WEEK 1 INITIAL POST
This week we are to develop a health history based on our particular patient that was assigned. I am assigned a preschool-aged white female living in a rural community. Children need special attention when gathering a health history. Preschool children want to know what you are doing to them at all times and need their parent by their side to feel more comfortable. I will call the child Cindy in this discussion.
Amber Hairfield and David McCormick (2017) from the Department of Pediatrics, University of Texas Medical Branch states to allow preschool-aged children to sit on their parent’s lap during the exam. Most of the organ systems can be examined with the child on the parent’s lap. Having the child first sit on or near the parent allows the child to not be as scared. Also, always try to play a quick game or even draw a smiley face to get a nervous child less nervous of the exam process and the provider (Hairfield, A., & McCormick, D., 2017).
Cindy is 4 years old and brought her mother to the exam with her. First, I would enter the room with a smile and friendly hello. I would talk to Cindy and tell her how big she is and smart she is. When talking to Cindy on her mom’s lap, I would sit in a chair close to her at the same level as she is. It may scare her by standing over her. If the patient were a teenager or an adult, I would not sit as close to the patient. If Cindy were not a small child, I would please ask the parent to leave the exam room until the physical examination is complete.
Social determinants play a factor in the type of questions and concerns for each patient. Cindy is 4 and lives in a rural community in the country. She probably plays outside a lot in the dirt, rides a tricycle, plays with farm or other animals, and may or may not have adequate food supplies. Lead exposure, safety car seats, parasite exposure, wearing safety gear when riding bikes, sexual or physical abuse, and adequate food and shelter will be assessed during the examination with Cindy and her mother. A safety risk assessment that I would use would be a pamphlet explaining the proper type of car seat Cindy should be using and if she is using the correct seat. Heather Corley (2019) states the car seat laws for the United States. Children ages 3 to 4 should still be in a toddler rear-facing seat. If the child were too big to sit rear-facing then a 5-point harness forward-facing seat would be appropriate (Corley, H., 2019). Using the correct seat for babies up to 12 years old is essential to maintain their safety.
I would start off by explaining to Cindy who I am and that I am here to make sure she is healthy and happy. I would play a quick game of where her body parts are such as ask Cindy to point to her eyes, ears, nose, and feet. I would then have Cindy get on a scale and measure her height, weight, and BMI. I would gently ask Cindy to let me listen to her heart, lungs, and abdomen. Then I would ask Cindy to stand up tall and I would examine her musculoskeletal system. We would then put Cindy on the exam table and explain to her that I need to quickly look at her private parts to make sure everything is okay. At the end of the physical examination, I would give her a sucker and sit her down to finish the health history with questions.
Questions I Would Ask Cindy
1. What do you do for fun? Do you ride bicycles, play with animals, and play in the dirt? This would allow me to elaborate on safety precautions and make sure she is wearing a helmet and is safe around the farm and domestic animals.
2. Do you sit in a car seat when you are riding in the car? This would ensure she is actually riding in a safety seat and allow me to explain the proper seat she should be riding in.
3. Do you hurt anywhere such as your head, ear, stomach, or throat? This would ensure the physical exam was complete and Cindy did not have any concerns that were not addressed. I would make this question very simple for Cindy to ask.
4. Do you wash your hands after you use the bathroom and brush your teeth every day? I could use this question to explain to Cindy the importance of hygiene.
5. What types of foods and drinks do you normally like to have? This will allow me to make sure she is eating healthy foods and drinking plenty of water. I will explain to her that a lot of juices are not good for her and sodas are very unhealthy.
6. I would ask Cindy how she is punished when she gets in trouble or if anyone hurts her in any kind of way.
Read, Hamersley, and Rudegeair (2014) explained that physical and sexual abuse screens must be completed on children during examinations. They concluded after a study that 47 children told about sexual abuse when asked about it. Only 6 brought it up without being asked about it. 30 children told about physical abuse when asked and 0 told when not asked about it (Read, J., Hammersley, P., & Rudegearir, T., 2014). This proves that clinicians somehow have to ask children about abuse.
After the examination with Cindy, I will be able to better understand and decide if there are any further questions I need to ask her or her mother about and educate on those concerns. I will leave Cindy and her mother with a smile and ensure Cindy is okay after the health history.
Corley, H. (2019). State car seat laws in the U.S. Retrieved from https://www.verywellfamily.com/us-car-seat-laws-by-state-4082814.
Hairfield, A., & McCormick, D. (2017). Health Assessment of the preschool child (12 months- 4 years). Well Check Care: Promoting Health and Development, 2nd edition. Retrieved from https://www.utmb.edu/Pedi_Ed/CoreV2/WellChild/WellChild8.html.
Read, J., Hammersley, P., & Rudegeair, T. (2014). Why, when, and how to ask about childhood abuse. Advances in Psychiatric Treatment, 13(0), p 101-11-. Doi: 10.1192/apt.bp.106.102840. Retrieved from https://www.acesconnection.com/fileSendAction/fcType/0/fcOid/423376111565766179/filePointer/458424046365761432/fodoid/458424046365761428/Read%20et%20al_2007_Why,%20when%20and%20how%20to%20ask%20about%20childhood%20abuse.pdf.
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