Some Tips For Examining Young Children 14yearolds

Useful Strategies for Examination Useful Toys and Aids

Examine a child sitting on parent's lap. Try to be at the child's eye level.

First examine the child's toy or teddy bear, then the child.

Let the child do some of the exam (e.g., move the stethoscope). Then go back and "get the places we missed."

Ask the toddler who keeps pushing you away to "hold your hand." Then have the toddler "help you" with the exam.

Some toddlers believe that if they can't see you, then you aren't there. Perform the exam while the child stands on the parent's lap, facing the parent.

If 2-year-olds are holding something in each hand (such as tongue depressors), they can't fight or resist!

"Blow out" the otoscope light. "Beep" the stethoscope on your nose. Make tongue-depressor puppets.

Use the child's own toys for play.

Jingle your keys to test for hearing.

Shine the otoscope through the tip of your finger, "lighting it up," and then examine the child's ears with it.

Sequence of the Examination. Begin by reviewing Chapter 3, Beginning the Physical Examination: General Survey and Vital Signs, for the methods and sequence of examining adults. When examining infants and children, the sequence should vary according to the child's age and comfort level. Perform nondisturbing maneuvers early on and potentially distressing maneuvers near the end of the examination. For example, palpate the head and neck and auscultate the heart and lungs early, and examine the ears and mouth and palpate the abdomen near the end. If the child reports pain in one area, examine that part last.

The format of the pediatric medical record is the same as that of the adult record, so although the sequence of the physical examination may vary, you should then convert your written findings back into the traditional format.

H Assessing the Newborn_

The first year of life, infancy, is divided into the neonatal period (the first 28 days) and the postneonatal period (29 days to 1 year). Often, the first pedi-atric examination outside the delivery room is performed in the hospital within 24 hours of birth.

If possible, do the physical examination in front of the parents so that they can interact with you and ask questions. Often parents have specific questions about their baby's physical appearance, so stating normal findings as you go can be quite reassuring. This is also an excellent time to observe parental bonding with the newborn, and to observe how well the breastfeeding baby latches and sucks. To detect problems early, try to observe breast-feeding firsthand. Breast-feeding is physiologically and psychologically optimal, but many mothers will need help and support. Early detection of difficulties and anticipatory guidance can promote and sustain healthy breast-feeding.

Aroused Feeding Milk

Newborns are most responsive 1 to 2 hours after a feeding, when they are neither too satiated (becoming less responsive) nor too hungry (and often agitated). It is helpful to start with the newborn swaddled and comfortable. Then undress the newborn as the examination proceeds, for gradual stimulation and arousal. If the newborn becomes agitated, use a pacifier or a bottle of formula (if not breast-feeding), or allow the baby to suck on your gloved finger or the baby's own hand. You can also try reswaddling to silence the baby long enough to complete the parts of the examination that require a quiet baby.

A child is fed with milk and praise.

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