tips for pediatrics?

[medchick]

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just started meds after a hiatus from rotations.

tomorrow is my first day doing ambulatory..

any tips on the physical..

i am going through reentry anxiety and anxious about presenting on rounds and such..

plus don't you hate it when everyone else is such an ass kisser?
🙄

 

[Jaded Soul]

just started meds after a hiatus from rotations.

tomorrow is my first day doing ambulatory..

any tips on the physical..

i am going through reentry anxiety and anxious about presenting on rounds and such..

plus don't you hate it when everyone else is such an ass kisser?
🙄

There was another post about starting peds that has some info. Try a search.

The peds physical is different from the adult physical--don't worry, they'll teach it to you. Same with the history.

Don't be anxious. They know you're new and will be understanding as you get used to it all. Peds is one of the best to start with because all the pediatricians are nice.

 

[starayamoskva]

just started meds after a hiatus from rotations.

tomorrow is my first day doing ambulatory..

any tips on the physical..

i am going through reentry anxiety and anxious about presenting on rounds and such..

plus don't you hate it when everyone else is such an ass kisser?
🙄

Peds is a great rotation to start on! For the most part the people are really nice (you have to be to work with kids).
Don't know if you are on the east coast or west coast so it may be too late for these tips:
1. Get some stickers, kids love stickers
2. Get a small squeeky toy that you can use to distract them while you do the exam.
3. Do as much of the exam with kid in mom's lap as possible.
4. Do the ear exam last.

As far as presenting on rounds just try to keep it organized and start with vital signs.

 

[Scott_L]

From meeting with Pediatric Clerkship Directors, I know that many of them criticize their students for not properly introducing themselves to the patient and the parent. If the child is old enough to answer questions, make sure the parent allows the child to speak.

Warm up your stethoscope and let the little ones see your instruments prior to you using them and make sure that you tell them what you are going to do.

You should do very well on the physical exam and history if you can effectively manage the patient and parent. Also, know if and when it is appropriate to ask a parent to leave the room. If you need to talk about drug use or sexual activity, it is best to ask the parent to leave. These are probably good scenarios to discuss with your attending prior to seeing the patient.

By the way, great tip on doing to ear exam last, little ones hate it!

Good luck!

-Scott

 

[labangel]

For younger kids, never underestimate the power of bubbles. A screaming kid will switch to laughing and smiling in a heartbeat.

 

[pikachu]

a lot of the kids (especially the ones who are a little older like 4+) get a kick of listening to their own heart with the stethoscope first. I would second the poster who recommends to do much of the exam with mom/dad holding the child. make sure you have them hold the head very still for the ear exam though (there's a way to do it which you should find in a physical exam or peds text). Ears are the hardest part as far as I'm concerned.

 

[DOtobe]

A great tip I learned from one of my fellow classmates:
To get the kids to take deep breaths, hold a piece of paper in front of them and tell them to blow on it like they are blowing out a candle.

And definitely agree on the "ear exam last" thing.

 

[Homunculus]

defintely do as much as possible in the parents lap. the rest of the advice is good, too-- but remember to tailor them to your patient. some 2-3 year olds are very cooperative, and the ones that aren't are usually either scared or victims of too many ear infections and associate ear exams with pain. the first is easier remedied than the latter.

another trick for kids that may allow you to forego the tongue depressor if "ahhhh" doesn't work is to tell them to take a deep breath in. sometimes (maybe half) this will elevate the palate more than "ah" and let you see the posterior pharynx. it's something quick to try and worth not having to gag them.

otherwise, peds is all in the delivery 🙂

--your friendly neighborhood "let me see what's in your ears" caveman

 

[FosterChild]

0-3mo: learn to change a dirty diaper yourself. It endears you to the parents.
3-8mo: Your ID and badge reel can entrance to no end.
9-12mo: Have a squeaky and or bendy, chewable and washable toy to give them to play with. Then, remember to wash it afterwards!
12mo-3/4yo: Listen to yourself, then the parent, THEN the patient.
School age: don't ask how much tv do they watch. Ask what their favorite shows are and judge by "pokemon and Yugioh and this and this and this and this and this" that they watch too much. Also, you can have them pretend your thumb is a candle to get a deep breath.
Teenagers: get mom out of the room, any way possible. Then ask "are you getting any?" Less clinical, but more likely to get a straight answer.

DAVE

 

[DOrk]

Wash your hands at least 100 times a day-Keep yourself healthy. (I was sick the whole six weeks). Four year olds (or thereabouts) got a kick out of me listening to their bellies and guessing what they had for breakfast.....

Listen to the heart and lungs first.

