question about pediatric/adolescent physicals

Specialties Pediatric

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hi everybody i work in a doctors office as a nurse and wonder if it is really necessary to have the child undress for their physical and if they do do you give them a gown to put on to cover up? i am just wondering if other pediatricians offices do this for their patients or do you have your patients keep their clothes on? what is the procedure at other pediatricians offices for when a child/adolescent comes in for their annual physical. i look forward to hearing back about this from everybody. let me just mention that i am a student nurse presently and working in a pediatricians office working with the regular nurses there. i hope this does not seem like a stupid question for everyone i am just wondering the protocol at other pediatricians offices. i hope to get some good responses back.

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Specializes in pediatric ER.

I've worked in two different pediatric offices, so I don't have a whole lot of experience with this, but the scenario was the same in each of these offices. For younger children, say younger than 12 or so, they stayed in their street clothes. Once the kids were older and starting puberty and so forth, they were changed into a gown with a sheet to cover their legs.

I know not all pediatric offices have their kids change, it just makes it a little easier in some ways for the doctor to examine the patient. I'm sure there are doctors out there that don't do this.

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thank you for your response, since i am just starting out in the nursing field i want to go into office based nursing working with children and adolescents. i got a few questions i hope other members dont mind that i ask. i hope you all dont think these are dumb or stupid questions but i want to learn as much as i can from on the job experience and from talking with other members on here. At what age do adolescent patients go into the exam room alone with the doctor? i have seen videos where nurses weigh baby's without their diaper on? do they normally do that or can the baby's keep their diapers on? at the office where i work we can keep the childs diaper on when we weigh them. Is it common practice for the pediatrician to do breast exams on female adolescent patients? or is it really not necessary at this age to do a breast exam on the patient? i hope you dont mind that i asked these questions. i look forward from learning alot from other members on here.

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Specializes in pediatric ER.

Hey! I figured I'd answer the rest of your questions.

The two offices I worked in, we weighed the babies naked, no diaper. I haven't seen weighing WITH diapers except in hospitals where we are more concerned about medication dosing than measuring weight gain.

With adolescent physicals, parents stay in the room with the patient until the doctor is ready to do breast/testicular exams. These are done on the older adolescents. I have even seen a few doctors do pelvic exams on sexually active adolescent females. If this is done by a male doctor, a female nurse or medical assistant must be present during the exam.

And STOP worrying about them being stupid questions! When you're new to a field, it's totally natural to have a lot of questions. No one would think that your curiosity because you're stupid. I LIKE it when the students I'm working with have a lot of questions, lets me know that they're thinking and not just going through the motions.

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good morning everybody i hope you all are having a good weekend so far, i still do have a few more questions i know at the office where i work when our pediatric/adolescent patients come to the office for their annual physical we ask them to bring a urine sample with them i was wondering if that was ok to do or they should give a sample right in the office just prior to their physical? should the child give a sample every year they come for their physical or just every few years? i also know at the office for our female patients who are going into 7th grade since it is mandated by new york state where i live that kids going into 7th and 10th grades are required to get physicals before school starts we ask them to undress to their underpants and have the females patients take their bra off as well because as the doctor i work for wants to get a baselinebreast exam done on them to make sure nothing is abnormal and no lumps are starting to grow in their breasts.Is this exam really neccessary at this point in the childs development or is the physician going over borard with this? the child is given a gown to cover up with after they change? since being a new nursing student i got these questions. i hope to get some responses back and if i should mention something to the physician about this. hope everybody has a good rest of their weekend and go new england lol.

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bumping up to hopefully get some responses to my last question. i am looking for some answers if anybody could help me out it would be greatly appriciated. I dont want to approch my boss with these questions, i am hoping i can get some answers from fellow nurses on here who have more experiance dealing with pediatric & adolescent patients in the office setting. I am new to the student nursung field and want to go into office based nursing in a pediatric office. if anybody could help me out it would be appricaited. thank you.

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I'm going to answer this based on my own experience. I never took off my bra at the pediatrician's office and I was seen there until the age of 18. I did go down to panties and a bra, but my mother always bought me a little robe to wear. They also gave out gowns to male and female patients as they got older and modesty set in. We were also given a sheet.

If you are saying they are left topless without a gown that should not be happening with developing girls. I agree that the topic should be addressed at once. Do the parents know this is happening?! The doc might be the most decent doc alive, but he is potentially setting himself up for trouble. It sounds off.

