Your time at a pediatrics office will involve seeing children typically right from birth all the way up to around 18 years of age. I’m going to talk about what’s important in peds, how to deal with common problems, and tips on physical exams and sports exams.
I won’t be covering the pediatric ICU or any pediatric specialties at this time, but maybe at a future date.
Let’s get started.
HANDLING SICK VISITS LIKE A PRO
Sick visits are quite common in pediatrics. Parents get concerned if their kid has to start missing school or if the school nurse said little Johnny is too sick and should go home. There’s also the worry of new parents when their kid develops a cough that lingers a tad too long.
Common pediatric problems
Common pediatric problems include pink eye, ear infections, strep throat, sinusitis, croup, the common cold, asthma, diabetes, abdominal pain, and viral exanthems.
As a result, definitely know the centor criteria for strep throat. Although some practices will indiscriminately swab throats. Know that we’re providing antibiotics to prevent post-streptococcal infections. And if things don’t point towards a bacterial infection – don’t give antibiotics. Gold standard is Penicillin, many give Amoxicillin or Augmentin (amox-clav). Penicillin allergy? You’re looking at a macrolide next.
You should brush up on pediatric doses for acetaminophen (Tylenol ®), ibuprofen, and amoxicillin since it will be prescribed often.
Rashes are very common in kids.
You should get an idea of what’s dangerous, what will pass, and what is completely benign. I had a child with molluscum contagiosum before and dad was super concerned. It’s harmless. I also had to identify roseola and measles through visual inspection and a quick history.
If a mother explains that a young child has not been himself recently, he’s had decreased feeding, decreased appetite, a small rise in temperature, and he’s been touching an ear a lot… no other real symptoms?
I guarantee that kid has an ear infection.
And if mom says her child has a mild fever and that’s it… it’s still probably an ear infection!
Understand that if a child suffers from multiple ear infections, they may need tubes placed.
When dealing with young children, perform any “non-invasive” parts of the exam first. For example, listen to their heart and lungs before trying to look in their ears. Because once the child becomes fussy (kicking, screaming, crying, etc), then it’s a lot harder to auscultate what you need. It also may be difficult to console them once they get worked up.
Parents should get used to holding their child properly for exams. This makes looking in ears a breeze.
Children around the age of 2 are very apprehensive of strangers. Having mom & dad present is paramount. Meanwhile, kids around the age of 4 are typically very friendly towards you and will happily tell you things.
Remember that while you may get a large portion of a child’s history from caregivers to address the child in a playful manner.
Enthusiastically ask them their name and how old they are. Ask them what’s wrong. And finish the visit by giving them Disney stickers… because what kid doesn’t love picking out a sticker?
Always ask if a child is in day care and if there are any recent sick contacts. If the older sister had strep throat a few days ago and now little Johnny comes in with similar symptoms… sometimes it’s that easy.
PHYSICAL EXAMS & SPORTS EXAMS
There are many sports physicals and monthly or yearly exams for kids. So it’s beneficial to develop a routine progression for doing your exams to ensure you don’t miss anything. I like going from head-to-toe and that’s the tactic I’ve seen many other providers employ.
In young children, you’ll also be tracking their height and weight progression on growth curves. You may experience counseling on children who are too high or too low on the curve.
Any time Timmy wants to play football or go to summer camp, he’ll need forms filled out for school.
Most of these kids have no medical problems. But that doesn’t mean you should let your guard down!
You’ll need to do a quick neurologic assessment, listen to their heart (super important) and their lungs. Check their spine and general range of motion. The school, coaches, and parents are counting on you to clear this child for physical activity.
You may get to experience handling concussion protocols for teens who become injured in school sports. It’s your job as a pediatric PA (student) to explain when they can get back to sports or when to refer them to specialists.
Understanding Vaccination Schedules
Vaccines are bread-and-butter pediatrics. You should know what vaccines a child needs at his/her 2-month visit. It’s also important to know which vaccines are contraindicated in certain patients.
You can find the official CDC vaccination schedule on their website.
As a student, you may find yourself having to explain the importance of vaccines and dispelling any myths parents may have about them.
Vaccination counseling tips
– I find it helpful to encourage the patient to relax while receiving their vaccine because it won’t “hurt” as badly. Obviously this sort of convincing would only work with older pediatric patients.
– Set realistic expectations. Receiving the flu vaccine will help prevent the flu, but if you still wind up getting it… the illness will be milder and with less of a likelihood to be life-threatening.
– The flu vaccine is recommended yearly, ideally in the fall but it can be given later.
– Encourage the HPV vaccine for both boys and girls at age 11-12. Yes, even if they are not sexually active. HPV is the most common sexually transmitted infection and it still is a leading cause of head & neck cancer.
– Don’t forget that kids going off to college with plans on living in dorms should receive the serogroup B meningococcal vaccine (usually given between ages 18-23).
– Tell the patient that they may have a localized skin reaction to the vaccine. This does not necessarily mean that they’re allergic.
RECOGNIZING CHILD ABUSE
When it comes to child abuse, verbalize suspicions to your preceptor. Possible abuse includes multiple bruises, burns of an entire extremity, cigarette burns, injuries in the shape of a household object (belts, spoons), multiple fractures, and inconsistent stories for injury. However, that list isn’t exhaustive.
You should also understand the laws when it comes to child abuse. PAs are mandated reporters when these situations arise.
If you’re interested in some other resources for your Peds rotation, or if you plan on becoming a future pediatrics PA, I would recommend the following:
Harriet Lane Handbook, 21st edition – essentially the encyclopedia of pediatrics and very good for handling sick visits
The Red Book [2018 edition] – a great resource on infectious diseases in clinical pediatrics
Lange Current Diagnosis & Treatment, 24th edition – the Pediatrics version
Neonatal and Pediatric Respiratory Care, 5th edition (2018) – obviously for respiratory care and very specialized, only recommended for future PAs in peds
I hope that through this quick pediatrics guide, you can handle your rotation like a pro!
Working in peds can be a joy as the patient population is fun and energetic. Just be extra prudent at washing your hands because those kids will smear their germs everywhere. You’ll want to avoid the “Pediatric crud,” as they say.
Physician Assistant – Founder
John is a current Physician Assistant. He attended The Pennsylvania State University (2014) for a double major and Salus University (2018) for his PA education. John is an avid lover of France and the French language.
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