Early And Late Childhood And Adolescence

Toddlers and young children commonly have protuberant abdomens, most apparent when they are upright. The examination can follow the same order as for adults, except that you may need to open your bag of tricks to distract the child during the examination.

An exaggerated "pot-belly appearance" may indicate malabsorption due to celiac disease, cystic fibrosis, or constipation or aerophagia.

Most children are ticklish when you first place your hand on their abdomens for palpation. This reaction tends to disappear, particularly if you distract the child with conversation and place your whole hand flush on the abdominal surface for a few moments without probing. For children who are particularly sensitive and who tighten their abdominal muscles, you can start by placing the child's hand under yours as shown in the following photo. Eventually you will be able to remove the child's hand and palpate the abdomen freely.

Late Childhood

You can also try flexing the knees and hips to relax the child's abdominal wall. Palpate lightly in all areas, then deeply, leaving a site of potential pathology to the end.

To detect abdominal tenderness, have the young child tell you which specific area is tender, and note a change in his facial expression or cry.

The liver is easily palpated in most children. The edge of the liver is normally felt 1 cm to 2 cm below the right costal margin. It is sharp and soft and moves easily when pushed from below upward during deep inspiration. As in infants, you should start feeling for the liver edge in the right lower quadrant and work upwards, because a greatly enlarged liver can be missed in children.

The size of the liver is determined better by percussion than by palpation. The table below shows the expected liver span noted by percussion in the right midclavicular line.

Expected Liver Span of Infants, Children, and Adolescents by Percussion

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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