Students will develop skills in the following areas as they apply to infants and children:

 

A. History

 

Problem focused history.

 

Problem specific past medical history, family history, developmental history, social history, and review of systems when indicated.

 

Demonstrate an understanding of the modification of the medical history depending upon the age of the child.

 

B. Physical Exam

 

Establish rapport with children of various ages in order to perform the physical examination.

 

Recognize that age of child influences the areas to be included in the exam, as well as the order of the examination, and the approach to the patient.

 

Use developmental assessment as part of the physical examination for all ages.

 

Demonstrate the appropriate use of the limited or focused examination.

 

Observe and demonstrate physical exam findings unique to the pediatric age group, and understand how findings have different clinical significance depending on the age of the child. Findings include, but are not limited to:

 

GENERAL

Signs of acute illness in an infant, toddler and child by evaluating skin color, respiration, hydration, mental status, cry and social interaction

Measure heart rate, respiratory rate, blood pressure and temperature in an infant and child, demonstrating an understanding of the appropriate sized blood pressure cuff, interval to count respirations, and normal variation in temperature depending on the route of measurement

Understand normal values of heart rate, respiratory rate and blood pressure depending on age

Accurately measure and plot height, weight, and head circumference

 

HEENT

Identify and assess anterior and posterior fontanelles

Recognize red reflex and strabismus

Assess hydration of mucous membranes

Examine the tympanic membranes using pneumatic otoscopy

 

NECK  

Palpate lymph nodes

Recognize and demonstrate maneuvers that test for nuchal rigidity

 

CHEST

Observe the rate and effort of breathing as a measure of respiratory distress

Recognize stridor, wheezing and rales

Interpret less serious respiratory sound such as transmitted upper airway sounds

 

CV

Palpate pulses in upper and lower extremities

Auscultate heart for rhythm, rate, quality of heart sounds and murmurs

 

ABDOMEN

Understand that the liver edge, spleen tip and kidneys may be palpable in the normal newborn

Examine umbilical cord for signs of infection

Examine abdomen for distention, tenderness, rebound and mass lesions in an infant or young child with lethargy, irritability or signs of acute illness, noting the inability of the patient to communicate symptoms of abdominal complaints

Perform rectal examination and recognize when it is indicated

 

GENITALIA

Recognize the appearance of the normal male and female genitalia in the newborn

Identify the physical changes of puberty and be able to conduct Tanner staging

Recognize the need for privacy at all ages

 

EXTREMITIES

Examine the hips of the newborn for dysplasia

Evaluate gait and limp

 

BACK

Know how to test for scoliosis

 

NEUROLOGIC

Elicit primitive reflexes

Assess tone, gait, strength and reflexes

Assess developmental milestones

Recognize that much of the neurologic examination of infants and children is accomplished through observation alone

 

SKIN

Recognize jaundice, petechiae and purpura, common birth marks, vesicles, urticaria and common rashes such as erythema toxicum, impetigo, eczema, diaper dermatitis and viral exanthems

Recognize common skin findings associated with child abuse

 

C. Communication Skills

 

1.Communication with the patient and/or family

 

Establish rapport with patient and family

 

Identify the primary concerns of the patient and/or family

 

Recognize the triangular relationship between physician, patient and parent and be able to communicate information to both the patient and parent, making sure both understand the diagnosis and treatment plan and have the opportunity to ask questions; be aware that the relationship changes with the increasing age of the child

 

Recognize the important role of anticipatory guidance and patient education in well child care and the management of acute and chronic illnesses

 

2. Written communication skills

 

Write a complete summary of the history and physical exam in a timely manner which is suitable to place in the patient chart

 

Write a prescription

 

Write instructions for parents

 

3. Oral communication skills

 

Present a complete, well organized, brief summary of the findings of the patient’s history and physical

 

Communicate effectively with other health care workers, including consultants, nurses, and social workers

 

Explain the thought process that led to the diagnostic and therapeutic plan

 

Use precise descriptions of physical findings and avoid vague terms and jargon

 

D. Clinical Problem-Solving Skills

 

Develop a complete problem list and differential diagnosis for each problem; combine problems where appropriate to develop a differential diagnosis for the patient’s unique combination of symptoms

 

Use knowledge of key signs and symptoms and the frequency and prevalence of diseases at different ages when developing a differential diagnosis

 

Formulate and initial diagnostic and therapeutic plan, considering the cost, risks, benefits and limitations of laboratory tests, imaging studies, medications, consultations, hospitalizations, and more conservative measures such as observation

 

Interpret the result of commonly ordered lab tests including CBC/hemacue, urinalysis, lead, TB skin testing

 

Use the pediatric literature to research the diagnosis and management of clinical problems

 

E. Procedures

 

Perform routine outpatient procedures such as throat culture, urinalysis by dipstick, urine pregnancy test, vaccinations

 

Observe and provide emotional support for patients undergoing procedures.