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Pediatric physical examination techniques are some of the most valuable skills a health practitioner can have. Understanding a child’s psyche accounts for a safety assessment, patient satisfaction, and more precise results. Since the process of physical examination includes a socioemotional aspect, a healthcare professional needs to be considerate about a child’s needs in regards to the developmental stage that he or she is going through. This paper will explain how physical examination needs to be adjusted to better meet the needs of children between the ages of five and 12 and describe the case of a child patient in relation to developmental theories.
Physical Assessment of School-Aged Children
Physical assessment typically includes physical examination per se (inspection, palpation, percussion, and auscultation) and a conversation with a patient. While the same is more or less applicable to children, a health practitioner needs to consider some pediatric assessment strategies. By the age of five (initiative vs. guilt stage), children should get rid of stranger anxiety, which means that for them, visiting a doctor is likely to be less stressful than it could be for a toddler (Duderstadt, 2017). However, between the ages of five and seven (preschool), children might not be articulate and struggle with describing their symptoms (Duderstadt, 2017). In this case, a medical professional should rely primarily on the physical examination and a child’s parents’ account of what happened. The general rule is to escalate from the least stressful to the most stressful procedures. Therefore, it makes sense to start with inspection and auscultation and then proceed to palpation and percussion.
Children over the age of seven (industry vs. inferiority stage) are usually more independent than their younger counterparts. They are more verbal and may want to participate in the conversation and explain what they are feeling in their own words. They do not need to be distracted (for instance, with a toy) as much as children under seven (Duderstadt, 2017). What applies to all children between the ages of five and 12 is that they appreciate honesty. If a specific procedure is going to be painful, a health practitioner needs to communicate it to a child so that he or she knows what to expect.
The Case of M.
M. is a little girl aged six who came to visit a doctor with her parents because she has had painful sensations in her stomach. According to Erickson, M. is going through the initiative vs. guilt stage, during which children need to understand whether what they do is good or bad (Scheck, 2014). They want to initiate activities and explore the world around them, but at the same time, they are wary of not fitting and losing trust in people. At this age, children try to exercise as much control as they can and gain partial independence from their caregivers. Erickson argues that the main conflict is that a child wants more freedom of self-expression but can easily feel flustered if it derives a negative reaction from family or friends (Scheck, 2014).
The initiative vs. guilt stage can be frustrating for both parents and health practitioners. First, a medical professional should not exclude M. completely from the conversation and let her share her thoughts in a way that she sees fit (Newman & Newman, 2017). This way, the child’s need for autonomy will be covered, and she will feel more at ease. Second, a professional might consider presenting the situation in a playful way and explain to M. that she is on a mission, and she needs to withstand all the procedures to complete. Obviously, it is only one of the possible options, but the overall idea is clear: M. is open to exploration, so a game or a funny story can help her feel relief. Lastly, a doctor should use appropriate vocabulary not to confuse M. and gather as much information as possible.
Physical assessment is a challenging task in itself, and having to handle children makes it even more difficult. A health practitioner needs to keep in mind that children are not just little adults – they have unique characteristics that require special attention and adjustments. Children between the ages of five and 12 vary in autonomy and verbality. Generally, the older the child, the more likely he or she is to articulate their symptoms and cooperate. The youngest patients need to be handled with caution to not subject them to unnecessary stress. M., 6, may feel better if a doctor acknowledges her growing independence and meets her need for exploration and adventure.
Duderstadt, K. (2017). Pediatric physical examination-E-book: An illustrated handbook. Amsterdam, Netherlands: Elsevier Health Sciences.
Newman, B. M., & Newman, P. R. (2017). Development through life: A psychosocial approach. Boston, MA: Cengage Learning.
Scheck, S. (2014). The stages of psychosocial development according to Erik H. Erikson. Munich, Germany: GRIN Verlag.