Pediatrics Rotation

Finished pediatrics and I finally have some down time to write about it. I began the rotation rather hesitantly—many of you know I was not looking forward to it.

**GASP**...but why?

To be honest, I’ve just never seen myself as a pediatrics provider. Prior to starting, I imagined encounters filled with screaming/crying children, tantrums, overbearing parents, snot filled kids, poop/vomit. And to a certain extent, this is all true…haha!
 
A lot of encounters will begin or end with children crying....kids will have a code brown or throw up while you’re getting a strep test…you will get sneezed or coughed on…some parents will be overbearing…others will ask a multitude of questions— some you won’t have answers to…”why does she swallow her food so loudly,”….but I soon realized that this was all superficial. 
 
As the weeks went by, I began to appreciate everything about pediatrics; the clinical skills required, the immense amount of patience & caring, and the confidence it entails to just give parents reassurance (sometimes this is the most difficult part!).
 
Towards the end of the rotation, I became comfortable with well child checks, understood the importance of asking certain questions that would aid in the diagnosis, and most of all...enjoyed connecting with the children. My clinical skills also improved--diagnosing AOM in the twisty ear canals of squirming children became doable and I began having a better understanding on the difference between adult and pediatric presentations. 
 
I learned so much but also know that there is SO much more to pediatrics. While I still do not see myself  strictly in peds, I learned some invaluable lessons/tips/pearls which I’m sure to use no matter where I end up.
 
So… why are kids such a challenge? 

• Vitals signs are slightly different
• Anatomy is slightly different (I was asked about ossification centers, which sinuses develop at what age, etc)
•  Classic signs/symptoms we’re taught in adult medicine are often not the same in children
• Pharmacology related
  • Peds dosing…it isn’t particularly difficult but it is tedious!
  • Remember that some medications are contraindicated in certain age groups (know when to use ibuprofen/acetaminophen or antibiotics like Doxycycline)

 
Rock your pediatrics rotation:
These tips are by no means the only material you should focus on but deserve a special mention for anyone about to go through their peds rotation. Hope it helps! 

1. Know developmental milestones-​I’m not saying memorize the whole milestone table—that’s pointless. But, part of your rotation will include performing LOTS and LOTS of well child checks.  It will be your chance to tell parents: your child is on track….OR….something is off.  Both are equally important. You must know what is considered normal in order to recognize abnormal. Long story short: know IMPORTANT milestones, not minutia. It helps to carry around a milestone chart in your first weeks.
2. Practice pediatric dosing-​I know most of us have Epocrates or other apps that perform peds calculations. But, I encourage you to do some manual calculations if possible. This not only helps you understand, but once you get better at it, you can almost just eyeball what the dose will be before doing anything. Plus, a peds dosing problem is almost always guaranteed in your EORs. Get some practice in!
3. Learn how to read & interpret developmental charts-Reading these charts isn’t rocket science but get use to explaining them to parents. Know that you are especially looking at trends rather than individual data points.
4. Vaccines-DO NOT memorize vaccine schedules; it is helpful to have a vaccine chart on hand or an app. Also know that you will encounter various anti-vaxxers! 

 Other tips (thanks to my preceptor!)

• Diet (breast v bottle) & bowel movement questions are usually relevant in most encounters—be sure to ask them. Asking about number of wet diapers also gives you an indication of hydration status & if feeding is adequate
• Always carry stickers (or lollipops) in your pocket. "You build friendships"--as my preceptor would say. 
• Having a small toy to test EOMs works wonders
• Introduce yourself to the kid, even if you think they might not understand. Show them your stethoscope, have them touch it or play with it, then begin the physical exam
• Always begin the physical exam with the least invasive parts. I always started with heart and lungs...then abdomen..then worked my way down towards the feet...then HEENT..and always ended with ears! ​Each clinician will have a different way of doing their exam, this worked for me. Once you know what works for you, perform the exam in that same order. You're less likely to forget anything if you have a set way to performing your physical exam
• At younger ages, kids aren’t that great at hiding their feelings. If they’re in pain, they will show it. If they are sick, you will know it. If they’re jumping, running, laughing…that’s a good sign
• If you want to check peritoneal signs, having them jump on one foot is a good way!
• Always ask the parents if all questions were answered during the encounter 

 
Ways to beat/prevent the dreaded pediatric rotation illness: 

• WASH HANDS...this goes without saying, but cannot stress this enough in peds! 
• I only got sick for 2 days out of my whole rotation, this herbal remedy was my go-to & I was able to bounce back quickly
• “Golden Milk”—Turmeric latte
  • 1 oz Synchro Gold Turmeric Elixir 
    • Note: this is NOT sponsored, I'm just a huge fan! I also do a shot of this elixir on a daily basis. 
  • 1 cup unsweetened Coconut milk--can substitute unsweetened soy or almond milk
  • 1 (1/2 inch) piece fresh ginger, peeled and cut
  • 1 cinnamon stick
  • 1 tablespoon honey or honey to taste
  • Instructions:
    • Mix milk, turmeric elixir, ginger, honey, cinnamon in pot & bring to a boil; reduce heat & simmer for 10 minutes.
    • Remove ginger piece & transfer latte to mug.
    • Let cool & drink up!

​Study Resources:

• Step up to Pediatrics
• Pance Prep Pearls
• ​OnlineMedEd (this helped me so much during EORs)
  • Free online videos are a must! 
  • Quick table book worked more for exam prep

Podcasts: 

• Peds in a Pod: Pediatric Board Review (good for which milestones are important!)
• Peds RAP—Hippo Education (need to pay for subscription but so worth it)
• Pediatric Emergency Playbook
• Pedscases.com: Pediatrics for Medical Students

 
Websites: 

• UptoDate
• Medscape
• http://www.npstudent.com/well-child-check.html
• https://www.pedscases.com

 
Reference books: 

• Current Pediatric Diagnosis & Treatment
• Atlas of Pediatric Physical Diagnosis

These reference books were not purchased for my rotation but were accessed via my school library..don't forget you have these available to you through your school!