Lecture V: Approach to Children Flashcards Preview

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Flashcards in Lecture V: Approach to Children Deck (10)
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1
Q

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

A

• 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)

2
Q

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

A
  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)
3
Q

Demonstrates a basic approach to performing a pediatric physical exam

A
  • 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…)
4
Q

Differentiate how the age of a child changes your approach

A

See other cards

5
Q

Developmental History

A

• 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)?

6
Q

Well Child Check-Up

A
  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.
7
Q

Problem Visit History

A

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

8
Q

Infancy

A

• 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

9
Q

Early Childhood

A

• 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

10
Q

Middle Childhood

A

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