Pediatric HEENT examination
🔴 1. หลักการสำคัญ
- การตรวจ HEENT ในเด็กต้อง:
- observe
ก่อน touch
- ใช้ behavioral technique (distraction, caregiver
assist)
- เน้น:
- developmental
variation
- dysmorphic
features
- early
detection ของ systemic disease
🧠 2. HEAD
🔍 Inspection
- head
shape, scalp lesion, trauma
- mass:
- bone
(exostosis)
- soft
tissue (hemangioma, dermoid, encephalocele)
📏 Head circumference
- วัดทุก visit ในช่วง 0–2 ปี
- ใช้ติดตาม:
- microcephaly
- macrocephaly
🧩 Fontanelle (high yield)
|
Finding |
Significance |
|
tense/bulging |
↑
ICP |
|
sunken |
dehydration |
|
early closure |
craniosynostosis, microcephaly |
|
delayed closure |
hypothyroid, ↑ ICP, Down syndrome |
🧠 Other clues
- frontal
bossing →
skeletal/genetic disorder
- craniotabes
→ rickets, syphilis
- cranial
bruit → AV
malformation
😊 3. FACE
🔍 Evaluate dysmorphism
- eyes
spacing
- philtrum
- auricle
position
👉 clue:
- genetic
syndrome / fetal alcohol
🚩 Abnormal findings
- facial
edema → allergy /
nephrotic / mono
- unilateral
swelling → cellulitis
/ parotitis
- facial
palsy → CN VII lesion
👁️ 4. EYES
🔑 Basic exam
- alignment
(corneal light reflex)
- EOM
- pupil
- conjunctiva
🚨 Red flags
🔴 Red reflex abnormal
- cataract
- retinoblastoma
👉 ต้อง refer ทันที
🔴 Leukocoria (white
reflex)
- malignancy
until proven otherwise
👁️ Common findings
- conjunctivitis
- stye
/ chalazion
- ptosis
→ CN III / MG
👀 Strabismus
- <4
เดือน → normal variant
- 4 เดือน → refer ophthalmology
👂 5. EARS
🔍 Inspection
- low-set
ears → syndrome
- preauricular
pit/tag → ↑ risk hearing loss
🩺 Otoscopy (core skill)
normal TM:
- translucent
- mobile
abnormal:
|
Finding |
Diagnosis |
|
bulging |
AOM |
|
↓ mobility |
effusion |
|
perforation |
trauma / infection |
🧪 Pneumatic otoscopy
- best
for:
- middle
ear effusion
🔊 Hearing assessment
- newborn
→ screening (ABR/OAE)
- older
→ whisper / audiometry
👃 6. NOSE
🔍 Exam
- septum
(midline?)
- mucosa
(pink?)
🚩 Important clues
|
Finding |
Suggestion |
|
unilateral foul discharge |
foreign body |
|
clear watery discharge |
CSF leak |
|
nasal polyp |
cystic fibrosis |
|
obstruction newborn |
choanal atresia |
🔑 Practical
👉 neonate nasal
obstruction →
ลอง pass NG tube
👄 7. MOUTH & THROAT
🔍 Examine:
- lips,
mucosa, tongue, palate
- tonsils
🚩 Important findings
🔴 Oral lesions
- herpetic
stomatitis
- aphthous
ulcer
- immunodeficiency
🔴 Tonsils
- exudate
→ bacterial infection
- asymmetry:
- infection
vs lymphoma
👉 red flags lymphoma:
- rapid
growth
- systemic
symptoms
- large
LN
🦷 Teeth
- eruption
delay →
metabolic/systemic disease
🧠 8. NECK
🔍 Inspection
- short
neck → congenital
syndrome
- webbed
neck → Turner
🧩 Neck mass approach
midline:
- thyroglossal
duct cyst
lateral:
- lymph
node
- branchial
cleft cyst
- lymphangioma
🚩 Red flags
- hard,
fixed mass
- systemic
symptoms
- rapidly
enlarging
🫀 Other findings
- JVP ↑ → cardiac/mediastinal disease
- torticollis
→ muscular / neuro /
reflux (Sandifer)
🧠 9. Clinical pearls (ใช้จริง)
🔑 Must not miss
- abnormal
red reflex → refer
immediately
- neonatal
nasal obstruction → airway
emergency
- unilateral
nasal discharge → foreign
body
- tonsillar
asymmetry + systemic sign →
rule out malignancy
❗ Pitfalls
- ไม่ตรวจ red reflex
- misdiagnose
AOM โดยไม่ดู mobility
- overlook
dysmorphic features
- biopsy
midline mass โดยไม่ imaging
🧩 High-yield workflow
1.
Look →
general + dysmorphism
2.
Airway (nose/oral)
3.
Vision (red reflex)
4.
Hearing (otoscopy + response)
5.
Neck mass differentiation
🔚 Bottom line
Pediatric HEENT exam เป็น เครื่องมือสำคัญในการ
detect disease ตั้งแต่ benign → life-threatening
ต้อง:
- รู้ normal developmental variation
- หา red flags ที่ต้อง refer ทันที
- ใช้ systematic approach ทุกครั้ง
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