question about pediatric physicals

[twahls65]

I am a new nurse working in a pediatric office and got a few questions I hope you all can answer for me. I have noticed when we have our patients come in for physicals, for our adolescent patients the physician wants us to tell the patient to undress to thier underpants and for the female patients to take off their bra so the physician can check their boobs for development. we provide them with a gown. Is it nescessary for the physician to check the female patients boobs at this stage of development? I know it is nescessarry for the physician to check a males genitalia for development would the physician need to check the females genitalia as well or just ask the patient about her periods making sure there are not any problems developing. I would think this would make the patients uncomfortable. I just don't know if I should talk to the physician about this since i am new to the pediatric nursing field. Any responses would be appriciated.

[NotReady4PrimeTime, RN]

Breast development (or the absence of) is an important assessment for teenaged girls. Are you familiar with the Tanner Scale? Have a look at it and it will help you understand this part of the physical. Most male pediatricians WILL draw the line at pelvic exams though, and refer girls needing them to a female colleague or a gynecologist.

[xoemmylouox, ASN, RN]

Most male pediatricians WILL draw the line at pelvic exams though, and refer girls needing them to a female colleague or a gynecologist.

All of our pediatricians male or female do breast exams for girls but refer to OBGYN for lady partsl.

[twahls65]

Thank you for your responses, let me clarify a few things i live in NY and the law states here in NY that children have to have a physical when then enter kindergarten, first grade, third grade, seventh graqde and then again in tenth grade. Our physicians in our group require that we tell all of our female patients during their seventh and tenth grade physicals to take their bra's off as well when they undress. My question is, is it really appropriate and nescessary for the girls have their breasts examined during their seventh grade physical or are the physicians going over board with the breast exams on the adolescent patient at that age? I have read about Tanner Stages and understand how that works and would along with doing a breast exam looking at the females lady partss for maturity age be nescessary or just asking the female patient about her periods and if they are regular or not is appropriate? I hope I am not going over board with this. Any suggestions and comments would be greatly appriciated.

[twahls65]

bumping up for more responses hopefully

[ECUPirateRN]

I would assume that since breast buds develop about 2 years prior to the start of menarche, it would be important for a physician to examine the breasts of a 7th grader who would be approximately 11-13 years old. If there was no evidence of breast buds, that would be a pertinent clinical finding that would need to be further investigated.