What You Need To Know About Your Pediatric Rotation

Well, my time with the little kiddos is officially over, and now I have all the advice you will ever need to know before beginning your pediatric rotation! First of all, it has been my favorite rotation up until this point- I absolutely LOVED it! There are a few things that are specific to pediatrics that I personally loved, but can also be a bit challenging at times because of its extreme differences from adult medicine (the main way in which we learn during didactic year!). 

Everyone is Nice

Seriously, I don’t think I met one single unhappy person. Of course, this is slight hyperbole, and ask any pediatric provider, I’m sure they have had plenty of rough days. However, something that truly stood out to me in the pediatric world was how kind, cheerful, and upbeat everyone is.  Yes, there are difficult families. Yes, there are very sad outcomes. Yes, there are challenging conversations and frustrating circumstances. However, there really is an optimistic, kind, gentle, and friendly thread that is strung throughout pediatric clinics and hospitals. It made me enjoy going to work every day and was a very safe and approachable environment to be in as a student and I’m sure as a provider. Also, even if you are having the worst day, you still have to go in the room and be like, “Oh my gosh, Josh, you have a shark on your shirt! Should we see if sharks are rumbling in your stomach! Should we draw a shark! Wow!” It’s just silly and cute and fun and I literally loved it.

Social History Matters

You heard it here first folks, you actually have to take a DETAILED and THOROUGH history about those silly fluffy often times glossed-over social history questions! And it doesn’t stop there- school, diet, hours of sleep, bullying, favorite class, what you want to be when you grow up- these are the actual questions we as medical providers get to ask and truly do care about. SO much of pediatrics is social and developmental. As someone who loves the social and familial and environmental aspects of medicine and outcomes, it was so exciting to lean into that during this rotation.  Additionally, it’s crucial to keep track of how kids are feeling, what is happening in the household that may affect their learning and development, and how we can best support not only the child, but the entire family so that their kids are the happiest and healthiest they can be.

Past Medical History Doesn’t Exist

And neither does medication lists! Call me crazy, but sometimes I LOATHE sifting through years of chart review to figure out what the heck is happening with an adult’s problem list. Kids? These little gems have pretty much no medical issues! I mean, plenty have complex medical issues which is actually way more confusing than an adult, because it’s often rare and extremely complex medical diagnoses. However, the vast majority of kids or healthy! Yes, you get lots of asthma, or chronic ear infections, or eczema, or allergies. But broadly speaking, most kids are quite healthy, so it’s not only your job to stay vigilant and thorough in your history and physical to catch scary things quick, but it is also your responsibility to take seriously those “less medical-ly things” like how they feel at home, what their body image is like, if they can draw a square at an appropriate age, etc. Medications- same drill- most don’t take anything. It’s great. It’s different than adults. But so great.

Chart Review is Quick

See number 3. You can get in and out of an urgent care or emergency room quite quickly because there just isn’t a million moving parts, ya know? There are big things to know, and again, complex kiddos are COMPLEX. But, they are tiny little humans, who haven’t been alive too long, so chart review is just easier.

You Get a Range

This is probably the most challenging part of pediatrics compared to adults. With adults, yes, there are certain things you need to look out for more in a 25 year old than an 85 year old. However, in adult medicine, you need to remember one set of vitals, the body is pretty much established in how it works, and dosing is standard. With kids, you truly need to know how the body works from birth through adulthood. Vitals are different in different ages, tons of medicine is contraindicated in certain age groups, and most importantly, a child’s physical and emotional development is vastly different throughout the life course. What is normal for a 1 year old is very abnormal for a 2 or 3 year old. You need to know the differences and know how to appropriately care for a RANGE of anatomical and physiological systems in a human. 

5 Tips and Tricks

1. You don’t need to memorize vitals or developmental milestones, but you should do your best to have a pretty good idea, and always have quick references in your pocket to check. As a side note, there wasn’t a single developmental question on my EOR so I mean, don’t put your heart and soul into that stuff.
2. Don’t forget everything is administered based on weight! This isn’t just a “we kind of try to base on weight” thing. No. Everything is 100% totally and completely based on weight and you must not forget this! Very different from adults!
3. You need to develop some sort of ability to interact with kids. You have to joke around, you have to “listen to their knee” before you actually listen to their heart sounds. You have to tickle their stomach after palpating it. You have to have a flashlight that is shaped like an animal. You have to say “open up real wide and roar like a lion!” to look in their mouth. You get it, right? You have to get all kid-friendly. It’s silly but adorable.
4. I didn’t see this with all providers because everyone practices differently, but I really appreciated the way some providers approached the GU portion of the exam. They told every kid, “I have to look down their really quick. This is only ok because your parent is in the room, and I am a medical provider. It is not ok if anyone else does this, and you should tell your parents or me if anyone does. It will be very fast then we are all done.”  Again, other providers did it so nonchalantly that the kid hardly knew it happened, they made it so NOT a big deal. Others, as described above, talked about it directly. It’s up to you how you want to do it, and both approaches are appropriate. You have to figure out what is best for you.
5. Take this time to truly figure out how to interact with families. Most of the time in pediatrics, crucial information or almost all information is provided by someone who is not the patient. Figure out how best to interact with all family members. It’s a very interesting dynamic that isn’t as scary as it may seem, but is critical to know and perfect. Work on this throughout your rotation. On the flip side, work on politely asking the family to step out of the room when you have an adolescent. Learning how to talk to everyone from the parents to the 3 year old to the 18 year old is going to take some time, but it is important during your rotation. It’s also kind of what makes it so fun!

Final Thoughts

I hope this has been somewhat helpful, and you love your pediatric rotation as much as I did!  It is such a gift to be able to keep kids healthy and happy, so remember that each day of your rotation! These little guys and girls are just bustling with energy, excited about the mundane, and exploring the world around them with innocent eyes and big bold happy hearts. Keep them healthy, be interested in their lives and development, and EMPOWER those families- they are the cornerstone to the health of their children. Be with them as a team.

Cheers!