PROPERTY LAW OF TODDLERS-ANONYMOUS-

If i like it, it’s mine

If it’s in my hand, it’s mine

If i had a little while ago, it’s mine

If it’s mine, it must not ever appear to be yours in any way

If i’m doing or building something, all the pieces are mine

If i saw it first, it’s mine

If it looks like mine, it’s mine

If you are playing with something and you put it down, it automatically becomes mine

If it’s broken, it’s yours

CLINICAL EXAMINATION IN PAEDIATRIC

SUCCESS IS DOING ORDINARY THINGS

EXTRAORDINARILY WELL

TIPS…

Practice makes perfect…..

Practice makes perfect…..

Practice makes perfect…..

IF YOU WAIT FOR PERFECT CONDITIONS, YOU WILL

NEVER GET ANYTHING DONE

GENERAL PRINICIPLES OF PAEDIATRIC EXAMINATION

Always wash hands

Introduce yourself to patient & carer

Do not take child away from the environment that he or she comfortable with (positioning for examination)

Involve parent/carer as much as possible

Allow time for child to get used to you - toys, teddy bear

Visual clues - NPO2, inhalers, nebulizers, medications, sputum, urine pot

Do not hurt the child - ask parent/child first, examine painful area last

BE STRUCTURED AND OPPORTUNISTIC

Adapt set of routines used in adults to the age, mood, level of understanding and state of health of the child

Older and coorperative child - examine as an adults !

Youger and uncooperative child - will not follow the normal sequence or flow of examination

Complete the most informative and difficult task first or you can come back later !

Understand developmental stages’ impact on child’s response. For example, STRANGER ANXIETY is a normal stage of development, which tends to make examining a previously cooperative child more difficult.

APPROACH ?

POWER OF OBSERVATION!

WHAT TO OBSERVE?

Well being - comfortable, anxious, fretful,

Color

Respiratory effort

Nutritional status

Growth/built/FTT/pubertal stage

Dysmorphism

Development

Rashes

Physical characteristics of parent eg. Achondroplasia, Marfan, Myotonic dystrophy, NF

Others :

• NPO2

• Nebulizer

• IVD, Branullas

• Sputum pot, urine container

• NGT

• Spectacles, hearing aid

• Older child wearing napies

NEXT APPROACH

Do not ask whether you can examine them

Adequate exposure

Hands should be warm

Get down to child’s level

Talk in age appropriate manner

Avoid technical terms and unrealistic requests eg. take deep breaths to 2 year old - simulate!

Continue to talk to patient while examining them

Encourage, praise, thank them afterwards

OPENING GAMBIT….

The child looks well/comfortable/anxious

Color

Nutritional statusDysmorphic features i.e Down syndrome

Size appropriate for age, need to confirmed by anthropometric measurement

IV access , O2 supplement , IV fluids, Nebulizer, sputum, urine container ?Other gross abnormalities?

Facial puffiness,abdominal distension, chest wall abnormality, bruises, bandages , surgical scars…

COMPONENT

Inspection

Palpation

Percussion

Auscultation

INSPECTION

The most important step

Gives many clues.

More specific for that system

★Hands, Face, Neck

★RR, Shape, Symmetrical? Deformity? Scars?

★Accesory muscle usage

INSPECTION

Avoid many no(s)& negative (irrelevant)No cyanosisNo respiratory distressNot on O2Not anxiousNo bruisesNo chest wall deformity

If not necessary

PALPATION

Build up rapport with parents…and then the child…

Ask for PAIN !

Don’t “jump” on patient

Wrong question: “ Can I palpate your tummy?”

Right question: “ I’m going to feel your tummy, let me know if it’s painful”

PERCUSSION

For older children

For babies only with presence of positive findings upon inspection & auscultation (respiratory & abdominal)

AUSCULTATION

Respiratory

CVS

Abdominal

Over a swelling..

REPORTING

Running commentary vs presents at the end?

ASSESSMENT OF DEVELOPMENT MILESTONES

Visual

Fine motor

Gross motor

Social & language

DON’T BE LAZY!

NO EXCUSE!!!

I took the history..but did not examine the child because:

★He’s sleeping.. He’s eating..

★He’s in toilet..

★He’s grumpy, cranky, crying non stop…

★He kicked me!

★I am afraid he/she will cry

HOW TO BE COMPETENT…

Preparation

Pre reading

Friends & dummies..

Practice on patients…

Practice makes perfect…..

Practice makes perfect…..

Practice makes perfect…..

YOU MEASURE THE SIZE OF THE ACCOMPLISHMENT BY THE

OBSTACLE YOU HAD TO OVERCOME

SUCCESS IS SWEET WHEN YOU HAVE KNOWN DEFEAT, SWEETEST WHEN YOU HAD A LOT OF THEM

TAKE HOME MESSAGE

Talk to patient..

Examine the patient..especially the well patient

Practice, practice, practice…

GOOD LUCK