladder
should be at least40% of the circumference of the midpoint
of the upper arm and the length should be 80% of the upper
arm.
TAKING THE BLOOD PRESSURE
1. Place the cuff around the upper arm with the lower edge of
the cuff, with its tubing connections, placed one inch above
the antecubital space across the inner aspect of the elbow.
2. Wrap the cuff snuggly1 around the inflatable inner bladder
centered over the area of the brachial artery.
3. Close the valve of the pump.
4. Inflate the cuff while palpating the radial pulse.
Inflate the cuff rapidly to 70 mmHg then 10
mmHg at time till the pulse will no longer be felt
(the pulse obliteration pressure). This is the
approximate systolic blood pressure.
5. Deflate the cuff
6. Add 20-30 mm Hg to previously measured number to know
the maximum inflation level (MIL).
7. Place the earpieces of the stethoscope into ears,
with the earpiece angles turned forward toward the
nose.
8. Palpate the brachial artery.
9. Apply the diaphragm in of the stethoscope over the brachial
1
Snuggle: properly fitting not tight nor loose.
10

11. STEP/TASK CASES
artery, just below but not touching the cuff or tubing.
10. Close the valve of the pump.
11. Inflate the cuff rapidly to the MIL previously determined.
12. Open the valve slightly and maintain a constant rate of
deflation at approximately 2mm per second.
13. Allow the cuff to deflate
14. Listen throughout the entire range of deflation until 10mm
Hg below the level of the diastolic reading. The first loud
beat will be the systolic recording (Korotkopf I) ,the sudden
reduction of sound (Korotkopf IV) will denote the diastolic
reading1.
15. Fully deflate the cuff by opening the valve.
16. Remove the stethoscope earpieces from the ears.
17. Write down the systolic and diastolic readings to the nearest
2mmHg.
18. Deflate cuff completely, if the sound were not heard clearly
or the blood pressure recording is high raise arm above head
level for one minute then lower arm and repeat steps 3 to 15.
1
In case the sound continues to zero, record the diastolic blood pressure as a
range of the kortokopf IV sound to zero.
11

12. Appendix 6
Clinical Learning Guide
Measuring Pediatric Axillary Temperature Using
a Mercury Thermometer
STEP/TASK CASES
Getting Ready:
1. Prepare equipment (thermometer tray, tissue
paper and thermometer)
2. Tell the mother what is going to be done and
encourage her to ask questions.
Procedure:
1. Place the baby on her/his back or side on a clean,
warm surface.
2. Shake the thermometer until it is below 35°C.
3. Place the tip of the thermometer high in the apex
of the axilla and hold the arm continuously against
the body for at least two minutes.
• Remove the thermometer and read the
temperature by holding it at eye-level and
rotating the stem until the mercury is clearly
seen
Post Procedure:
1. Wipe the thermometer with a disinfectant solution
after each use.
2. Record results on a notepad
12

13. Clinical Learning Guide
Appendix 7
Clinical Learning Guide
Measuring Apical Pulse
Examination of Lymph Nodes
STEP/TASK CASES
Getting Ready
7. Greet the patient respectfully and with Kindness.
8. Tell the patient you are going to examine the neck.
9. Ask the patient to sit on the examining table with arms at
sides.
10. Wash hands thoroughly and dry them
11. Exposure: Instruct the patient to remove all clothing
covering the examination areas
Examination of Peripheral Lymph Nodes
Lymph Nodes in the Inguinal Region
Ask the patient to:
 Fully expose the inguinal region
 Lay supine
 Flex the contra-lateral knee
 Palpate above and below the inguinal ligament
 Examine both sides
Lymph Nodes in the Axilla
Examine the patient from the front:
 With the patient’s arm adducted, rest his/her left
forearm on your right forearm
 Insert your right hand into the patient's left
axilla
 Slide the fingers against the chest wall
 Palpate the anterior axillary fold
 Palpate the lateral axillary wall
 Using the tips of your fingers
 Use the left hand for the patient’s left side
 With the palm directed laterally against the
upper end of the humerus, palpate for the
lymph nodes
 Palpate the posterior axillary fold from behind
Epitrochlear Lymph Nodes
13

14.  Place the patient’s elbow in a semiflexed position
 For examining the right side, put your right palm
over the posterior aspect of the patient's right elbow.
Do the opposite when examining the left side.
 Using the thumb for palpation, roll the epitrochlear
lymph node against the bone in an antro-posterior
direction
14

