Hey! I’m a OMS3, and I recent did my first wellness checkup on a child (7) and realized I don’t know what child specific things to check on physical exam. Google gave me some good questions to ask about nutrition, dental visits, and socialization, but I couldn’t find anything about the physical exam. I asked the resident I’m working with, but he is sorta clueless as he just started, too. What should we do differently for child wellness checks vs adult? Any advice would be greatly appreciated!!
Hello! Congrats on starting clinicals, aren’t they fun??
My typical well child exam for a 7 year old is to use the history to go through “everything in their life” e.g. sleep, transportation, school, fun, home, eating, drinking, pooping, peeing, teeth brushing. 5 and below I also throw in developmental milestones but above that you can just confirm with the parents that the school/teachers have no concerns. I also try to get the kid as involved as possible, getting answers from them and confirmation from the parents.
For the physical exam, I usually start with listening to the heart and lungs because if you’re thinking after the history that they might be a bit scared you can tell them exactly what you’re listening for and then put the stethoscope on their ears and there it is!! While I already have the stethoscope on, I also listen to the belly. After that, I look in their ears, eyes, nose, and throat. Then I do an abdominal exam and at 7 you can finish with a quick peek at the genitals to ensure they’re still Tanner I. With younger kids this is the opportunity to check for hip dysplasia, with older kids it would be a full genital exam likely with the parents out of the room or behind a curtain (skip this is you’re not comfortable yet or if there are any rules requiring an attending present). Then I do muscle strength which kids always love “show me how strong you are!!” With the C6, C7, C8, L4, L5 myotomes (push/pull of arms and legs and finger squeeze) I usually finish it off with some gait analysis, asking them to walk in their toes, heels, and walking “like a duck” bent down close to the floor.
This is just a general benign exam. If there are any flags in the history, follow up on those in your exam but otherwise this should be fairly comprehensive!
