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“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.

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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