Monday, January 28, 2013

The not necessarily head-to-toe of the pediatric physical exam

You learn that at about 6 months of age a child will begin to sit --initially for a few seconds, then for longer periods of time-- without support.  But what a mistake it is to assume they can already do it!  Be there very ready to support them, as you examine their capabilities.

Most medical students and residents don't (or don't yet) have kids of their own. And for that matter, when it comes to your own child's or nephew's belly, it's more about tickling it, not palpating and examining it.

So as you set out to learn the basics and then hone your pediatric physical exam skills over time, you'll need and want to spend many a moment actively observing every infant, child, and teen from the moment you meet them, assessing their developmental stage and chronological age and maturity level.  How alert are they, are they sick or well, in distress or comfortable?  Is it naptime or is it lethargy?

And as you perform various aspects of the physical exam you'll make sure to first wash your hands, keep the developing pediatric patient safe, be a model of professionalism, and even introduce some primary prevention... demonstrate to the parents that you won't walk away from the infant on the exam table, nor will you be angry at their infant for crinkling that table paper or eating the new book, but rather you will marvel at their curiosity and zest for exploration.  

What might you watch to learn more of the basics?   Here are some resources:
Oh, and can I look in your ear?  Oops, I mean should I look in this ear or that ear first?

What pediatric physical exam educational resources do you use?

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