We get gowns at the gyn for breast exams and I would use that as my example. We aren't left bare breasted and rightfully so. My mother also never left the room nor was she asked to do so by myself or the medical staff.

I don't understand why a breast exam would be done on a 7th grader barring a mass being found. I wouldn't have one done on my 7th or 10th grader unless there was a problem. If my child was sexually active I would take them to the gyno.

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I forgot...I did have a urine sample done at my yearly physical. I think I gave it at the office before my physical.

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Specializes in Wannabe NICU/PED Nurse.

I currently am not a Nurse [yet]- but I have an 8 year old daughter and we go to the same hospital every time- sometimes they have her change into a gown other times they do not. I think it depends on what the child is being seen for. If it's just a check up for Ritalin [which my daughter is on]- then there is no need for her to change. But I had to take her to the Dr the other day- she had a rash- where it pretty much covered her whole body- so of course it made more since for her to change into a gown [which she wouldn't even wear b/c she thought it was too itchy- LOL -so she was just in her underwear... LOL]- So I think it does depend on the Dr.'s office, as well as what the child is being seen for.....

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Specializes in Wannabe NICU/PED Nurse.
good morning everybody i hope you all are having a good weekend so far, i still do have a few more questions i know at the office where i work when our pediatric/adolescent patients come to the office for their annual physical we ask them to bring a urine sample with them i was wondering if that was ok to do or they should give a sample right in the office just prior to their physical? should the child give a sample every year they come for their physical or just every few years? i also know at the office for our female patients who are going into 7th grade since it is mandated by new york state where i live that kids going into 7th and 10th grades are required to get physicals before school starts we ask them to undress to their underpants and have the females patients take their bra off as well because as the doctor i work for wants to get a baselinebreast exam done on them to make sure nothing is abnormal and no lumps are starting to grow in their breasts.Is this exam really neccessary at this point in the childs development or is the physician going over borard with this? the child is given a gown to cover up with after they change? since being a new nursing student i got these questions. i hope to get some responses back and if i should mention something to the physician about this. hope everybody has a good rest of their weekend and go new england lol.

Hey, again I am not a Nursing student yet, but I would def be questioning why patients in the 7th grade need to remove their bras:down: and have a breast exam- I don't think they should need to- and as a mom myself- would question the Dr. BEFORE I let them do that to my daughter. That's a little weird- and I don't remember having breast exams either until I had my daughter at 20.:icon_roll Like someone else mentioned unless they are sexually active [in the 7th grade- :nono:ugh!]-- but it does happen! I would think it shouldn't be done yet. Are there other Nurses or other Dr.'s where you work you could ask about this?:idea: I mean if it isn't right then YES it needs to be brought to someones attention! You shouldn't fear asking- I mean you are a student and you can ask the Dr. kind of nonchalantly- just be like since I am new to this, why do we give Breast Exams starting at this age? [And I could be wrong- maybe it is when the patient hits puberty? IDK- but I would ASK!] I hope you get some answers soon- can't wait to read what happens!;) Ohhh and just a side note about getting a Urine sample- If it were me -I would wait until the day of- just b/c some teens -as some of you may know- do get into drugs and stuff around that age- if they know they have to go in for a physical- they may get someone else to urinate in a cup for them... Just a thought though....;)

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Thank you all for your responses the reason I fear asking the physician or other better trained nurses there is I dont want them to think i am questioning them with what they are doing with their patients. Since i am just starting out in the field i like what i do i just dont want to loose my job for questioning them. Would it be appropriate for an older adolescent who is 15 or 16 and entering the 10th grade to get a breast exam? or is that still unappropriate action on the physcians part? I do know when the physician is doing physicals on older boys they do testicular exam and the physician does ask the girls about their menstral periods. I have learned this part so far. All this sounds ok to me but other people disagree i would just like to know should I fear loosing my job over asking the physician these questions. The people in the office are very nice and i dont want to loose the job i have. I hope you dont think i am going overboard with this thread. i would just like the right answers.

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I would talk to your manager about your concersn ASAP. I don't believe your job will be in jeopardy for doing so. Some of these issues should be addressed before they lead to a problem. I bet the parents don't even know their daughters are being left completely topless. I'm shocked at least one parent hasn't asked to be in the room with their young teenage daughter.

As a rule a breast exam wouldn't be done on a 10th grader from what I know. I never had one. If there is a mass or abnormality of course it should be examined. Also, if the teenager is sexually active and on birth control that would change things. That however is often done by a gyno.

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