Paediatrics Clerkship Guide
Pediatrics offers unique challenges and rewards, as you will have the opportunity to care for some of the most vulnerable patients - children. This specialized field requires not only a solid foundation of medical knowledge but also exceptional communication skills and a deep understanding of child development.
I. Overview of Paediatrics
a) What is Paediatrics
Pediatrics is a medical specialty that focuses on the healthcare and well-being of infants, children, and adolescents. Pediatric physicians and healthcare providers specialize in diagnosing, treating, and preventing a wide range of medical conditions specific to this age group. Their expertise encompasses the physical, emotional, and social aspects of child development, with a primary focus on promoting growth, addressing childhood illnesses, and providing comprehensive care tailored to the unique needs of pediatric patients. As advocates for the health and safety of children, pediatric specialists play a crucial role in ensuring optimal physical and mental development from infancy through adolescence, making a significant impact on the lifelong well-being of their patients.
b) Paediatric Subspecialties
General pediatrics: focuses on providing comprehensive healthcare for infants, children, and adolescents. Pediatricians in this field serve as primary care physicians, diagnosing and treating a wide range of medical conditions common in children, guiding parents in promoting a healthy lifestyle, and administering vaccinations to ensure their patients' well-being from birth through adolescence.
Adolescent Medicine: Adolescent medicine focuses on the unique healthcare needs of adolescents, providing specialized care for issues related to puberty, mental health, sexual health, and social challenges during the teenage years.
Pediatric Inpatient: Pediatric inpatient care refers to the specialized management of acutely ill children who require hospitalization. Pediatric inpatient teams provide intensive monitoring, medical treatment, and support to pediatric patients with complex medical conditions.
Pediatric Emergency Medicine: Pediatric emergency medicine deals with urgent medical conditions and emergencies in children, providing rapid and specialized care in the emergency department for a wide range of pediatric conditions and injuries.
Developmental Pediatrics: Developmental pediatrics involves the evaluation and management of developmental delays and disorders in children, such as autism spectrum disorders, intellectual disabilities, and language disorders.
Neonatal-Perinatal Medicine: Neonatal-perinatal medicine specializes in the care of premature and critically ill newborns, including infants with complex medical conditions requiring intensive care in neonatal intensive care units (NICUs).
Pediatric Orthopaedics: Pediatric orthopaedics specializes in the diagnosis and treatment of musculoskeletal conditions and injuries in children. Pediatric orthopaedists address a wide range of conditions, such as fractures, Salter-Harris fractures, bone deformities, scoliosis, and congenital limb abnormalities.
Pediatric Cardiology: Pediatric cardiologists specialize in diagnosing and treating heart conditions in children, including congenital heart defects, arrhythmias, and acquired heart diseases. They use various diagnostic tests and imaging techniques to manage pediatric cardiovascular disorders.
Pediatric Hematology/Oncology: Pediatric hematologists/oncologists specialize in blood disorders and childhood cancers. They diagnose and manage conditions like anemias, bleeding disorders, and leukemias, providing comprehensive care and treatment for pediatric patients with cancer.
Pediatric Gastroenterology: Pediatric gastroenterologists focus on gastrointestinal disorders in children, including conditions like gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), and celiac disease. They address nutritional challenges and feeding difficulties often encountered in pediatric gastroenterology.
Pediatric Neurology: Pediatric neurologists deal with neurological disorders and conditions affecting the nervous system in children. They diagnose and manage epilepsy, developmental delays, and other neurologic conditions unique to pediatric patients.
Pediatric Endocrinology: Pediatric endocrinologists specialize in disorders of the endocrine system in children, including diabetes, growth disorders, and hormonal imbalances.
Pediatric Pulmonology: Pediatric pulmonologists focus on respiratory conditions in children, including asthma, cystic fibrosis, and chronic lung diseases. They provide comprehensive care for pediatric patients with respiratory disorders.
Pediatric Nephrology: Pediatric nephrologists specialize in kidney-related disorders in children, including kidney diseases, urinary tract infections, and congenital anomalies of the kidneys and urinary tract.
Pediatric Rheumatology: Pediatric rheumatologists diagnose and manage autoimmune and inflammatory disorders affecting the musculoskeletal system in children, such as juvenile idiopathic arthritis.
Pediatric Allergy and Immunology: Pediatric allergists and immunologists specialize in diagnosing and treating allergic reactions and immune system disorders in children, including asthma, food allergies, and immune deficiencies.
