For hands, mouth, tongue, and eyes see respiratory and cardiovascular systems. Assess whether the child is jaundiced.
The child needs to be relaxed and positioned supine, with the knees bent and hands by the sides.
·Look at the shape of the abdomen: is it distended? Is the umbilicus everted?
·Does the abdominal wall move? Is the child in pain? Is peristalsis visible?
·Let the child know that you are going to touch the abdomen: they should be free to tell you if it hurts. Do not hurt the child. First auscultate for bowel sounds, and then percuss in your assessment of hepatomegaly and ascites. In the right mid-clavicular line an enlarged liver extends more than 2cm below the costal margin. The normal span of the liver—between its upper and lower margins—is shown in Table 3.3.
·Palpate the abdomen and check for any tenderness before assessing rebound: palpate for masses during inspiration and deep expiration. Can you feel an abnormal spleen, liver, or kidney?
·Watch the child feeding.
In most instances you will only need to observe the patency of the anus and to look for fissures and rectal prolapse. However, if the child has abdominal symptoms, a digital examination may be required to check for sphincter tone, masses, and tenderness.
·This examination should only be done once and you will need to decide whether this test should be performed by a senior colleague, or by the surgeon should the child have an acute abdomen.
· Never perform a rectal examination as a senior house officer.