Lecture V: Approach to Children

Question 1

Unique Challenges of communicating with infants, children, and their parents

Answer 1

• Children are not small adults
o The spectrum of diseases varies with age
o Process of ongoing physical and physiologic maturation
o A child’s response to stress and illness is unique
o A complete history involves communication with the child and caretaker (verbal and nonverbal)

Question 2

Describe how to obtain a history from pediatric patients of varying ages and/or their parents

Answer 2

1. Family/home environment
2. Growth
3. Immunizations
4. medications
5. Interval Illness, hospitalizations/surgeries
6. Problem List
7. Dietary History
8. Toileting Habits
9. Sleep Patterns
10. Screening for lead, anemia, TB
11. Developmental History
12. Anticipatory Guidance(safety)

Question 3

Demonstrates a basic approach to performing a pediatric physical exam

Answer 3

• Listen to parents-work with them-no dictator/servant business
• Try to engage the child early
• Modify your approach based on child’s age
• Save invasive elements of the exam for last-listen to heart early
• Have fun, children love to play! (And they can sense your fear so try to relax…)

Question 4

Differentiate how the age of a child changes your approach

Answer 4

See other cards

Question 5

Developmental History

Answer 5

• Gross motor skills/ fine motor skills/ social skills/ verbal skills/ school performance/ Denver developmental screening tool/ ages and stages/ MCHAT
• School Performance
o Grade level/ areas of concern, strength/ extra curricular activities
• Assessing development
o Observe the child as you talk to the family/ what are they doing (talking, walking, playing)? What are they not doing (disabilities)?

Question 6

Well Child Check-Up

Answer 6

1. To identify and monitor medical, developmental and psychosocial risks.
2. To provide families w/ info on the promotion of healthy habits and the prevention of injury and illness.
3. To provide families w/ info about normal developmental changes.

Question 7

Problem Visit History

Answer 7

o Always observe first and address the most pressing issue (e.g., respiratory distress, bleeding, pain)
o Obtain the “story” of the illness in chronologic order
o Deal with the main complaint, but look further, assess for any unspoken agenda or fear

Question 8

Infancy

Answer 8

• The period of growth and development that encompasses 0-14 months of age
• Infants are non-verbal but can still communicate
• History is entirely from caretaker
• Observe infant’s non-verbal cues e.g. cries when leg is moved, eye contact
• Learning is through sensory experience
• Use soft tones and gentle handling
• Consider examining the infant in parent’s lap
• Allow infant to keep comfort items during exam- e.g. pacifier/ blanket
• Keep infant warm
• Separation anxiety: age 9-15 months
o Approach child gradually (move in slowly after establishing rapport with a parent or a sibling first)
o Gain their trust directly by playing w/ them
o Use transitional objects/ toys (demonstrate the exam on the favorite doll, demonstrate on a parent or sibling)
o Examine the child on parent’s lap

Question 9

Early Childhood

Answer 9

• The period of growth and development that encompasses age 15 months through age 4 years
• Introduce yourself but approach slowly
• As a first approach, offer a toy or book to them to use while you talk with parent
• Allow space for them to warm up to you before beginning the exam.
• Talk with parents first
• Attempt to engage child in conversation – children at this age may know their age and name
• Don’t ask permission to perform a part of the exam- they know the word ‘no’
• Explain what you are going to do before you do it
• Be careful about word choice e.g. stick, poke
• The toddler is becoming an individual. Give the toddler some power/ choice
o “Would you like to sit on the table by yourself or on the chair w/ dad?”
o Allow them to climb onto table; praise them for their talent; observe motor skills

Question 10

Middle Childhood

Answer 10

The period of growth and development that encompasses ages 5 through 10 years
• Preschool age children
o The child develops more logical thinking and becomes increasingly curious about the world around them
o Self-esteem and gender identity develop during this time
o Early social skills are also developing
• School age children
o Thinks more logically and coherently (don’t talk down to them)
o Is learning more advanced social skills
o May be interested in learning about their body
• Preschool and school age children
o Make eye contact with child and address them first when you go in exam room
o Ask the child for information, not just the parent
o Give the child some control if they seem apprehensive
o Explain everything in concrete terms; abstract thinking is minimal
o Involve the child in the plan – he/she is the one who has to live w/ it
• Liquid vs. chewable medicine
o Rehearse the plan so it is clear to the child what is going to happen – let them ask questions