Diseases and disorders in pediatrics

Health problems most frequently seen in adolescent patients include eating disorders (anorexia nervosa and bulimia nervosa), obesity, and injury-related problems. Accidents are the leading cause of death and injury in adolescence, and suicide is the third leading cause of death. All healthcare personnel should be on the alert for indicators of suicide, including the following:

• Signs of depression, such as headaches, abdominal discomfort, anorexia, fatigue, aggressiveness, drug or alcohol abuse, and sexual promiscuity
• Verbal statements that hint at the adolescent’s intention to commit suicide; talking about dying
• Actions such as giving away prized objects, withdrawing from social groups, suddenly changing normal behavior patterns, or writing a suicide note

This patient population can be challenging to work with, but it can also be rewarding as you help the adolescent patient handle the hurdles of becoming a healthy adult.

Patient coaching

Unintentional injuries are the leading cause of death and disability in children in the United States. Injuries cause more childhood deaths than all diseases combined. The primary causes of childhood injuries are the following:

• Motor vehicle accidents
• Drowning
• Burns
• Falls
• Poisoning
• Aspiration with airway obstruction
• Firearm accidents

Childhood injuries are linked to the child’s growth and development level and usually are preventable. Young children are totally dependent on caregivers to keep them safe, so constant supervision and a childproof environment are essential for this age group. Older children need to be aware of health hazards and should be encouraged to protect themselves from injury (e.g., they should use bike helmets, protective padding when skateboarding, seat belts, and so on). The highest incidence of accidental injuries is seen in children under age 9, but as children grow older, the percentage of deaths from injuries increases. In the United States, more than 9000 children die each year—about 25 deaths a day—from injuries. Healthcare workers play a major role in injury prevention. The medical assistant is responsible for making sure the ambulatory care office is safe, and parents are educated about potential hazards.

Legal and ethical issues

The Child Abuse Prevention and Treatment Act states that all threats to a child’s physical or mental welfare must be reported. This means that every teacher, healthcare worker, and social worker, in fact, every citizen who suspects that a child is being neglected, abused, or exploited, must report this to the proper authority. The agency must record the report, and after three similar reports, the agency must investigate.

When suspected abuse, neglect, or exploitation is reported, the individual must provide his or her name. This is considered confidential information and is not given to the child’s parent or guardian, nor is it given to the investigating officer. The individual making the report is also protected under the law from any liability for reporting suspicions of child abuse.

If the medical assistant suspects a child is a victim of abuse, neglect, or exploitation, she or he should consult with the provider immediately. In most states, the medical assistant and the provider can make separate reports to the authorities. However, state laws vary, so state and local reporting protocols should be outlined in the office procedures manual.

Signs of child abuse:

Obvious signs:

• Previously filed reports of physical or sexual abuse of the child
• Documented abuse of other family members
• Different stories from the parents and the child on how an accident happened
• Stories of incidents and injuries that are suspicious
• Injuries blamed on other family members
• Repeated visits to the emergency department for injuries

Examination findings:

• Trauma to the nervous system
• Internal abdominal pain
• Discolorations/bruising on the buttocks, back, and abdomen
• Elbow, wrist, and shoulder dislocations

Changes in child’s behavior:

• Too eager to please the parent
• Overly passive and too compliant
• Aggressive and demanding
• Parenting the parent (role reversal)
• Delays in the normal growth and development patterns
• Erratic school attendance

Physical Indicators:

• Poor hygiene
• Malnutrition
• Obvious dental neglect
• Neglected well-baby procedures (e.g., immunizations)

Patient-centered care

In a pediatric practice, the child usually is joined by one or both parents during visits to the provider. Parents need reinforcement, praise, and understanding in dealing with the health and welfare of their children. Provide parents with information to help them understand their children’s behavior and improve their parenting skills. Understanding the normal behavioral characteristics of a particular developmental stage may increase the parents’ confidence and reinforce expectations for the child.

The waiting room is an ideal place for parent education. Use the space and resources available to provide up-to-date information on child health issues and on local resources for support and assistance. If the provider has pamphlets available, discuss them with the parents. Answer questions when possible or alert the provider so that questions can be answered during the office visit. Every opportunity should be taken to teach parents about sound healthcare. Because so many ambulatory care visits involve infectious disorders, educating children and parents on the following infection control measures may reduce the spread of disease:

• Children should cover their mouth with a disposable tissue when they cough or cough into their bent arm rather than their hands.
• A tissue should be used only once and then immediately thrown away.
• Children should not be allowed to share toys they have put in their mouths.
• After a child has discarded a toy that was in their mouth, it should be placed in a bin for dirty toys that are out of the reach of others. Wash and disinfect these toys before allowing children to play with them again.
• Make sure all children and adults follow good handwashing practices. Have pump hand sanitizers available throughout the office.

Professional behaviors

Working as a medical assistant in a busy pediatric practice can be very challenging. In essence, you are faced with two clients: a child who may be frightened and not feeling well and a caregiver who typically is stressed. When you are dealing with emotionally charged situations, it is easy to lose patience and act out yourself. Continuing to act professionally can help you manage these difficult situations. Consider the following suggestions:

• Routinely use active listening to get as much information as possible from the parents. Paying attention not only to the parents’ words but also to their feelings helps the parents feel valued.
• Focus on age-appropriate methods for communicating with the child. Interacting with children on a level they can understand helps them feel more comfortable and hopefully promotes cooperative behavior.
• Use time management techniques to handle the work challenges you face each day. Staying organized keeps you from feeling overwhelmed.