Physical Assessment Techniques for School-aged Patients
The safety of any patient highly depends on the physical examination skills that are administered by medical practitioners. Poor physical examination not only leads to misdiagnosis of the patient’s ailment but also leads to delays in providing accurate results of the diagnosis thereby putting the life of the patient in danger. This paper discusses the different physical examination needs for pediatric patients between 5 and 12 years and discusses the development stages of a 10-year-old child. Finally, the development theory based on Erickson and how it can be applied in physical assessment for pediatric patients is discussed.
According to Armstrong et al. (2016), the physical examination of a pediatric patient is different from that of an adult patient and varies according to the age of the patient. Pediatric medication has faced a lot of dynamism requiring that a lot of attention is given when carrying out the diagnosis (Dersch-Mills, 2019). All school-aged children should often be subjected to the general approach principles such as gathering much information as possible, entering the examination room after knocking to avoid door hitting the child, starting the assessment with least stressing issue to most distressing issues, and being at the same level as the child being examined (Armstrong et al. 2016). Additionally, the creation of a rapport with children between age 5 and 12 is essential in bringing calmness, corporation and destruction in the patient as a tool to effectively carry out the assessment. However, based on the historical assessment and age, children may show anxiety, anger, developmental conflicts, psychological need such as hunger or sleep, or mental illness which clinicians ought to understand to determine the interaction approach during the assessment. During physical assessment, children between the age of 5 and 10 are mostly positioned on the lap of their parents as opposed to those at the age of 12 years who feel comfortable positioned on the examination table. This is so because children at a younger age tend to be closer to their parents and older ones feel comfortable when they are independent ().
During temperature examination, the rectal, auxiliary or oral temperature of children at age of 5 years is more ideal compared to older children at ages between 7 to 12 years where taking oral temperature is ideal since children can hold the thermometer firmly in their mouth and keep it closed (). In examining the heart and respiratory rates among school-aged children, it is important to note that it is easier to measure radial pulse and the breathing rate in older children at age 12 and above than in younger children. According to Barbaresi et al., (2020), brachial pulse in younger children can be checked by feeling the bicep tendon around the antecubital fossa. Additionally, measuring the periodic respiratory rate in younger children should be observed for at least a minute to avoid getting a skewed number.
Development stages of a 12-year-old child
A school-aged child at the age of 12 undergo changes that most mature teenagers go through including, physical, social, cognitive, and emotional development (Reinke et al., 2019). Children at this age suddenly start acting like little grown-ups with major changes in how they behave, act and think. Most girls and boys at this stage start to show signs of puberty having menstruation in girls and muscular developments in boys. Some become to gain more skills in sports and they experience a steady body growth. According to Reinke et al., (2019), both girls and boys at this age learn to work independently from parents though often seek approval from adults. Additionally, they tend to show rebellion, try to build personal viewpoints and often question family values. Such children also are keen on being recognized or accepted. This is the age where most children start being adolescents since they are interested in the opposite gender.
Erick Erikson Theory
Based on Ericson’s theory of psychological development, the early childhood stage plays a critical role in the personality development of an individual. According to Erikson’s a child at 12 years is in the process of transition from child development of skill competency to development of identity and direction. At 12 years, the child is at stage 5 of Erikson’s Theory “Identify vs Role Confusion” According to Srinath et al., (2019), every effort needs to be made to gain the confidence of a child at this stage since they are establishing self and group identities. It is therefore vital to begin the assessment on a neutral ground with general enquiries such as what they like doing at their school and the people they admire in sports. This helps in establishing a rapport during the examination time. It is prudent to be familiar with the latest trends in gaming, sports and music so that the child can appreciate and be interested in the conversation. However, the conversation should not only be to win over the child to share the problem but to allow the child to share their views about identifying the problem. Discussing the cognitive, social and emotional developmental changes with the parents go along the way enabling effective assessment. In doing so, the parents must also appreciate that the assessment requires a holistic approach for accurate and timely outcomes.
References
Armstrong, S., Lazorick, S., Hampl, S., Skelton, J. A., Wood, C., Collier, D., & Perrin, E. M. (2016). Physical examination findings among children and adolescents with obesity: an evidence-based review. Pediatrics, 137(2), e20151766.
Barbaresi, W. J., Campbell, L., Diekroger, E. A., Froehlich, T. E., Liu, Y. H., O’Malley, E., … & Chan, E. (2020). Society for Developmental and Behavioral Pediatrics clinical practice guideline for the assessment and treatment of children and adolescents with complex attention-deficit/hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics, 41, S35-S57.
Dersch-Mills, D. (2019). Assessment Considerations in Pediatric Patients. In Patient Assessment in Clinical Pharmacy (pp. 387–401). Springer International Publishing. https://doi.org/10.1007/978-3-030-11775-7_28
Reinke, W. M., Smith, T. E., & Herman, K. C. (2019). Family-school engagement across child and adolescent development. School Psychology, 34(4), 346–349. https://doi.org/10.1037/spq0000322
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. In Indian Journal of Psychiatry (Vol. 61, Issue 8, pp. S158–S175). Wolters Kluwer Medknow Publications. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18