Paediatric Abdominal Exam
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Below is a brief summary of what to check for in a paediatric abdominal examination. For a detailed explanation of these features, and for adult abdominal examination, please see the abdominal examination article.

General inspection

Get the child to take their top off
Look around the bed for:

  • Medications
  • Drip
  • Special dietary requirements
  • Stool sample pot

Look at the patient for:

  • Obvious signs of illness


  • The 5 ‘Fs’ (only 4 apply in children! – Fat, faeces, flatus, fluid (+ fetus)
  • Scars
  • Bruising
  • Stoma
  • Mass / discolouration (e.g. in Pancreatitis:)
    • Grey-Truner’s sign – discolouration in the flank
    • Cullen’s sign – discolouration around the umbilicus
  • Obvious movements e.g.: Pyloric stenosissometimes you can see a peristaltic movement from left to right, particularly after a feed


  • Leukonychia – white nails – hypoalbuminaemia (liver failure)
  • Koilonychia – spoon shaped nails – iron deficiency anaemia
  • Polished nails – sign of scratching – rash (e.g. jaundice)
  • Clubbing – Crohn’s, UC, coeliac’s
  • Beau’s lines – horizontal white lines – caused by any acute severe illness – grow out in 12 weeks
  • Asterixis – high levels of urealiver failure
  • Dupytrens contracture – idiopathic / liver failure
  • Bruising – liver failure / vitamin K deficiency (in neonates)


  • Ulceration – Crohn’s
  • Angular stomatitis – iron deficiency anaemia
  • Gum hypertrophy – leukaemia, scurvy, anti-epileptics (phenytoin)
  • Glossitis – big red smooth tongue – iron deficiency anaemia / B12 deficiency
  • Candida immunodeficiency (AIDs, leukaemia)
  • Freckling around the mouth – Putz-Jehger’s syndrome – associated with polyps in the bowel. High risk of cancer / obstruction


  • Yellow sclera – jaundice
  • Pale conjunctiva – anaemia
  • Keyser-Fleischer rings – Wilson’s disease (mean age of presentation 6-20)
  • Xanthelasma – Hyperlipidaemia (can be inherited in an autosomal dominant fashion but unlikely to present in children)
  • Corneal arcus – cholesterol deposits


Inspect if you didn’t earlier
  • Palpate all 9 areas
  • Look at the patients face for signs of pain as you palpate
  • Abdo pain in children
    • Many causes!
    • Classical signs of appendicitis may / may not be present if there is appendicitis.
    • Pain tends to be less localised than in adults
  • Superficial palpation first
  • Then deep palpation
    • Faeces?
    • Other masses?
  • Size / placement of the liver
    • In children it is likely to be up to 2 fingers palpable. This is normal, and prevalence of this decreases with age
    • Technique same as adult
  • Size / placement of the spleen
    • Same technique as adult
    • Tipping for the spleen – ask the patient to lie on their right hand side, and bring their left knee towards their chest. Put their left hand on your left shoulder, and ask them to take a deep breath in, as you feel under the costal margin. You might just feel the edge of the spleen.
  • Traube’s note – percussion at the 9th intercostals space at the mid-axillary line – normally resonant, but in splenic enlargement, becomes dull
    • Ballot for the kidneys
    • Gallbaldder – not usually palpable. If painful and palpable, then not gallstones!


  • Size of the liver
  • Shifting dullness


Listen 2cm above the umbilicus

  • Should be able to hear any renal artery bruits if present
  • Should be able to hear bowel sounds
  • Normal bowel sounds – aka borborygmi occur at least every 2-3 minutes
  • High pitched, tinkling bowel sounds – obstruction
  • Absent bowel sounds – peritonitis
Auscultation of the abdomen of a 15 month old child
Auscultation of the abdomen of a 15 month old child. This file is taken from wikimedia commons and is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Causes of Hepatomegaly in children

Causes of splenomegaly in children

10% of neonates will have a palpable spleen normally
  • TORCH Infections
  • Sepsis
  • Haemolytic anaemias (rare)
  • Juvenile Rheumatoid arthritis (rare)

Finishing off

  • Check external genitalia  / hernia orifices– e.g. testicular atrophy in liver disease, hernias
  • Do a PR – lumps, constipation, bleeding, lesions – Rarely performed in children, but may be indicated in some cases
  • Ankle oedema – liver failure
  • Urine dipstickrenal failure, diabetes, infection


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

This Post Has 2 Comments

  1. Sophie

    Hi, im a bit unclear.. does this page have signs that are specific to children or is this just a general abdominal examination?

  2. Bravo Whiskey

    The order is wrong, do not palpate before you auscultate as you will disturb the bowel contents thus making your auscultation assessment less accurate.

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