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Chapter 37: Pediatrics and Neonatal

GENERAL APPROACH TO CHILDREN

“Little Adults”

Clinicians who do not regularly care for children often are fearful of them, particularly because many are nonverbal and may not cooperate with an examination. While children are not just “little adults,” they will be much more willing to cooperate with the examination, 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 will not 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, human immunodeficiency virus (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.

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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 three or four 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 37-1, which was initially created to assess children in rural India.

TABLE 37-1Pediatric Developmental Assessment
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TABLE 37-1 Pediatric Developmental Assessment
Age Test Type Behavior
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 herself 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, she 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, she will walk, and may even ...

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