15. Appendix 8
Clinical Learning Guide:
Examination of the Neck
STEP/TASK CASES
Getting Ready
1. Greet the patient respectfully and with kindness.
2. Tell the patient you are going to examine the neck.
3. Ask the patient to sit on the examining table with arms at
sides.
4.Wash hands thoroughly and dry them
5. Put on new examination or high-level disinfected surgical
gloves on both hands.
6. Exposure: Instruct the patient to remove all clothing down to
the nipple line.
PROCEDURE
Inspection:
 Observe the contour of the neck and notice any
abnormalities
 Ask the patient to swallow and notice any masses
moving with deglutition
Define the anatomical site of any observed swelling
Notice any neck pulsations, dilated veins, scars
Allow patient to recline at 45 degrees, this makes
normal neck veins visible just above clavicles with their
characteristic pulsations
Comment on:
o Arterial pulsations(suprasternal and or prominent carotid pulsations)
o Venous pulsations; congestion, pulsations (a & v waves and x & y descent) and their
relation to inspiration
o Thyroid swelling
o Other swellings
15

16. 16

17. Palpation :
 Advise the patient to sit on a stool
 Stand behind the patient
 Instruct the patient to relax the neck muscles so as to
allow you to move the head in any direction
 Hold the head with one hand and flex it gently to one
side while palpating the front of the neck with the other
hand
 Flex the patient’s head towards the side that is being
palpated
 Ask the patient to resist your movement in order to
contract the muscles; continue to palpate the neck while
the muscles are being contracted.
 Examine the relationship of any masses detected to:
o The trachea: Notice the movement of the mass with
swallowing
o The hyoid bone: Notice the movement of the mass
with protrusion of the tongue
 Palpate the cervical lymph nodes
o Can be done either while facing or while standing
behind the patient
o Examine all the groups systematically (superficial
and deep, upper and lower)
o Palpate beneath the mandible, over the tonsillar L Ns,
over the anterior triangles. Above the clavicles and
deep to sternoclavicular attachments of the
sternomastoid muscles
 Palpate both carotid arteries for equality and presence of
a thrill
Comment on:
o Thyroid gland:
o size
o shape
o tenderness
o mobility
o consistency
o Lymph node enlargements
o Pulsations and thrill
Percussion :
 Tap with the index finger over the manubrium sterni in
order to rule out any retrosternal extension of the
thyroid gland, which will elicit a dull note on percussion
Auscultation:
 Listen over the thyroid gland (mainly over the superior
thyroid artery) for any bruit or murmur.
 Listen over both carotid arteries for any bruit or murmur.
17

18. Appendix 9
Clinical Learning Guide
Examination of the Mouth
STEP/TASK CASES
Getting Ready
1. Greet the patient respectfully and with kindness.
2. Tell the patient you are going to examine the mouth.
3. Ask the patient to sit on the examining table with arms at
sides.
4. Wash hands thoroughly and dry them
5. Put on new examination or high-level disinfected surgical
gloves on both hands.
6. Prepare a good light (torch) and spatula
PROCEDURE
EXAMINATION OF THE MOUTH
1. Retract the lip to inspect the buccal mucosa
2. Push the cheek outwards to see the buccal side of the
gum (for abnormalities)
3. Push the tongue away from the inside of the gum and the
floor of mouth; then push it aside to inspect the lateral
aspect of its posterior third
4. Depress the tongue to look at fauces (throat), tonsils and
pharynx
5. Always remember to palpate the structures in the mouth
bimanually; one finger inside the mouth and one outside.
6. Examination of the lips:
 Inspect the lips and evert the lip fully to examine
the mucous surface of its inner aspect and the
gingivo-labial fold
 Palpate the lips using two fingers
7. Examination of the cheeks:
 Retract the angle of the mouth and illuminate the
interior of the mouth using a torch
 Inspect the interior of the cheek for
pigmentations, ulcers, swellings
 Inspect the orifice of the parotid duct.
18

