KIDS SHOULD COME WITH INSTRUCTIONS

Now don’t I feel like a total idiot! Today was my first “real” day in my pediatric rotation. Last week I did an observation day to get an idea of the flow of the office. It was obvious today that I don’t know squat about peds. My background is emergency medicine and I got plenty of pediatric patients there. Most pediatric patients were in the ER for the little things like vomiting, diarrhea, cough, cold symptoms…etc. Every once in a while a kid was brought in with a true emergent situation. I had no trouble getting right in there and do my nursing stuff. I could put an IV or draw blood from any child. I even learned the best way of getting liquid medications down their throats without it coming back at me. I thought I became pretty creative with some of my assessment skills. Yeah right!

Today I found out I did not know the developmental stuff as well as I should. Examples I had today were when a child should start rice cereal, whole milk, vegetable and fruit baby food; when they should have completely rolled over, stand up, walk, or eat solid foods; or when their teeth are supposed to come in. I remember memorizing all this stuff in my undergraduate degree. I haven’t used it in a long time so it got pushed out of the already saturated brain tissue. These may seem like simple questions to those who have kids or have been around kids a lot. I have never had any children of my own or have been around them for any long length of time. I have nieces who I see about once a year. I think children should come with a pull-out instruction booklet.

After getting all of the developmental stages back in my head, I thought I was ready to go and conquer seeing more patients. This patient was a 12-month-old little boy. He was there for a well-baby check and immunizations. I thought okay so far so good. I did my assessment then got down to the genitalia. I was asked when the testes should drop. Uh well, ummm… I need to get back to you. I go ask my preceptor to find out. So I thought, okay I have that bit of information down, now I am ready for the next one. I walk in to see a 5-month-old male patient in for a well-baby check and immunizations. I had the rice cereal, baby food, and testes dropping bit down so I knew I was good there. Here we go, I do my assessment and everything looked good. I was ready for the testes question but never got it. What I was asked was why did he have this line going around his head? Also, what about his belly button? I look at the belly button and it had a little hernia. I told the mom this was small and should resolve on its own within a year. (I remembered that one from last week.) The hair line was something I did not know. Uh well, ummm…I need to get back to you. There I lost any trust with that mother. I knew it was something simple but I honestly could not think of an answer that did not sound like B.S. I go and find out and duh, head turning back and forth when lying down and their hair gets thinner. Okay, more information put in the old memory bank.

As the day went on I realized looking in these little ones ears was not easy. My preceptor did it with such ease. The first kids ears I tried to look in was like holding down a pissed off bull. I didn’t want to hurt the kid but again I didn’t want to shove the ear piece too far. The moving ear canal technique was not working well. I need to work on the head holding technique. I just didn’t want to hold the head down so hard it would hurt them. I definitely have to work on this skill and try to master in the very near future, i.e., next week.

By the end of the day I was confident of my baby formula, rice cereal, baby food, teeth, whole milk, solid food, dropping testes, herniated belly button, hairline around the head, snotty nose, hand grabbing, ear pulling, head lifting, walking, standing, pooping, and peeing questions. Okay now, I am ready for the next one. Here I go. This was a 2-month-old little girl who was in for a well-baby check and immunizations. She was a cute little thing. Everything looked good with her assessment. She had tiny ear canals. I still need to work on that. I asked about how she was eating and grabbing…etc. I was so proud of myself. I looked like I knew something. Then the mother asks, what is that dot on her chin and upper lip? I told her it looked like a little pimple. As far as the one on the upper lip, uh well, ummm…I need to get back to you. My preceptor said it was a little cyst that would resolve on its own. Okay, more information in the data bank. I thought it looked like a little pimple but who knew?

On the way home I bought two pediatric books. By next week I plan to have as much information as possible so I don’t look like I should be washing cars at a local car wash. I will be ready for the kids and my preceptor. I shall overcome my stupidity! I will be ready and full of information. It will get easier…I hope.