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"Little Adults"

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.

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Action50% Do It By97% Do It By
1. Sits unsupported6 months9 months
2. Walks 10 steps unsupported12 months18 months
3. Speaks 3 or 4 single words14 months20 months
4. Says phrase ("Daddy go work")24 months36 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

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