The key to successfully examining adolescents is a comfortable, confidential environment. This makes the examination more relaxed and informative. Consider the cognitive and social development of the adolescent when deciding issues of privacy, parental involvement, and confidentiality.
As in middle childhood, modesty is important. The patient should remain dressed until the examination begins, and you should leave the room while the patient gowns. Most adolescents older than age 13 prefer to be examined without a parent in the room, but this depends on the patient's developmental level, familiarity with the examiner, relationship with the parent, and medical issues. For younger adolescents, ask the adolescent and parent their preferences. While the examination of the adolescent can be anxiety-provoking for the novice clinician, with practice, these interactions can be very rewarding for both the adolescent and the clinician.
The sequence and content of the physical examination are similar to that of the adult. However, pay particular attention to issues unique to adolescents, such as puberty, growth, development, family and peer relationships, sexuality, decision-making, and risk behaviors.
It is important to have a chaperone (parent or nurse) present during the genital examination of adolescent females.
Now that you have formed your approach to the child before you, you are ready to begin the physical examination.
Children need models rather than critics.
Important components of the physical examination of children include measurement of body size (height, weight, and head circumference) and vital signs (blood pressure, pulse, respiratory rate, and temperature). Table 17-3, Blood Pressure, and Table 17-4, Growth Charts, (pp. 740-749) show norms for blood pressure, height, weight, body mass index (BMI), and head circumference. Deviations from normal may be the first and only indicators of disease (see Table 17-5, Abnormal Growth Patterns in Infancy and Childhood, pp. 750-759). Except for body temperature, it is important to compare the child's vital signs or body proportions to age-specific norms, because they change dramatically as children grow older. Recently, an increasing number of pediatric practitioners are also assessing pain on a regular basis, using standardized pain scales.
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