For a toddler the exam runs least invasive first, ears and mouth last, with age-specific vital sign ranges and each change justified beside the adult version. Searches like "mn 552 unit 6 assignment example", "mn552 unit 6 sample" and "mn552 unit 6 example" land here.
Adapting the Head-to-Toe Examination for an 18-Month-Old: Sequence, Position, Normal Values and Documentation
[Student Name]
Purdue University Global
MN552: Advanced Health Assessment
Unit 6 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. No real child, family or clinician is described.
The Encounter and the Problem With Adult Order
A composite 18-month-old boy is brought by his mother for a well-child visit. He walks well, says about ten words and clings to his mother when the examiner enters. An adult head-to-toe sequence would begin at the head with the otoscope, move to the mouth with a tongue blade and reach the chest last. With a child this age, that order would produce crying within two minutes, and a crying child cannot be auscultated or have an accurate respiratory rate counted. The examination therefore has to be rebuilt, not shortened. The adaptation below keeps every system the adult examination covers but changes the order, the position, the normal values and the way findings are recorded. Every change is paired with its reason, labeled as anatomy, physiology or development, because an adaptation that cannot say why a step moved is only a pediatric examination described.
Adult Order Beside Adapted Order
Row 1. Adult: general survey on entry, brief. Adapted: extended observation from across the room while the examiner talks with the parent, noting color, work of breathing, gait, interaction and play. Reason (development): stranger anxiety peaks at this age, and a child observed before being touched shows his baseline behavior.
Row 2. Adult: vital signs first, patient seated alone. Adapted: respiratory rate counted by watching the abdomen while the child sits calmly on his mother's lap, then heart rate by auscultation. Temperature and blood pressure are deferred to the end or omitted. Reason (physiology): toddlers breathe mainly with the diaphragm, so abdominal movement is easier to count than chest movement, and rates rise sharply with crying.
Row 3. Adult: heart and lungs late in the sequence. Adapted: heart and lungs next, while he is still calm, with the child sitting upright on his mother's lap facing outward and the stethoscope warmed. Reason (development): auscultation needs quiet, and quiet is most likely early in the visit.
Row 4. Adult: head and neck inspection. Adapted: head circumference measured and plotted on the growth chart, and the anterior fontanelle palpated. Reason (anatomy): the skull is still closing, and head growth is a key developmental measure at this age.
Row 5. Adult: abdomen supine on the table. Adapted: abdomen palpated with the child lying across his mother's lap, knees flexed. Reason (development): lying flat on a table away from the parent is likely to cause distress, and relaxed abdominal muscles need a relaxed child.
Row 6. Adult: ears and mouth early. Adapted: otoscopy and the oral examination last, with the child turned sideways on his mother's lap, his head held against her chest and his arms held in a hug. The pinna is pulled down and back rather than up and back. Reason (anatomy and development): the ear canal in children under about three is shorter and directed upward, so pulling down and back straightens it, and these are the steps most likely to cause crying.
Row 7. Adult: extremities and skin examined in sequence, patient on the table. Adapted: hips, legs and feet examined during play on the floor or on the lap, with the skin inspected as clothing is removed in stages rather than all at once. Reason (development): a toddler tolerates being undressed gradually, and watching him stand, squat and pick up a toy shows strength and joint range better than passive movement.
Row 8. Adult: mental status by conversation. Adapted: developmental observation, noting words used, pointing, following a one-step command such as "give the block to Mommy," and stacking blocks. Reason (development): at this age, language and motor milestones replace orientation questions as the measure of neurologic function.
Normal Values for This Age
Adult normal values cannot be applied to a toddler. For a child of 12 to 24 months, awake heart rate typically falls between 98 and 140 beats per minute and respiratory rate between 24 and 40 breaths per minute (American Heart Association, 2020). A respiratory rate of 36 would be abnormal in an adult and normal in this child. Reference centiles show how wide the normal range is at this age and how much values fall during sleep, which is why the state of the child must be recorded with each measurement (Fleming et al., 2011).
