 Welcome to Nursing School Explained and today's video that will be helpful if you go into clinical in the pediatric setting. If you have experience with children or have children of your own, it's probably fairly easy for you to handle children of different ages. But if you don't have a lot of experience or have experience with children who are ill, it can be a little bit daunting to go to the pediatric clinical setting because they are little people and we don't really know how to approach or interact with them. So this video is designed to kind of help you, give you a little bit of an understanding of how to approach the pediatric patient and their family of course, so that you have a better clinical experience. And so we always have to take into account the different developmental levels and ages of the pediatric population. So starting out with infants from birth to six months old, they're an Ericsson stage of trust versus mistrust and their trusted person is always their parent or caregiver and in any pediatric patient, it is super important to establish rapport not only with the patient, but also their caregiver. So of course, we want to always go through the regular introductions, introducing yourself, who you are to the patient as well as the caregiver. And for infants, because we know that their bodily functions are quite fast, so the heart beats are fast, their respiratory rate can be fast. So we want to do that when they are at risk. So it's best to catch them, so to say, when they are sleeping or nursing to listen to the hearts and lungs and also count their respirations. And we always want to keep the most invasive exams as last in the pediatric population. In general, that means that we want to start from the neck and work our way down and then examine the head last. So that would be a mucus membranes, your perler, the ears, fontanelles, any of those things that you need to check. And then for an infant, we want to undress them, but keep the diaper on if you've ever taken care of a baby. If you take off the diaper, sure enough, there will be urine or feces coming out of that patient and it will go all over the place. So keep the diaper on to protect yourself and your work area. But certainly we need to take a look at their genitals to check for their normal growth and development and to examine that area. We want to evaluate their primitive reflexes and those you can separately look up what those are. And again, uncomfortable exams, we want to keep that for last. So if we need to take a look inside their mouth, we want to keep that for last. And we want to talk softly, calmly in a reassuring way, not only for the patient, but also for their parent. And if we need to distract them, so if they tend to not cooperate or they want to be a little bit fussy, a rattle, a pacifier always helps. If you don't have a pacifier handy, it always helps if you have a glove on a hand and you can just let them suck on your index finger. For example, sometimes they'll get them to calm down enough to where you can actually listen to the lungs and heart if you haven't been able to catch them while they are sleeping or nursing. Now still in the infant phase here, but a little bit older now, children from 6 to 12 months old. So they have a little bit more of a sense of who you are and they are more in this trust versus mistrust phase now. They know who their parents are. They can identify their faces. And so they have a little bit of that beginning kind of stranger anxiety. And so we want to distract them with a toy or an object. Again, rattles. Anything that makes noise is usually very helpful. And it's easiest with the parent holding the patient. And again, we want to keep the head, ears, eyes, nose and throat exam last. And one more thing to say, easiest with the parent holding. So sometimes in pediatric exams, you have to get creative. And if the parent is sitting there with that child on their lap and they are calm and they're cooperating, we're not going to put that patient in their crib or in their bed and take them out of that comfortable environment because they're going to start crying. They're going to be uncomfortable and they're going to be anxious. So sometimes you have to do your assessment while the parent is holding. The patient may be listening to their back as the parent is hugging them. So you have to kind of get creative and kind of work your way around to get the most cooperation. Talking about cooperation, toddlers, a lot of times, the most difficult patients to deal with because they're in the space of autonomy versus shame and doubt. And that's usually between two and three years old. They kind of push their independence. They want to push your limits and know and why are their most common words, it seems. And it's always important to set limits with them. And again, establishing of the report is super important. Involving the parent here will be very important and beneficial to help you perform your exam. And it helps if you sit or stand next to the parent to kind of build rapport so that the child feels safe for you being close to the parent and they see you too next to each other. And that kind of puts them a little bit at ease. Toys and books help to cooperate and allow them to handle the equipment. They might have never seen a stethoscope before and you come in at them with your stethoscope. That might be very scary. But if you show them, hey, here do you want to take a look at this? Or you even do a little bit of a role play. You let them listen to your heart sounds or lung sounds or their parents or you might examine the parent first, air quotes, to just kind of pretend to do. Then the child will know that it's okay for the stethoscope to be put on their chest. So allow them to handle the equipment. Allow time for them to warm up to you. It's probably one of the most important things. Communicate honestly and in simple terms. They do understand when you're not honest and when something that you say is not going to come true. So that's super important. Again, least the most invasive exam. Utilize the parent to keep