PHYSICAL EXAMINATION OF CHILDREN: THE DOCTOR’S PROCEDURES AND PARENT’S ROLE
The doctor’s procedures
In a complete physical examination, the doctor uses a combination of his or her senses and knowledge of the body to check over your child, system by system. The doctor uses instruments to extend the senses. For example, the stethoscope magnifies sounds, and the otoscope (for examining the ears) and ophthalmoscope (for examining the eyes) have lights and magnifying lenses in them to extend the doctor’s vision.
In the process of an examination, the doctor will look at the child’s skin, ears, eyes, nose, bone structure, and body openings. He or she will feel the lymph nodes and other organs that can be felt through the skin. The doctor will tap body cavities and listen to the sounds that result. He or she will also listen to the sounds made by the heart, the lungs, and the digestive system. A blood pressure reading is an important part of the child’s examination from an early age.
The doctor’s senses are further extended by laboratory tests. Some of these tests are routine, such as vision and hearing tests, hemoglobin and haematocrit blood tests, and urinalysis. These tests are discussed elsewhere in this book. Other tests may be done if the doctor finds a possible problem.
Each physical examination your child has will vary, depending on the child’s age, stage of development, and state of health. During the first six months the doctor will be giving particular attention to the baby’s growth and development, including how well the baby is learning to move and control his or her muscles. The doctor will also check to be sure the hips are stable and listen for heart murmurs, which may be normal or may indicate heart problems. The doctor will take the pulse at the baby’s groin (the femoral pulses) to be sure that there is no obstruction to blood flow in the aorta (the main artery carrying blood to the lower part of the body). The baby’s developing language skills are also an important part of growth, and the doctor will ask about progress in that area.
After about six months, the child may begin to be afraid of the doctor. The child may just cry, or may be actively uncooperative. This will, of course, make the physical examination and conversation more difficult for the doctor, but a doctor who deals with children every day knows what to expect. You can help make the examination go more smoothly by trying to reassure or distract your child. If your efforts and the doctor’s fail, the doctor will get as much information as possible under the circumstances.
The parent’s role
Especially with younger children and babies, you will play an important role in the examination. Most of the time, the doctor will want you to be present. Your presence has two main purposes: you can learn about your child’s health; and you can comfort and reassure your child during the examination. An infant is often examined on the parent’s lap, and you may also be asked to help with measuring the child and taking his or her temperature.
If you have questions during the examination, be sure to ask them, even if you think they may sound silly, or feel that you ought to know the answers already. Part of the doctor’s job is answering your questions. The more you know about how to care for your child, the better off both you and the child will be. You will, after all, be responsible for carrying out the doctor’s instructions when your child is sick. The doctor needs you to be well informed.
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