Pediatric emergency medicine trisk 4224 4224

CLINICAL PEARLS AND PITFALLS
First and foremost, assure that the child is provided optimal
comfort during what can be an anxiety-provoking clinical
encounter. Efforts to gauge the child’s level of uneasiness prior to
conducting the examination will guide the approach to the
examination. If a nonoffender caregiver is available, and is able to
provide comfort and reassurance to the child, maintaining contact
with that adult during the assessment can be very beneficial.
Second, prepare all necessary equipment, supplies and specimen
and testing swabs and collection kits prior to positioning the child
for the examination. If a colposcope or some other related
equipment for visualization and photo documentation is used for
these examinations, allow the child to become acclimated with the
equipment to alleviate anxiety.
Third, utilize child life specialists or other personnel to provide
distraction techniques and additional comfort to support the child.
While the optimal examination position is a supine frog-leg position
using stirrups on an examination table, for the younger child,
positioning the child on the lap of a trusted caregiver facilitates
cooperation with the examination. Examination and photo
documentation may be enhanced by placing a towel roll under the
child’s sacral region to allow for best visualization while in the
supine and frog-leg position.
Finally, a head-to-toe examination is conducted to look for signs of
physical abuse or neglect. Given the importance of the child’s
cooperation to adequately visualize all of the genital structures,
avoidance of any potentially noxious examination experiences (i.e.,
otoscopic examination) should be considered. When obtaining
specimens for testing and/or evidence collection, avoidance of any
direct contact of the hymenal tissue reduces discomfort in the
prepubertal patient.

The Children’s Hospital of Philadelphia Clinical Pathway