Chapter 4 Approach to the Pediatric Patient
How Do I Approach the Pediatric Patient?
Evaluation in pediatrics requires attention to development. Some patients may be unable or unwilling to cooperate, including nonverbal infants, anxious toddlers, and adolescents who are complex and protective of their privacy. The sequence, structure, and content of the interview; the optimal approach to verbal and physical interactions; and the focus of the physical examination all depend on the age and developmental stage of the patient and the reason for the evaluation. If you are aware of development, you will be able to anticipate patient responses and interpret findings. Information specific to newborn infants is found in Chapters 14 and 67; for more about adolescents, see Chapters 15, 18, and 54. Development is discussed in Chapter 9.
How Do I Incorporate Development into the Evaluation?
A basic understanding of development can be gained from your personal experiences and from Chapter 9. Do not make assumptions. Instead, use history, observations, and physical findings to guide your assessment of an individual’s development. Careful observation of your patient will allow you to compare developmental progress with the milestones highlighted in resources such as the Denver Developmental Assessment (Denver II) (Figure 9-1). The Bright Futures Pocket Guide (www.brightfutures.org/pocket/) helps you develop a developmentally appropriate approach to patients, especially with regard to the information you provide to parents about healthy children.
How Does the Age of the Child Influence My Approach?
Understanding the dynamic process of growth, development, socialization, and maturation will allow you to plan your interview and examination. Your interactions with a child and parent will vary depending on the patient’s age, the parent’s experience, and the reason for the visit. As the human grows, body size increases dramatically, physiologic processes mature, cognition and behavior develop, and relationships mature and change. Parents, other family members, and the community all influence the growing child. In addition, risk factors, exposures, and disease processes change from home, to daycare, to school, and ultimately to the wider world as the adolescent gains independence and mobility. The content of health supervision visits at different ages is discussed in Chapter 11.
