Clerkship Ready: Pediatrics Med Ready

Pediatrics is different from any other rotation that you will do. Children are not just small adults. There is a huge range of ages and developmental stages. This episode will provide you with some general tips and tricks for all clerkships in general and the Pediatrics clerkship specifically, and essential resources that will help you to succeed in your clerkship.
Essential Resources
 Podcasts:

Clerkship Ready-Pediatrics
Charting Pediatrics - Weekly podcast with lots of bread-and-butter pediatrics discussed. 
Pediatrics on Call - The most recent research and the newest policy updates from the American Academy of Pediatrics. 

Books:

Red Book (also an app for AAP members) - the definitive source for pediatric infectious diseases. 
Harriet Lane Handbook (also an app) - has drug doses, commonly used charts, and algorithms.  

Websites:

Peditools for bilirubin 
Uptodate
CDC website is a great source for vaccine guidelines

Apps:

PedsScripts App: specifically to work on illness scripts

General Tips and Tricks:

Be Proactive
Know what the expectations are. 
Become familiar with the electronic medical record system. 
Be Self-sufficient, but ask for help when appropriate. 
Know when you should come in to round, who to pre-round on, and where to meet.  Pair up with an intern to pre-round.
Ask for feedback.  

Pediatric-specific Tips and Tricks:

Pediatrics is different from any other rotation. 
Huge range of ages and developmental stages.

At every age, children act differently - and you need to adjust appropriately.
If you can, get as much of the history from the child, but you will likely need to supplement that with history from the parent or guardian. 
When you do your physical exam on younger children, have t

This episode will prepare you to see well newborn babies in the newborn nursery on day 1. We will talk about the typical newborn stay, the information you need to gather to successfully give oral presentations on your patients, the newborn physical exam, and the tests and procedures commonly performed on all newborns.

Nursery orientation: family expectations and goals of the healthcare team, expected length of stay
History 

Maternal History:

Gs and Ps
Prenatal Care: prenatal labs and ultrasounds
Past Medical History & medications
Social situation/support



Baby History:

Gestational Age
Delivery type and why, resuscitation efforts and complications
Growth parameters


The complete newborn exam: head to toe
During the newborn stay:

Ins and Outs
Medications and vaccines
Routine screening labs and tests
Parental discharge education 
Discharge criteria and follow up

This episode will prepare you for your first well child visit. In primary care, about half of a pediatrician's time will be spent in well child visits. We will talk about what you need to review before you walk into the patient's room, the elements of the history (diet, sleep, elimination, development, etc.) that you need to ask about in well child visits, tips to approaching the physical exam in children, and anticipatory guidance. Finally, we will provide an example of an oral presentation for a well child visit.
 

In Pediatric Gastroenterology (or GI) clinic, you will see patients with a host of gastrointestinal, pancreatic, liver, and nutrition issues. This episode will discuss specific questions that you will want to cover in your history and the elements of a complete GI exam - which is a lot more than just an abdominal exam!
Peds GI clinic covers a host of gastrointestinal, pancreatic, liver and nutrition issues
-3yr fellowship after peds residency 
Before Clinic 

Review what types of patients you will be seeing. It may be a mix of lots of issues, or just a liver transplant clinic. This will tell you what type of prep you should do (conditions to read up on, medications to review, etc) before the day of clinic.
On the day of clinic, review expectations with the attending, fellow or resident physician. Do they want you to see patient independently and write notes, just shadow or somewhere inbetween. Review what questions they always want asked, what exams you should do alone vs with your whole team. Setting expectations before you start will set you up for success! 
Questions: Pain, the PQRST mnemonic is helpful to better understand the pain

Provoked the pain
Quality of the pain
Radiating
Severity 

Specific questions to ask in Peds GI: 

Does pain wakes the patient at night? 
how much school or other activities the Patient has missed because of symptoms? 
Does defecation or passage of gas alleviates pain? 
Any specific dietary changes already tried?

Poop! understand the:

Quality of the stool
Size and caliber of the bowel movement (Use Bristol stool scale)

GERD vs EoE  
A complete GI exam– a lot more than the abdomen!

This episode describes how to prepare for a newborn’s first outpatient visit after they have been discharged from the birth hospital, including the information that you need to obtain from the medical record before the visit, the topics you need to discuss during the visit, and how to approach the physical examination in a newborn.
Introduction
Socio-emotional state of parents
Before the visit, you should review

Prenatal history
Delivery history, gestational age
Physical exam at time of birth
Preventative treatments
Course in newborn nursery or NICU
Type of feeding
Concerns for infection
Bilirubin
Screening tests

Newborn visit

Parental questions and concerns
Feeding history and any problems with feeding
Elimination 
Sleep and safe sleep
Social history and parental support system
Review of systems – irritability, fever, rashes. 

Normal newborn vital signs
Infant growth parameters and weight trajectory
Physical exam

General
Head size and shape
Eyes – pupil shape, red light reflex, scleral icterus
Cardiovascular – murmurs, capillary refill
Respiratory
Abdominal
Genitourinary – testicles, hernias/hydroceles, circumcision, vaginal discharge
Musculoskeletal-  clavicles, hip 
Skin – jaundice, birthmarks, sacral dimples
Neurological: tone, reflexes

Anticipatory guidance

The goal of the adolescent well visit is to empower the adolescent in starting to take ownership of their health with the support of their parent/caregiver and their health provider. There are thus specific ways in which the adolescent well visit differs from well visits for younger children. We will discuss how you can approach these visits, how to handle patient confidentiality, and how to ask those sensitive questions.
Before visit:

Review normal psychosocial development of adolescence
Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence 
Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available. 
Vital signs (including BP), height weight, BMI.
Any screening questionnaires (e.g., PHQ-9A)

During visit:

Introduce yourself; ask how they would like to be addressed
Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality
Direct questions to adolescent as much as possible
Concerns from adolescent/parent or from prior visits that require follow up or updates
Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview. 
Nutrition: number of meals/snacks, dairy intake 
Sleep: nighttime and naps
Screen time: duration, type(s)
Dental: frequency of brushing, last seen by dentist
Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses
Review medications, allergies, growth chart, vaccines
Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety

Physical exam

Head to toe
Discuss acne
Need chaperone for breas