 

[Starflyr]

I found an easier way to do the ear exam on kids (old enough to understand) is to look for "superheros" in their ear - KimPossible and the Naked MoleRat usually get them laughing - and for younger kids, finding Barney, Baby Bop or Dora usually works too.

Of course, there are the screamers who just want you to GO AWAY.

Star

 

[DOrk]

I found an easier way to do the ear exam on kids (old enough to understand) is to look for "superheros" in their ear - KimPossible and the Naked MoleRat usually get them laughing - and for younger kids, finding Barney, Baby Bop or Dora usually works too.

Of course, there are the screamers who just want you to GO AWAY.

Star

If superheroes don't work, try bunnies, elephants, or various other animals 🙂

 

[realruby2000]

If superheroes don't work, try bunnies, elephants, or various other animals 🙂

anyone know a good way too ask mom or dad to leave the room w/o offending them? It seems kinda awkward by just telling them "can you excuse us while I ask your daughter some personal questions?"

 

[Homunculus]

anyone know a good way too ask mom or dad to leave the room w/o offending them? It seems kinda awkward by just telling them "can you excuse us while I ask your daughter some personal questions?"

i usually just tell them that their kids are getting to the age that we need to ask them personal questions. straightforward is usually the best.

another time to do it is when you do the genital exam-- most kids will want their parents to leave, and when you are finished you can take a few minutes to complete your HEADDS exam without parental interference.

--your friendly neighborhood how many partners caveman

 

[itsaliger]

i am queen of new-rotation-anxiety. i just want to say that i feel you! i had the same feelings about doing exams for peds. thankfully, they didn't expect me to have any idea what i was doing (i didn't). i improved a lot over 4 weeks of primary care that i did, and so will you! and if you're like me, you will get so distracted by how fun and cute the kids are that you will forget to be nervous 🙂 good luck!!!

s

 

[realruby2000]

i usually just tell them that their kids are getting to the age that we need to ask them personal questions. straightforward is usually the best.

another time to do it is when you do the genital exam-- most kids will want their parents to leave, and when you are finished you can take a few minutes to complete your HEADDS exam without parental interference.

--your friendly neighborhood how many partners caveman

what do you mean by HEADDS exam?

 

[stoic]

and remember KIDS ARE NOT JUST LITTLE PEOPLE!!!

 

[roja]

I encounter this all the time int he peds er.... Simply tell the parents that they need to wait in the waiting room while I talk/examine thier child. Of course, some of them get attitude and try adn say, but I'm the mom... but I just firmly tell them: "i know and you still need to wait in the waiting room while I examine/talk to your child. I'll be out to come and talk to you shortly". Its all in your attitude. If they smell fear, they grab on to it.


Because remember, most adults are just small children.



Oh and looking for money/dinasours,etc in the ears is a great trick... also, teach the parent how to hold the kid for ear exams...: sitting on lap, facing out... one hand of mom's goes across the chest, pinning the arms, other hand goes on the forehead adn turns head and holds against chest: minimizes movement.... switch for other side. works like a charm.


And remember, AAP states no antibiotics unless you see pus in the ear.

 

[phoenixsupra]

just started meds after a hiatus from rotations.

tomorrow is my first day doing ambulatory..

any tips on the physical..

i am going through reentry anxiety and anxious about presenting on rounds and such..

plus don't you hate it when everyone else is such an ass kisser?
🙄

medchick, it doesn't surprize me that you've been taking a break from rotations. Your thread/post on toxic personalities seemed to be ther result of much reflection. It really helped me and sort of get the wind back in my sails again. I was somewhat refreshed just to know that threre were people out there who think the way you do.

From reading your posts I doubt that you'll have any problem with the kids. I'm guessing it's more the staff you're worried about and rituals such as presentations and pimping. Try this. Sit down with a good resident or serior student you know. Pick a sample patient and practice it with them. Find out exactly what they want ot hear in this five minute bable. On asking around I'm surprized how many students actually practice these things in the mirror. This is not an aspect of medicine that I'm particularly fond of either, so I'm planning on working on it, myself (rather than ignoring and dreading it).

Yeah, suck-ups and ass-kissers are not a pleasant part of the medical landscape. Don't focus on them. Negativity is difficult to deal with. If you fight it you can become it. Stay focused on yourself and maintaining your mood and energy. Pay no mind to jackasses. They are their own punishment. 🙂

 

[Homunculus]

what do you mean by HEADDS exam?

adolescent medicine mneumonic. Home Education Activities Drugs/Depression Sexual activity. something every adolescent should get screened with on visits.

--your friendly neighborhood adolescents are scarier than toddlers caveman