the patient calm, which helps. And they do have a sense of control over themselves and their body function. So we want to take that into consideration. So they kind of already are starting to know what's going on with their body. They know how to maybe go to the bathroom. They're poly-trained or not. So they have some sort of a sense of what a normal should be, although they like to push the boundaries. Now over here for preschoolers, that's probably my favorite age for children between four and six where they're in the stage of initiative versus guilt where they are pretty cooperative. They kind of go into this imaginary phase where they have an imaginary friend. They get a little bit competitive. They learn how to play cooperatively with others. And they are happy to show you that they can cooperate. So getting them involved, not giving them options and choices is a good way to approach the patient. We want to make sure we praise them for good behavior. Again, head-to-toe assessment. Keep the head, ears, eyes, nose and throat for last because it still might be scary at this age. And have them interact with them but more so with them than the parent but have the parent there to help you in case they are a little bit on the shy side or they don't want to cooperate. Now school age typically is from six to ten years old. They're in the phase of industry versus inferiority. So it's best here to involve the child to talk to them. Of course the parent will still be there. To establish rapport, talk about their friends, about their school, about their activities, about their games they like to play, maybe sports that they're getting involved in. So now they are more into this cooperation with others and they are very proud to tell you about their friends and their activities that they do. Modesty in school age is something that comes into place. We want to make sure we keep them covered when we examine them. In infant, for example, that's not that big of a concern but in the school age child we want to make sure that we treat them as an adult and kind of keep their private parts covered as we work our way through the head to toe assessment. An assessment might be an opportunity to teach. So if there are questions or you can teach them that you're listening to their heart and why it is important and how it relates to their sports activity. So that can be a very nice opportunity here. And give honest answers. If they ask you a question, tell them honestly because otherwise the next day you come back or the next time they go to the doctor they might have a hard time trusting the professional if they were given a dishonest answer in the past. For adolescents, which typically is 11 years now, so fairly young, to adulthood and they are in the space of identity versus role confusion. And you can see there's a wide age range here. So an 11-year-old certainly is different than a 17-year-old and so we have to take their age and developmental level into consideration but we want to be pretty straightforward with them and almost approach them like an adult. If they are more in the teenage years where sexual development comes into play you might want to ask the patient who they want present during the exam if they want the parent to step out or maybe for all or only part of the exam. We want them to wear a gown just like an adult and the genital exam should be incorporated because we want to make sure that they develop appropriately to the tanner stages but we kind of want to make not a big deal out of it and you don't want to just play that you don't want to make a big deal out of it you really want to just incorporate it in your head to toe and the best way to do this is to look at the genitals after you've examined the abdomen on your way down to the lower extremities and it is a, this actually allows for time if the patient has questions about their genital exam or about any of their sexual development which some might be really shy about or some might be pretty open and ask you questions or you can mention, okay I see you're starting to develop pubic here this is normal at your age here's what you should expect next so kind of tell them what their normal stages of development are going to be for development of again pubic care, breast development, all those things so that they can kind of know that they are normal because many times they are very shy or too shy to ask about it and so they don't know what's normal, what's normal and they might not want to ask anybody else about it and ask them what questions they have if any so just like an adult, is there anything that I can explain to you today that we've gone over through the exam and adolescents have the sense of an eye and they are heavily influenced by peers which is also when they are at high risk for behaviors such as drug use or you know, driving without a seat belt or kind of high risk behaviors so education here in the adolescent is always important to kind of guide them and make sure that they are safe now for all of this being said depending on what clinical setting you are in there might be a requirement that you cannot do any exam on a pediatric patient without a second set of eyes whether that's the parent or another caregiver that's up to the facility and maybe even up to you what you are comfortable with and I just want to caution you that the pediatric population is very delicate and sometimes we encounter patients who have been abused in the past or who are currently being abused and it hasn't been detected yet so it can be a very, very delicate exam to do but to protect you as a student as well as a nurse as you go into your career make sure that you protect your license and that you follow your hospital's policies and guidelines as to who you should be going to performing the exam with and how you also very carefully document that so thank you for watching this video hopefully this will make your pediatric clinical rotation a little bit easier and less anxiety inducing I always look forward to your comments thanks so much for watching this video here on Nursing School Explained