new nursing student working in ped's office

[twahls65]

i am a new nursing student working in a ped's office and i have a question hopefully someone can answer for routine pediatric/adolescent physicals is it nescessary for the child to undress to their underpants because at the office where i learning we have the child undress to their underpants and for girls have them put on a paper gown to keep them covered? i have read in books where the child does not have to undress for the physcian to do their checkup. Another question I have is especially for our female adolescents we have them take their bra off as well so the doctor could checkup their breasts for any lumps. I live in ny and the law states that a child needs to have a physical before entering the 7th and 10 grades so as part of the female physical during the time is it really necessary for the physician to check the females breasts during the 7th grade physical? i find it really unnecessary since the girls are continuing to grow and develope so i was wondering what the protocal is at other ped's offices as it pertains to a child/adolescent physicals.

[mlvnurse03]

I work in a family practice office and we do school physicals and sports physicals all the time. We have never had a child undress unless it was due to a medical problem that needed to be looked at. Never for a physical. I did speak to my doc and she says that some peds office do have kids undress for physicals but doing a breast exam on a little 7yr old girl is very bazaar. I don't think I'd feel comfortable with this.

[twahls65]

thank you for your response it is very appriciated. i think you misread my post a little at our office since i live in new york state the law states that a child needs to have a school physical before they enter the 7th & 10th grades. the physician in my office does a breast exam on females entering the 7th grade which is a 12 or 13 year old not on a 7 year old. Do other pediatricians do this at other pediatric offices? Do the parents have a problem with their daughter having a breast exam at this age or is it normal? We do give the child a gown to cover themselves with. Since i am just new to the student nurse's field i dont know if this was appropriate or not? I know for boys that the physician checks the boys testicles just did not know if a breast exam was proper at this age. I thank you for your response and hope to learn more as i continue learning. If other people can help it would be appriciated.

[twahls65]

bumping up to get some more responses, please help me with these questions. I cant get a straight answer from the office where i work, so i am asking for help on here so if anybody could help me out it would be appriciated.

[Little Panda RN, ASN, RN]

I have never heard of a physcian doing a breast exam on a 12 -13 yo. This seems really out of line to me. I worked family practice for years and this is not the norm. I also have worked in mammography and we were taught that a self breast exam is not indicated at the age since the breast tissue is very dense at this age, you more than likely would not be able to find an abnormality upon exam. Even a mammogram at this age is not recommended. If something is suspected an ultrasound would be the exam of choice.

I hope you get your answers!

[twahls65]

bumping up this post to hopefully get more responses. I thank you to those that have all ready commented and i appriciate it very much. I am still looking for more peoples opinion and experience since i am a new nursing student.

[Nurserton]

Well, from a personal perspective, I had a friend who had a lump in her breast at 13. It turned out to be a fibroid, but if no one would've inspected her, who knows if it would have been detected, and it could've been something worse. 12-13 years are pubescent and will usually have at least some breast tissue. Even though it's rare to find anything, you never know. Better safe than sorry.