19. STEP/TASK CASES
8. Examination of the teeth:
 Inspect the teeth for their shape, color, dental cares
and presence of rough or broken edges.
 Inspect for pulpless, impacted, non-erupted or
missing teeth by counting their number
 If the patient wears dentures, ask for its removal
before proceeding with the examination, notice if
it is smooth and well fitting.
9. Examination of the gum:
 Evert the lips fully to inspect the gums
 Look at the color, the crenated edges, the relation
to the necks of the teeth, pigmentation, ulcers,
swellings
10. Examination of the tongue:
 Inspect the tongue for size, shape, color, surface,
mobility
o Determine the general condition of the
mucous membrane; dry or moist, clean or
furred
o Note if there is any swellings, ulcers or
fissures
 Palpate the tongue
o Ask the patient to relax the tongue and not
to move it.
o Palpate with the index finger of the right
hand while pressing the fingers of the left
hand firmly into the cheek, in such a way
that the cheek intervenes between the
teeth. In order to prevent the patient from
biting the examiner finger.
o To palpate the posterior quarter of the
tongue, ask the patient to open the mouth
widely.
11. Examination of the floor of the mouth :
 Ask the patient to open the mouth and to put the
tip of the tongue on the roof of the mouth and to
bend the head slightly backwards.
 Inspect the floor of the mouth and the
undersurface of the tongue
 Bimanually palpate any visible swelling
19

20. STEP/TASK CASES
12. Examination of the fauces (throat) and palate
 Ask the patient to tilt the head slightly backwards
and to open the mouth to its fullest extent
 Inspect the movement of the palate while
instructing the patient to say (AAH)
 Depress the tongue with a spatula and illuminate
the throat; inspect the tonsils, pillars of the fauces
(throat) and the posterior pharyngeal wall
 To palpate the pharynx,(if needed):
o Seat the patient on a stool, and stand on the
right side.
o Hold the head firmly with the left hand, the
index finger of which is pushed in between
the jaws to prevent the patient from biting
the examiner's finger.
o The right index finger is then passed
behind the soft palate to palpate the
posterior nares, nasopharynx and back of
tongue.
20

21. Appendix 10
Clinical Learning Guide
Measurement of the Height of a Child
Above Two Years
STEP/TASK CASES
Getting ready:
• Use a measuring device e.g. studiometer or
wall- mounted measuring ruler.
1. Introduce yourself to the mother
2. Ask her the permission to examine the
child
3. Ask the mother/child to remove shoes and
socks.
4. Ensure the correct positioning by beginning at
the feet and working upwards.
• Place the feet together flat on the ground
with the heels touching the zero point.
• Ask the child to stand as straight as
possible with the heels, buttocks and
shoulders touching the measuring
device/wall
• Be sure the knees are fully extended
• Put the head carefully in the neutral
position with the lower margins of the
orbit in the same horizontal plane as the
external auditory meatus (Frankfurter
plane)
5. Record the reading and plot it on an Egyptian
growth chart.
21

22. Appendix 11
Clinical Learning Guide
Measurement of the Weight of an
Infant Below 2 Years
STEP/TASK CASES
Getting Ready:
1. Prepare a clean scale and a disposable piece of
Paper.
2. Put a cloth on the scale pan to avoid chilling of the
Infant.
3. Adjust the scale to the zero point.
4. Introduce yourself to the mother and explain
The steps you are going to do to her.
5. Instruct the mother to remove the child's cloth
leaving as least as possible of it
Procedure:
1. Place the child gently on the center of the weighing
Scale
2. Wait till the scale display stops flashing (digital
scale), or the pointer settles (mechanical scale). In
case you use a beam scale, move the weight on
the main scale beam away from the zero point until
the indicator settles at the center1.
3. Take the child off the scale and repeat the previous
Step
4. Record the average of both readings
Post procedure:
1. Return the child to his mother and instruct her to
dress it
2. Record the weight and plot it on a growth chart.
Recording weight on the growth chart (plotting measurements)
1. Write the month of birth in the box below the
first vertical column) the first box which has
thick lines around it). Near the box, write the
year of birth.
2. Beginning with the month of birth, write out the
following months of the year in the following
boxes. When you reach January, write the year
1
The child must not touch the table and the mother must not support his body.
22

