Clinicians who don't regularly care for children often are fearful of them, particularly because many are nonverbal and may not cooperate with an exam. While children are not just "little adults," they will be much more willing to cooperate with the exam, and even procedures, if you spend a few minutes interacting with them, rather than interacting only with the parent. As much as possible, talk with children directly, as if they were an adult patient. Also, tell children the truth. If a procedure is going to hurt, tell them. They may not like that it hurts, but they will trust that, when you do something else and you tell them it won't hurt, you are telling the truth.1
Pediatric Developmental Milestones
Failure to progress through normal developmental milestones may indicate underlying medical problems, including malnutrition, anemia, HIV, hearing loss, chronic infections, lung disorders, and chronic toxicity (e.g., lead poisoning).2 To determine how well children are progressing, remember the four important milestones listed below.
|Action||50% Do It By||97% Do It By|
|1. Sits unsupported||6 months||9 months|
|2. Walks 10 steps unsupported||12 months||18 months|
|3. Speaks 3 or 4 single words||14 months||20 months|
|4. Says phrase ("Daddy go work")||24 months||36 months|
For more complex testing, use the developmental assessment provided in Table 34-1, which was initially created to assess children in rural India.
Table 34-1 Pediatric Developmental Assessment |Favorite Table|Download (.pdf)
Table 34-1 Pediatric Developmental Assessment
|3 months||T||Visually very alert, particularly interested in human faces.|
|T||Moves head deliberately to look around.|
|T||Definite response to mother's voice, either by becoming quiet or by smiling.|
|6 months||A, T||Can roll over from belly to back.|
|T||If placed face down (prone), will lift head and chest, supporting himself on extended arms.|
|T||If held standing with feet touching a hard surface, the baby bears his weight on his feet and bounces up and down actively.|
|A, T||Reaches for and grasps small objects.|
|9 months||A, T||Sits alone for 10-15 minutes on a firm surface.|
|A, T||Moves on the floor by rolling or squirming.|
|A, T||Tries to crawl on hands and legs.|
|T||If the baby is held standing, he steps on one foot then the other.|
|A, T||Can distinguish strangers from known persons. May become distressed with strangers.|
|12 months||A, T||When lying down, can get into a sitting position.|
|A, T||Pulls himself to standing and lets himself down again, holding on to furniture.|
|A, T||If the baby's hands are held, he will walk, and may even walk without help.|
|T||Gives objects to an adult on request.|
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