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The child may find it reassuring for you to go through the examination with the parent first. If the child will not cooperate in walking, carry her to the opposite side of the room. The child will usually walk or run back to the parents. If the child has pain, always examine the painful site last. Screening Evaluation Examine the adolescent in a gown [A] or, even better, in a swimsuit. It is essential to see the whole child to avoid missing important clues in diagnosis such as a skin dimple that may accompany an underlying spinal deformity [B].

The lack of experience with new imaging methods makes interpretation even more difficult. Over-reading imaging, such as the MRI, poses risks and may lead to over-treatment. For example, MRI studies of discitis often show extensive soft tissue changes, which might prompt operative drainage if the nature of the disease is not appreciated. Conventional Radiography B Normal variation The supracondyloid process of the humerus (yellow arrow), a bipartite patella (green arrow), and malleolar ossicles (orange arrow) are uncommon developmental variations of normal.

Excessive wear on the toes of the shoes is indicative of a more severe degree of equinus (yellow arrows,right) in a child with spastic diplegia. foot–ground contact normal gait Gait can be assessed by using a videocamera to record visual observations. More sophisticated techniques can also be used, including dynamic electromyography to assess muscle firing sequences, kinemetric techniques for assessing joint motion, force plate to measure ground reaction forces, and sequence and rate measurements [A, next page].