23. near that box exactly as you wrote the year of
birth near the box for the month of birth.
3. Carefully calculate the child's age to the nearest month.
4. Record the weight by putting a big dot on the
line corresponding to that weight in kilograms.
For example, if the weight of a child is 6 kg in a
given month, find the horizontal line
representing 6 kg and put a dot at the point on
that line where it meets the column for the
month in which the weight is being taken. Use a
straight edge (as shown in the figure below) to
draw a horizontal line across from that point
until it intersects the vertical line.
5. Adjust the position of the dot within a column.
If the child is being weighed early in the month,
put the dot towards the left side of the column.
Put the dot in the middle of the column if the
weight is being taken in the middle of the
month. If the weight is being taken late in the
month, put the dot towards the right side of the
column.
6. Follow the above instructions each time you
record the weight on a chart. Join subsequent
dots by a line. This is the line of growth.
Interpreting the growth line
1. Look carefully at the growth line. Remember
that when the line is going up, parallel to the
reference curves (3rd and 97th percentiles, as
shown in this figure), the child is growing well;
this is good. If the child is not following his
percentile i.e. the lines becomes horizontal or
going down, then the child is not growing well.
23

24. 2. The importance of the direction of the growth
curve is illustrated in Fig. below. Arrows A, B,
C, and D have been drawn on the growth chart
parallel to the growth curve for different
periods. The growth curve parallel to arrow A is
good. The growth curve parallel to arrow B is
not satisfactory and action should have been
taken. When the growth curve fell, parallel to
Arrow C, the child has a problem, and an urgent
action is needed. When the growth curve
returns to the direction of arrow D, the child's
growth is becoming normal again.
3. Remember that it is the direction of the growth
24

25. curve that is more important than the position
of the dots on the curve, The dots parallel to
arrow B (in Fig. above) are above the lower
reference line, but the growth curve is leveling
off and this is a matter for concern. The dots
parallel to arrow D are below the reference
lines, but the direction of the growth line is once
again upwards and therefore the mother is
congratulated for her good care.
Counseling the mother about her child's growth
1. Tell the mother the difference in her child's
weight compared to the previous month. Use
the growth chart to do this.
2. Explain whether her child is gaining weight or
not. Use the growth chart to do this.
3. Tell the mother if her child is malnourished or
not.
4. Ask the mother open-ended questions (related
to her child's feeding practices).
5. Write down proper notes about the child's
feeding practices.
6. Compliment the mother for what she is doing
correctly.
7. Urge the mother to continue the things she is
doing correctly.
8. Counsel the mother on any problems identified
during the diagnosis.
9. Urge the mother to change any faulty behavior
that needs to be changed.
10. Ask the mother what things that would make it
difficult for her to follow the advice that she is
given.
11. If so, help the mother to work through any
obstacles.
12. If the child has been ill, talk about ways to
prevent or manage the illness.
13. Verify that the mother understands the advice
by using questions.
14. Ask the mother to mention the key things that
she should stop doing.
15. Ask the mother to repeat back the key things
that she should continue to do in the upcoming
month(s).
16. Ask the mother to commit to the suggested
behaviors.
25

26. Appendix 12
Clinical Learning Guide
Measurement of the Head
Circumference
STEP/TASK CASES
Getting Ready:
1. Prepare a non-stretchable measuring tape
2. Introduce yourself to the mother
3. Ask her permission to examine the child
Procedure:
1. Pass the tape on the forehead along the plane
midway between the eyebrow and the hairline,
to the occipital prominence at the back of the head
2. Measure to the nearest millimeter
Post procedure:
Record measurement on head circumference chart
26

27. Appendix 13
Clinical Learning Guide
Measurement of Mid-Arm
Circumference
STEP/TASK CASES
Getting Ready:
1. Prepare the following tools:
• A non-stretchable measuring tape
• A skin marker
2. Introduce yourself to the mother
3. Ask her permission to examine the child
4. Ask the mother to undress the child exposing the
Left shoulder and arm.
5. Help the child put the arm in an extended relaxed
Position
Procedure:
1. Identify the mid-point between the acromion and
the olecranon on the lateral side of the arm.
2. Pass the tape around the arm at the identified
plane, perpendicular to the long axis of the arm
3. Measure to the nearest millimeter
Post procedure:
Record the reading
27

28. Appendix 13
Clinical Learning Guide
Measurement of Mid-Arm
Circumference
STEP/TASK CASES
Getting Ready:
1. Prepare the following tools:
• A non-stretchable measuring tape
• A skin marker
2. Introduce yourself to the mother
3. Ask her permission to examine the child
4. Ask the mother to undress the child exposing the
Left shoulder and arm.
5. Help the child put the arm in an extended relaxed
Position
Procedure:
1. Identify the mid-point between the acromion and
the olecranon on the lateral side of the arm.
2. Pass the tape around the arm at the identified
plane, perpendicular to the long axis of the arm
3. Measure to the nearest millimeter
Post procedure:
Record the reading
27