The test of the morality of a society is what it does for its children. ∼Dietrich Bonhoeffer
Infants, children, adolescents, and young adults create a unique population for health care providers. The initial approach to the pediatric patient should include creating a rapport with the child and parent, performing a primary examination, and developing a plan for treatment. The examination of a fussy child or a child who has special needs is particularly challenging. Awareness for the specialized pediatric patient interaction will go far in helping to get a good history and physical examination. The developmental changes throughout childhood will also impact the examination findings and major milestones should be noted as part of a history and normal examination (Table 49-1). Distinct anatomical and physiological differences distinguish the pediatric patient from the adult patient, creating a challenging clinical situation if the provider is unprepared. Notable increases in pediatric morbidity and mortality from trauma and respiratory complaints in tertiary care centers in the 1980s were directly related to a lack of specialty trained pediatric emergency providers. Multiple studies have confirmed these findings and in the late 1980s and 1990s more focus was devoted to developing pediatric emergency care training, curriculum, and prevention efforts (need references). Over the last several years there has been an explosion of pediatric critical care and pediatric emergency medicine literature that supports the field and its development. Our goal for this chapter is to provide a resource for basic pediatric assessment and intervention that will enable stabilization of the patient until a higher level of care is available.
||Download (.pdf) TABLE 49-1.
|Age ||Gross Motor ||Visual-Motor/Problem Solving ||Language ||Social/Adaptive |
|1 mo ||Raises head from prone position || |
Birth: Visually fixes
1 mo: Has tight grasp, follows to midline
|Alerts to sound ||Regards face |
|2 mo ||Holds head in midline, lifts chest off table ||No longer clenches fists tightly, follows object past midline ||Smiles socially (after being stroked or talked to) ||Recognizes parent |
|3 mo ||Supports on forearms in prone position, holds head up steadily ||Holds hands open at rest, follows in circular fashion, responds to visual threat ||Coos (produces long vowel sounds in
musical fashion) ||Reaches for familiar people or objects, anticipates feeding |
|4 mo ||Rolls over, supports on wrists, and shifts weight ||Reaches with arms in unison, brings hands to midline ||Laughs, orients to voice ||Enjoys looking around |
|6 mo ||Sits unsupported, puts feed in mouth in supine position ||Unilateral reach, uses raking grasp, transfers objects ||Babbles, ah-goo, razz, lateral orientation to bell ||Recognizes that someone is a stranger |
|9 mo ||Pivots when sitting, crawls well, pulls to stand, cruises ||Uses immature pincer grasp, probes with forefinger, holds bottle, throws objects ||Says “mama, dad” indiscriminately, gestures, waves bye-bye, understands “no” ||Starts exploring environment, plays gesture games (eg, pat-a-cake) |
|12 mo ||Walks alone ||Uses mature pincer grasp, can ...|