With an adult patient, a paramedic generally proceeds systematically from head to toe. In children, this approach remains the target framework, but the order of steps adapts to the developmental stage — with a single fixed principle across all ages: the least invasive steps come first, the most unpleasant last. This fifth installment of the PED series builds on the Pediatric Assessment Triangle from the previous installment and covers how to conduct the hands-on examination itself.

Approach by age category

Newborn and infant

The examination ideally takes place in the parent’s arms or on their lap — changing position and separation from the parent increase distress and make assessment harder. Proceed “toe-to-head” or at least in order from least to most disruptive: the heart, lungs, and abdomen are examined first, ideally while the child is calm or asleep; the ears, mouth, and throat (most unpleasant) are left for last. The examiner’s hands must be warm — a cold touch by itself provokes crying and invalidates subsequent steps.

Toddler (1–3 years)

This group offers the greatest resistance. Minimal direct contact at the start is recommended, examining from the child’s level (crouching, not from above), and keeping the child on the parent’s lap. Letting the child “explore” equipment (e.g., a stethoscope) before its use reduces fear. As with an infant: heart and lungs first, ears/mouth last.

Preschool age (3–6 years)

The approach is similar to a toddler’s, but the child usually responds better to play and simple explanations (“I’ll check if your tummy sounds good”). From this group onward, it’s generally possible to move closer to the classic head-to-toe order, though the most unpleasant steps still belong at the end.

School age and adolescent

The examination can be conducted systematically from head to toe, similarly to an adult. It’s important to explain the procedure in advance, respect privacy (particularly in adolescents), and actively ask for consent before individual steps — not just for cooperation, but also for building trust.

The role of the parent / legal guardian

The parent isn’t just a source of history — they’re an active tool for soothing the child and often the person best able to recognize a deviation from usual behavior. Keeping the child on the parent’s lap instead of isolated positioning on a stretcher significantly reduces separation anxiety and improves the quality of examination, particularly in infants and toddlers.

Practical implications for the paramedic

Connection to the next part of the series

In PED-06, we’ll return to the numbers — reference vital-sign values by age category and how to correctly interpret them in the context of the overall clinical picture, not in isolation.