I know this is LONG overdo, life has been a little chaotic, but I got some great encouragement from you guys to do this post. My pediatric rotation started out pretty rough. My preceptor was pretty old school, and had some incredibly high expectations of me. She also didn’t have the most supportive / encouraging personality, which was a little terrifying at first. But by the end of my rotation, she ended up telling me how amazing I did and gave me an outstanding evaluation!
So here are some of my tips on how to (hopefully) have your Pediatrics preceptor like you from day one and survive your Pediatrics rotation.
#1 Be upfront
If you’ve never worked with kids before, or don’t have kids, and have done everything in your power to avoid talking to them, let your preceptor know. Don’t tell them how much you love kids and how great you are at talking to them. Kids aren’t for everyone, and some people only love the kids that they end up having themselves. It’s totally okay! If you’re honest with your preceptor about not knowing how to interact with kids, they’re going to be a lot more understanding of how you talk with them. And they’re probably going to be able to provide you with some tips.
The main reason why I have this first on my list of tips is because of a classmate’s experience. She told her preceptor how much she loved kids at the beginning of her rotation (she doesn’t), and at the end her preceptor commented on her evaluation about how it was disrespectful of her to have lied about this. Don’t make this mistake
#2 Talk to them how you would want to be talked to
This is especially true for pre-teens and teenagers. Just because they’re smaller than you doesn’t mean that they’re stupid, and realistically it can be hard to tell a kid’s age just by looking at them. Treat every kid with the same amount of respect you would treat an adult with. Yes, for some kids you’re going to have to adjust your language, for instance using tummy rather than abdomen, but there’s a huge (and very important) difference between adjusting your language and talking down to someone. Be aware of this. You’re going to get a lot more information and have a better interview with the adolescent or child if you’re respectful to them.
#3 Don’t just talk to the parents
I know how tempting it can be to just get information from Mom or Dad. They understand all of your questions and are able to answer them correctly and quickly. But when it comes down to it, they’re not the ones who are sick! They can tell you objective things, like how many times the patient has throw up or how high their fever has been, and they’re great at telling you about dosages, but they can’t tell you anything subjective. The most they can tell you is if the patient has been complaining about that symptom or not. So to get all of the subjective information (which as we all know, is a huge component of diagnosing a condition) you need to actually talk to the kid. Typically, what I would do is address all of my questions to the kid first, and then double check with Mom or Dad if anything had been left out. This is where they would jump in and tell me about the things their child had been complaining about or when we would talk about the at-home remedies they had tried and what those had done. Depending on the age of the kid, I would ask closed- or open-ended questions. So if I had a three year old, I would ask them “Does your throat hurt?” And if I had an older kid I would just ask them to tell me about what was bothering them the most. It was nice because the MAs at the clinic I was rotating at did get a brief chief complaint when they brought the patient back, so I typically had a generally idea of what was wrong.
**Sometimes kids will just say “yes” when you ask them a question. This is where talking to the parents to double check comes in**
#4 Be Patient
The path to examining a kid isn’t straight forward. Doing a physical exam can be challenging and it takes SO much longer than an adult PE. You’re going to have to deal with a screaming, fighting child more often than not. You have to work with parents to hold kids down and get really good at seeing what you need to see with only a brief look (especially in ears). Doing an abdominal exam turns into a tickle fight. Listening to their heart and lungs is near impossible when they’re screaming bloody murder. Asking them a simple question can turn into a 5 minute long rambling story. But no matter what happens, you need to keep your cool. Smile, turn the physical exam into a game, let them use your stethoscope to listen to your heart, take your time and show them that you’re not there to hurt them. Remember that you’re the scary person who they don’t know, and they already feel horrible. Ask them questions during the physical exam, and show that you want to know them as a person. Patience is the key to pediatrics.
#5 Know the bread and butter conditions
This is SO important! Pediatrics has some very typically conditions that are incredibly important for you to know. The recommendations given to me by my preceptor were:
- Newborn exam
- Child physical exam – there are a LOT of tips online for how to work with a screaming toddler for the physical exam, and I strongly recommending looking over some of these.
- Vaccination schedule – later on she recommended that I know any side effects, contraindications, and the common myths surrounding the vaccines, which was incredibly helpful! I ended up making a chart on this, and the act of making this chart was really helpful for me in terms of memorization. I also shared the link to get a great pocket sized vaccine schedule from the CDC in my What’s in my Pocket: Pediatricspost.
- Asthma – make sure to know that Step-Wise treatment chart that is literally everywhere!
While I definitely thought that these were important things to know, and I’m so glad she recommended them to me, there are some additional things that I think it’s important for you to know before starting your Pediatrics Rotation.
- Developmental Milestones – I recommend knowing at least one Motor, Social, Language, and Cognitive milestone for each age. In most textbooks, they’ll mark out the most important milestone for you to know. This way if you know at least the most important one, you can rationally think through the ones you didn’t memorize.
- Know the typical things done at each well-baby/child visit. This goes hand in hand with knowing the vaccination schedule, but there are some extras like when should you start doing fluoride for teeth.
- Familiarize yourself with the different formulas for babies. You’re going to get asked so many questions on this, so it’s good to have some kind of base knowledge before you start. I recommend learning the most commonly sold ones (Gerber, Nutramigen, Similac). Also familiarize yourself with the effects a Mom’s diet can have on her breastmilk.
- Have some differential diagnoses for cough, fever, diarrhea, sore throat by age. And make sure to know the worst case scenario so that you can rule it out.
- Look over common pediatric rashes and know how to differentiate them from each other.