Pediatric Critical Care: Pediatric intensivists provide specialized care for critically ill children in the pediatric intensive care unit (PICU), managing life-threatening conditions and complex medical situations.
c) How Medicine differs in Paediatric Population vs. Adults
Pediatric medicine and adult medicine are distinct branches of healthcare that focus on different age groups and have unique considerations in terms of patient care.
Here are some key ways in which pediatric medicine differs from adult medicine:
Age Group: The most apparent difference is the age group of patients. Pediatric medicine primarily focuses on the care of infants, children, and adolescents from birth through the teenage years, while adult medicine caters to patients who are typically 18 years and older.
Growth and Development: Pediatrics encompasses the unique aspects of child growth and development. Pediatric healthcare providers monitor and assess milestones in physical, cognitive, and emotional development to ensure optimal growth.
Communicating with Patients and Families: Pediatric healthcare providers need to communicate effectively with both pediatric patients and their caregivers. This requires using age-appropriate language, addressing children's concerns, and building rapport with families to establish trust.
Family-Centered Care: In pediatric medicine, the family unit plays a significant role in decision-making and providing support. Healthcare providers often involve parents or caregivers in the treatment plan and consider the family's dynamics when making medical decisions.
Disease Presentation and Diagnosis: Many medical conditions present differently in children compared to adults. For instance, children may have unique symptoms, complications, or manifestations of certain diseases that differ from those seen in adult patients.
Treatment Approaches and Medication Dosing: Treatment strategies in pediatric medicine must consider the child's age, weight, and developmental stage. Pediatric healthcare providers use specialized dosing guidelines for medications and often utilize liquid formulations or age-appropriate dosage forms.
Specialized Care Units: Pediatrics includes specialized units, such as neonatal intensive care units (NICUs) for premature and critically ill newborns and pediatric intensive care units (PICUs) for critically ill children.
Child Advocacy: Pediatric healthcare providers serve as advocates for the well-being of their young patients, considering their unique vulnerabilities and rights.
Preventive Medicine and Vaccination: Preventive medicine plays a vital role in pediatric care, with an emphasis on vaccinations to protect children from infectious diseases.
Focus on Long-Term Impact: Pediatric healthcare providers often consider the long-term impact of medical decisions on a child's development and well-being.
II. Preparing for Paediatric Clerkship
a) Concepts to Cover in Paediatrics Clerkship
Gestation and Birth: Newborn exam, birth trauma (molding, clavicular fracture, erb-duchenne Palsy, etc.), perinatal infections (HepB, Parvovirus, Toxoplasmosis, Rubella, GBS, E. Coli, Listeria, HSV, Syphilis, HIV), newborn care and screening (routine prophlaxis, metabolic screening, audtory screening, DDH)
Growth and Development: Understanding normal growth and developmental milestones is crucial in identifying potential concerns or delays in pediatric patients. Familiarize yourself with age-specific milestones to assess a child's physical, cognitive, and social development accurately.
Pediatric Physical Examination: Mastering the pediatric physical examination is essential for diagnosing and evaluating a wide range of conditions. Learn age-appropriate examination techniques, including assessing growth parameters, developmental assessments, and specialized pediatric assessment tools.
Common Pediatric Conditions: Gain proficiency in diagnosing and managing common pediatric illnesses and conditions such as respiratory infections, febrile illnesses, gastrointestinal disturbances, and skin conditions. Recognizing these common ailments will form the foundation of your pediatric practice.
Vaccination Schedule: Understand the recommended vaccination schedule and the importance of immunization in preventing infectious diseases in children. Be familiar with vaccine administration techniques and vaccination guidelines.
Communication with Pediatric Patients and Families: Developing effective communication skills with pediatric patients and their families is crucial in gaining trust and ensuring patient compliance with treatment plans. Learn to convey medical information in a child-friendly and empathetic manner.
Pediatric Pharmacology: Gain knowledge of age-appropriate dosing, drug interactions, and potential side effects of medications commonly used in pediatric patients. Understanding pediatric pharmacology ensures safe and effective treatment.
Nutrition and Feeding: Familiarize yourself with the nutritional needs of infants and children at different stages of development. Recognize common feeding difficulties and nutritional challenges in pediatric patients.
Child Abuse Recognition: Be aware of the signs and symptoms of child abuse and neglect. Learn to recognize and report any suspicious findings following appropriate protocols.
Pediatric Emergencies: Acquire the skills to handle common pediatric emergencies, such as febrile seizures, respiratory distress, and allergic reactions. Understand the principles of pediatric resuscitation and stabilization.
