儿科体格检查Training for skills in paediatrics

Examples

a 4-yr-old child with a urinary tract infection may be observed by the parent to be holding his or her abdomen and to have a subtle change in the frequency of urination. The child, on the other hand, may perceive that his or her abdominal complaints are related to a specific food that was ingested just before the onset of symptoms.
UNIQUE CHARACTER OF THE PEDIATRIC CLINICAL EVALUATION
This
evaluation involves the physician, the parents, and the child. Historical information is often taken from the parents, and it is not until children reach later developmental stages that they can more actively contribute information about symptoms. These considerations change the manner in which pediatricians gather data about symptoms.
What concerns for parents and children

At well child visits, the parent or child might describe a specific behavior or symptom. The pediatrician demonstrates concern by listening attentively and by asking follow-up questions demonstrating that the behavior or symptom has been understood. These follow-up questions provide an opportunity for the parent or child to explore his or her own interpretation of these behaviors or symptoms, to understand their emotional response, and to learn from the interpretation provided by the physician.
Example

parents reporting that their 9-mo-old child cries when being put to bed and has difficulty falling asleep offers an opportunity for the pediatrician to explore their interpretations of this behavior, to discuss their response to it, and to discuss individual variations in sleeping behavior. Based on this discussion and a more precise appreciation of the meaning of that behavior, strategies to facilitate sleeping can be suggested.

PARENTS AND CHILD AS PARTICIPANTS IN THE CLINICAL EVALUATION

It is often left to the judgment of parents whether clinical symptoms should be brought to the attention of a physician. Moreover, children's interpretation of symptoms is intimately related to their developmental stage; this also influences the manner in which they transmit clinical information to a physician. Both parents and children must believe that the pediatrician is interested in their concerns and that interactions with the pediatrician will provide them support.
Examples
Rather
than asking, for example, if the child has abdominal pain, physicians ask questions that focus on the manner in which abdominal pain would present to an observer. Thus, questions about loss of appetite, sudden episodes of crying and drawing the legs up in a fetal position, or the child's crying when the parent has placed pressure on the abdomen are appropriate.
Training skills in paediatrics
Children‘s Hospital of Soochow University Prof. Hu Shaoyan
Overview of Pediatrics

Pediatrics is concerned with the health of infants, children, and adolescents; their growth and development; and their opportunity to achieve full potential as adults. As physicians who assume a responsibility for children's physical, mental, and emotional progress from conception to maturity, pediatricians must be concerned with social and environmental influences, which have a major impact on the health and wellbeing of children and their families, as well as with particular organ systems and biologic processes.
UNIQUE CHARACTER OF THE PEDIATRIC CLINICAL EVALUATION
In this instance, the pediatrician may conclude that the parents' history suggests the correct diagnosis (a urinary tract infection) by eliciting further information about, for example, discomfort when urinating(question to the older child). So, pediatricians have to distinguish the correct information from the two sides and determine which question should be asked next. The question can be concerned from the observer observed or the child felt or experienced personally.
Overview of Pediatrics
TБайду номын сангаасe
most powerful diagnostic technology available to pediatricians is the clinical evaluation: the process of observing the child, taking a history, and performing the physical examination. For pediatricians to maximize the benefit of the clinical evaluation, some of the complexities of this process must be appreciated
Examples
A 24-mo-old child with a sore throat often does not complain of this but rather is observed by the parents to have more difficulty handling oral secretions, to refuse solids, and to have a foul breath odor. Questions are tailored to elicit this information. So, taking history information for younger child,parents are more important to rely on. However, the parents are not patients but observers, so ask the questions closely related to what the observer do observe.