The examination of the mouth and pharynx is the last part of the examination in this age group.
The child should be seated on the parent's lap, with the parent holding the child's head. It is usually possible to examine a crying infant without using the tongue depressor. A frightened
Figure 24-37 Ear specula designed to facilitate pneumatic otoscopy. A comfortable but tight seal in the ear canal is important for insufflation to be effective. Both of these reusable specula have the same internal diameter. Note that the one on the right is flared at the tip (with a coating of soft rubber) to provide a seal.
child who is holding his or her mouth firmly closed can be examined if you occlude the nares; this will make the child open the mouth. Enlist the parent as the nose-holder if you must use this technique. The tongue depressor can then be slipped between the teeth and over the tongue.
Inspect the gingivae. Gingival ulceration is frequently the result of primary herpetic infection. Small, discrete, whitish vesicles are also present before ulceration. They are found on the buccal mucosa, palate, and tongue. Severe cases can produce external lesions around the mouth; see Figure 24-54.
Are any teeth present? The first teeth to erupt are the lower central incisors, at about 6 months. These are followed by the lower lateral incisors at 7 months and the upper central teeth at 7 to 8 months. The upper lateral teeth begin to erupt at about 9 months. Salivation is temporarily increased with the eruption of new teeth. (A summary of the chronology of dentition is given in Table 24-5 at the end of the chapter.)
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