Cultural Sensitivity: Recognize and respect cultural differences in pediatric care. Being culturally sensitive and understanding diverse family dynamics can significantly impact patient satisfaction and outcomes.
b) Paediatric History & Physical Examination
Here is an example of a comprehensive pediatric history taking and physical examination in an outpatient setting, ensuring a thorough evaluation of the child's health and well-being.
Pediatric History Taking:
Introduction and Establishing Rapport:
Introduce yourself and address the child and their caregiver(s) in a friendly manner.
Build rapport with the child by engaging them in age-appropriate conversation.
Patient ID: Sexual Orientation, Gender Identity.
Chief Complaint and Presenting Concern:
Identify the reason for the visit and the main complaint(s) expressed by the caregiver and/or child.
Obtain a detailed description of the presenting concern, including onset, duration, and any aggravating or relieving factors.
History of Present Illness:
Explore the specific symptoms related to the chief complaint in chronological order.
Inquire about associated symptoms and any changes observed since the onset.
Current Health:
Nutrition: breast milk/formula/food, quantity, frequency, supplements, and eating issues
Sleep (apnea, bedwetting, restlessnes)
Elimination: bowel or bladder issues, toilet training
Behaviour
Past Medical History:
Obtain information about the child's past medical conditions, hospitalizations, surgeries, and significant illnesses.
Ask about any chronic medical conditions or ongoing treatments.
Medication and Allergy History:
Document current medications, including prescription, over-the-counter, and herbal supplements.
Inquire about any known drug allergies or adverse reactions.
Family History:
Explore the family's medical history, including any relevant hereditary conditions or chronic diseases.
Note any history of consanguinity or familial conditions.
Developmental and Growth History:
Inquire about the child's developmental milestones, including motor, language, and social skills.
Obtain information on the child's growth parameters (height, weight, head circumference) and growth trends.
Immunization History:
Document the child's vaccination status and ensure compliance with the recommended immunization schedule.
Social History:
Assess the child's home environment, family support, pets, exposure to chemicals (smoke, lead, type of water city/rural/well), and living conditions.
Inquire about school performance, interactions with peers, and any recent life changes.
Pediatric Physical Examination:
General Observation:
Observe the child's overall appearance, behavior, and interaction with the caregiver.
Assess for signs of distress, comfort, and alertness.
Vital Signs:
Measure the child's heart rate, respiratory rate, blood pressure, and temperature.
Calculate and interpret growth parameters, including weight, height, and head circumference (for infants).
Head-to-Toe Examination:
Perform a systematic head-to-toe examination, including inspection, palpation, percussion, and auscultation.
Neurological Examination:
Assess the child's mental status, cranial nerves, motor and sensory functions, and reflexes.
Skin Examination:
Inspect the skin for rashes, lesions, and signs of allergies or infections.
Respiratory Examination:
Auscultate the chest for breath sounds and assess respiratory effort and accessory muscle use.
Cardiovascular Examination:
Auscultate the heart for abnormal sounds or murmurs and palpate peripheral pulses.
Abdominal Examination:
Palpate the abdomen for tenderness, organ enlargement, or masses.
Musculoskeletal Examination:
Examine the child's joints, muscles, and range of motion.
Developmental Assessment (Age-Appropriate):
Perform appropriate developmental screening tests based on the child's age.
Immunization Status and Vaccination:
Review and update the child's immunization status if necessary.
Assessment and Plan
Summarize the findings and discuss the assessment and plan with the caregiver(s).
Provide recommendations, prescribe medications if needed, and schedule any follow-up visits.
III. Resources
a) Online Resources
Pediatrics Clerkship - Medscape Education: Medscape offers a comprehensive online clerkship resource with educational modules, articles, and case studies covering essential topics in pediatric medicine.
Life in the Fast Lane - Paediatric ECG Basics: This website provides a free, evidence-based, and user-friendly resource with articles, case studies, and practice questions relevant to pediatric clinical clerkship.
Pediatrics - American Academy of Pediatrics (AAP): The AAP website offers a wide range of pediatric resources, including clinical guidelines, articles, and educational materials to support medical students during their clerkship.
Pediatrics - OnlineMedEd: OnlineMedEd offers free video lectures and study materials focused on pediatric clinical topics, providing concise and high-yield information for medical students.
