Pediatric cardiovascular assessment and referral in the primary care setting.

Pediatric cardiovascular problems, although not common, have the potential to have significant associated morbidity and mortality if they go unrecognized. This article focuses on pediatric assessment techniques required to perform a comprehensive cardiovascular evaluation on an infant or an older child in the primary care setting. Specific key physical assessment parameters to be evaluated and a general developmental approach to the assessment of children are suggested. Auscultation of the pediatric heart is a main focus, including strategies in approaching children, a guide for organizing the ausculatory process, and differences between adult and pediatric heart sounds. Assessment of peripheral pulses, blood pressure, skin and mucous membrane color, and capillary refill are emphasized as an important aspect of comprehensive evaluation of the child's peripheral circulation. Criteria for referral are provided in terms of which children should be referred, who the referral should be made to, and the time frame in which the referral should be made.