Several findings exist only in the adapted examination. The anterior fontanelle usually closes between about 9 and 18 months, so at this age it may be closed or small; a large or bulging fontanelle would be abnormal. The number of erupted teeth is recorded, with around 12 expected at 18 months and wide variation in either direction. Head circumference is plotted on a growth curve, since a crossing of centile lines matters more than a single value. A short gait observation notes whether he walks steadily with a wide base, which is expected at this age, or shows asymmetry or toe walking (Bickley et al., 2021).
Findings, Documented in the Adapted Order
General: Alert, interactive, clings to mother on entry, then plays with blocks on her lap. Walks steadily with a wide-based gait. Color pink, no increased work of breathing.
Vital signs: Respiratory rate 30 breaths per minute, counted over 60 seconds by abdominal movement while calm on mother's lap. Heart rate 118 beats per minute by auscultation, calm. Temperature 36.8 C axillary, taken at the end of the visit while fussing. Blood pressure deferred at this well visit; no indication.
Heart: Regular rhythm, no murmur, measured while calm and upright on mother's lap. Lungs: Clear to auscultation bilaterally, no wheeze or crackles, calm.
Head: Anterior fontanelle closed. Head circumference 47.5 cm, at the 50th centile, consistent with the 12-month measurement.
Abdomen: Soft, nontender, no masses, examined across mother's lap with knees flexed; child calm.
Ears (last): Tympanic membranes gray and translucent with a visible light reflex bilaterally, pinna pulled down and back; child crying during the ear examination. Mouth: 12 teeth erupted, no visible caries, examined while crying. Development: uses about ten words, points to request objects, follows a one-step command, stacks three blocks.
Deferred Items
Blood pressure was deferred because this was a routine visit without a risk factor, and cuff measurement in a toddler often causes distress that would affect the rest of the examination. The genital examination was completed with the diaper change at the end of the visit rather than during it. Vision and hearing screening were recorded as observed behaviors rather than formal tests, since both require cooperation this child could not give on this day. Each deferral is recorded with its reason so that a later reader can see that it was a decision, not an omission.
References
American Heart Association. (2020). Pediatric advanced life support provider manual. American Heart Association.
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Fleming, S., Thompson, M., Stevens, R., Heneghan, C., Plüddemann, A., Maconochie, I., Tarassenko, L., & Mant, D. (2011). Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: A systematic review of observational studies. The Lancet, 377(9770), 1011-1018. https://doi.org/10.1016/S0140-6736(10)62226-X
How this MN552 Unit 6 example is structured
Every change from the adult exam is paired with its reason, which separates an adaptation from a pediatric exam simply described. Reasons fall into three kinds, and the paper labels them: anatomy (the ear canal, the larger occiput, the proportion of head to body), physiology (faster rates and different normal ranges) and development (stranger anxiety, a need for the parent close, attention measured in seconds). Positioning is described concretely, the child facing outward on the parent's lap for the chest and turned sideways and hugged for the ears. Vital sign ranges are cited, not remembered. The findings that follow use standard clinical language, and each notes the conditions under which it was taken, such as a respiratory rate counted while asleep or while crying. Deferred items close the paper, each with its reason.
Get an MN552 Unit 6 example written to your instructions
The assigned age may be infancy in one section and adolescence, pregnancy or late life in another. Name the one your MN552 Unit 6 prompt gives, attach the rubric and any case details, and a free first adaptation will be written to your instructions and returned in 24-48h, every change set against the adult version it replaces. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN552 Unit 6 questions, answered
What if the assigned age is late life rather than early childhood?
The structure holds. An adaptation for an 85-year-old would pair each adult step with its change: slower pacing, a seated position for parts of the exam, hearing accommodation, and expected findings such as skin turgor that no longer reflects hydration. For any age the prompt specifies, each change sits beside the standard version with its reason.
How should vital sign ranges be cited?
From a current pediatric or age-specific reference your course accepts, with the range written beside the finding. Ranges vary slightly between sources, and so the sample brackets them and names where they came from. A range stated from memory, even an accurate one, tends to draw a request for a citation.
Does the paper need to include developmental screening?
That depends on the prompt. Some Unit 6 prompts attach a milestone check to the physical adaptation, and others keep the two separate. The sample includes a brief gait and language observation because both affect how the exam is performed, and marks the spot a formal screening tool would occupy if your instructor required one.