Pediatric Education Online (PEO): PEO is an online educational resource from the Canaidan Paediatric Society, University of Alberta Dept of Paediatrics and the Alberta Medical Students’ Association that includes interactive case studies, videos, podcasts, notes, videos and self-assessment tools to enhance pediatric clinical knowledge.
UpToDate - Pediatrics: UpToDate is a reputable medical resource providing evidence-based clinical information on pediatric topics, including diagnosis, treatment, and management.
b) Paediatric Handbooks
“The Hospital for Sick Children Handbook of Pediatrics” This is an up-to-date diagnostic and therapeutic methods for managing pediatric patients across various healthcare settings, offering concise, evidence-based answers and practical, system-based approaches to a wide array of clinical problems from primary to quaternary care.
"The Hospital for Sick Children Handbook of Pediatric Emergency Medicine" is a comprehensive and practical guide providing evidence-based approaches and management protocols for pediatric emergency medicine scenarios encountered in clinical practice.
"First Aid for the Pediatrics Clerkship" handbook provides concise and high-yield information to assist medical students during their pediatric clerkship, covering essential topics and management strategies encountered in pediatric medicine.
"Case Files Pediatrics" - Part of the Case Files series, this book presents real-life patient cases with discussions to aid students in understanding pediatric concepts.
"Nelson Essentials of Pediatrics"- This handbook is a concise and comprehensive resource covering essential pediatric topics in a user-friendly format.
“Oxford Handbook of Paediatrics” A comprehensive medical reference book that provides practical and up-to-date information on pediatric medicine. It covers a wide range of topics related to the care of infants, children, and adolescents, including diagnosis, treatment, and management of common pediatric conditions and emergencies.
"Pediatrics PreTest Self-Assessment and Review" This book includes clinical vignettes and multiple-choice questions to help students prepare for pediatric clerkship exams.
“Handbook of Paediatric Orthopaedics” a comprehensive and practical guide providing evidence-based approaches and management strategies for diagnosing and treating musculoskeletal conditions in pediatric patients.
c) Paediatric Textbooks
"Nelson Textbook of Pediatrics" - This comprehensive textbook is considered the gold standard in pediatric medicine, covering a wide range of topics and providing evidence-based guidance on pediatric care.
"Rudolph's Pediatrics" - Edited by Mark W. Kline, Joseph W. St. Geme, and Nina F. Schor. This classic textbook offers a comprehensive overview of pediatric medicine, emphasizing clinical relevance and practical applications.
"Textbook of Pediatric Emergency Medicine" - This comprehensive textbook focuses on pediatric emergency medicine, providing practical guidance on managing acute and critical conditions in children.
d) Podcasts in Paediatrics
"Pediatric Podcasts" - Produced by the American Academy of Pediatrics (AAP), this podcast series covers a wide range of pediatric topics, including clinical updates, research summaries, and interviews with experts.
"PedsCases" - This podcast focuses on pediatric medicine and provides case-based discussions, interviews, and interactive quizzes to enhance your understanding of various pediatric conditions.
"Pediatric Emergency Playbook" - Geared towards emergency medicine in pediatrics, this podcast offers practical guidance and management strategies for common pediatric emergencies.
"Pediatric Education for Prehospital Professionals" - This podcast provides education and updates on pediatric care for prehospital professionals, including emergency medical services (EMS) providers.
"The Cribsiders" - Hosted by pediatricians, this podcast covers a wide range of pediatric topics, offering practical clinical insights, case discussions, and interviews with experts.
"Pediatric Research Highlights" - Produced by the journal "Pediatrics," this podcast series presents interviews with authors of recent research articles, summarizing key findings and their clinical implications.
"Pediatric Pain Focus" - Focusing on pediatric pain management, this podcast explores various aspects of pediatric pain assessment, treatment approaches, and strategies for providing compassionate care.
"Pediatric Pharmacotherapy" - This podcast offers discussions on pediatric medication management, including dosing, safety considerations, and evidence-based prescribing practices.
"Pediatric Surgery NaT" - This podcast covers a wide range of pediatric surgical topics, including congenital anomalies, surgical techniques, and management approaches in pediatric surgery.
"Pediatric Podcast Club" - This podcast reviews and discusses various pediatric podcasts, highlighting episodes and topics of interest within the field of pediatrics.
Final notes
Embarking on your pediatric clerkship is an exciting and invaluable opportunity to immerse yourself in the world of pediatric medicine. As you navigate through the diverse clinical areas of inpatient, outpatient, emergency, and subspecialties, remember that each patient encounter is a chance to learn, grow, and make a positive impact on young lives.
