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In this pediatric age group (1-year-old to approximately 10 years, old), cooperation with the history and physical exam may take time, patience, and skill development on behalf of the provider. You will see children from a variety of socioeconomic and cultural backgrounds, developmental levels, and medical histories, and their desires, needs, anxieties, and fears will differ. Your goals will vary based on whether the patient presents for an acute illness, a well-child check, or a behavioral concern. Therefore, be flexible in your approach, with the goal of developing personalized tools that work for you.
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Some key tips for approaching a young child’s physical exam:
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Let the child play around the room while you talk to their caregivers and give them distance for the first few minutes. This facilitates trust when they see you chatting with people they know.
Avoid sudden movements. Call out what you plan to do or examine before you move your instrument or hands there and use words which they understand. This also informs the caregivers and allows them to try and help as much as possible.
Allow the child to sit wherever they want to when starting the exam: in their caregiver’s lap or in their own chair. Avoid starting on the exam table until you build trust, unless that is where they want to start.
Let them touch and play with the instruments as much as safely possible!
If the child has an acute illness, once you gain trust, focus on the pertinent physical exam maneuvers.
Be malleable with your exam—you will not always go in the same order (eg, head, eyes, mouth, neck, heart, lungs). You may need to approach the heart first if they take an interest in the stethoscope and then move to other areas.
Speak to them gently but firmly, using simple commands (eg, “Open your mouth please.”)
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The history is obtained in discussion with the caregivers. The initial information presented in this section focuses on the outpatient, primary care setting, where the bulk of pediatric care is delivered. Additional tips related to the inpatient setting are presented at the end of this section. It is also relevant to mention that elements covered in the newborn/infant section around birth and family history can be repeated if those aspects are unknown. Children presenting for an acute concern (eg, sore throat, cough) typically undergo a focused history and examination, capturing core domains of a concern as described in Chapter 1, History Taking.
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From infancy into adolescence, children are seen at various time intervals for well-child checks, as recommended by the American Academy of Pediatrics (AAP) Bright Futures Guidelines for Preventive Care Screening and Health Supervision (ie, wellness) Visits.
These wellness visits are used to assess growth, development, nutrition, mental health, past medical issues, the overall health of ...