The pediatrics rotation in PA School is an important rotation that allows you to learn many things that you may have not learned in other rotations. Since most of the rotations are with adult patients, pediatrics may be your first experience with younger patients.
Pediatric rotation experiences can really vary as well, since pediatric rotations are harder to come by for PA schools. Some people end up more in an outpatient pediatric setting, while others have more of a pediatric ER rotation. It really depends on your school and your geographic location.
Some people really look forward to the pediatrics rotation while others dread it. Whichever group you fall into (or if you’re in between), there is a lot to learn that you can take with you no matter what specialty you plan on working in as a PA.
Please note, this is just my personal experience and all opinions and recommendations on this blog are my own. My opinions and recommendations do not reflect the opinions or recommendations of my employers or schools. Nothing in this article is intended as medical advice. I share all this information to share information I wish I would have known prior to my experiences. Everything on the blog is just my opinion and experiences.
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My Pediatrics Clinical Rotation Experience
For my pediatrics rotation, I was at a private practice in a small town. The practice had a few physicians and I followed the same doctor throughout my rotation. I personally loved my experience in pediatrics and learned so many useful things. The doctor I followed had many years of experience, so they had a ton of tricks and tips that aren’t taught in school that I can use to help patients of any age.
Prior to the rotation I was nervous about pediatrics with tiny kids and a whole different range of treatments than adults, however I ended up loving it. Even though I don’t necessarily plan on working in pediatrics only, you will still see kids in most specialties you go into, so learn as much from peds as you possibly can.
Things to Review Before Your Pediatrics Rotation
*** As with all rotations, there will be many more things you need to learn and study, however studying these prior to rotation will give you a head start from day one of the rotation as these are all things you will likely encounter a lot.
- Antibiotics for kids (and ones that kids cannot take)
- Medications that are contraindicated in kids
- Physical exam differences between the different ages
- CDC vaccination schedule
- Concussion criteria
- Ottawa Ankle Criteria
- Common Orthopedic conditions in kids (nursemaid’s elbow, slipped capital femoral epiphysis, Osgood-Schlatter’s, etc)
- Vomiting causes (when it is normal, viral syndromes, pyloric stenosis, and allergy)
- Allergies (anaphylaxis, hives, angioedema)
- RASHES (measles, rubella, mono, meningitis, varicella, etc. There are so many rashes in peds.)
Tips for while on your pediatrics rotation
Practice your physical exam
The physical exam on children is different than the physical exam of adults. Even the physical exam for kids at different ages differs so knowing what to look for in each age is really important. In infants, you are often looking at various reflexes (or lack thereof). Knowing what reflexes to test and how to test them is important.
It is also important to check for physical abnormalities and certain signs as children grow so that any abnormalities can be corrected early. One exam of this is the Barlow and Ortolani tests which check for congenital hip dislocation in young infants. If found and corrected early, the child will have little to no problems when they reach full development. The Barlow test checks for dislocation of the hip while the Ortolani test checks for reduction of the hip after dislocation. There are many other tests to do, but this is one example of part of the physical exam that is only done at a certain age and never in adults.
Also, the physical exam on children can be more difficult due to different factors. Looking in the ears of a one-year-old is much different than looking in the ears of adults. Learning and practicing different techniques to help you safely conduct a physical exam while also making sure the child is comfortable. The pediatrician I was with would often distract children with animal noises while looking in their ears which made them feel that the exam was fun rather than uncomfortable.
Learn the milestones
Developmental milestones are really important in assessing if a child if a child is growing and developing as they should. By each age landmark, kids should be progressing to certain social and physical capabilities. If the child is not progressing as expected, it could be indicative of a deeper issue that can be addressed early on in the child’s life. Early intervention is essential to minimizing lifetime effects, so milestones should always be assessed.
It is also good to know the milestones well because many parents are concerned that their child is acting strange or different than they should, when it often is just a normal part of development. Knowing the milestones will help you to be able to reassure parents that their child is developing as expected and that there is nothing to worry about in terms of development at this current point.
Patient (and parent) counseling is important
While in other areas of medicine patients are pursing care due to a pathology or illness, children are often seeking their pediatrician for well-child check-ups and may not have a major sickness. Since children can often be healthy when seeking care and are rapidly growing, there are other things that you will be discussing with the parents such as health counseling. This can be regarding when to start solid foods, preventing allergies, what age they should change car seats, and how to stay healthy while they’re growing and interacting with other children.
There is a lot of health counseling in pediatrics and many pediatricians have different things they like to address counseling to the parents. Watching and learning from the pediatrician you follow can be valuable in helping you become better at counseling parents.
Medicine in general definitely requires a lot of patience, but patience is especially needed in pediatrics. Kids often don’t understand or want to be at your clinic, so there can be a lot of crying and screaming. I think that many kids associate getting medical care with getting shots, so naturally they don’t like being in the office.
Kids also have a lot of energy and are talking or crying or yelling while you’re trying to talk to the parent. The physical exam can be difficult and sick kids are never happy. All of these things combined can make providing care to kids more difficult. Have patience, try to make the visit as fun as possible for the kid, even if it takes a little longer. Having patience in pediatrics will make both your patients and their parents happier.
Things to have in your pocket while on your pediatrics rotation
- Stethoscope – As with all rotations, having your stethoscope is really important. No matter how focused the exam, you should always listen to the heart. Listening for murmurs is important in children as it can allow for earlier intervention in the case that there is a heart issue. I’ve linked to the one I have which is the Littman Cardiology IV. I have tried multiple other stethoscopes before, but this one has been my favorite.
- Pen light – Having a pen light is important. I found myself doing a lot more in depth EENT exams in children (versus adult patients) due to frequent sore throats and upper respiratory infections.
- Pens – Any pen will do, but I recommend a pen that is unique if you don’t want to lose it (aka someone taking it). I used the same 2 pens (black and red) for almost all of my rotations, just because they looked a little different and for this no one accidentally took them. Regardless, it is good to have more than one with you in case you find yourself without one.
- Paper or notebook – Have a small notebook or folded piece of paper with you to take notes, write down questions to ask your preceptor at a later time, or to log your patient cases (if required by your school).
- Reflex hammer – Having a reflex hammer can be useful for testing reflexes. Some providers use the end of their stethoscope (in a particular way), and some pediatric offices have reflex hammers designated to each patient room. Regardless, if you have a reflex hammer from learning physical exams in your didactic year, it isn’t a bad idea to bring it to your pediatric rotation.
- Mask – This one really depends on your specific rotation and their rules. Some offices may be requiring mask use anyways, but if it is optional and you’re not usually wearing a mask, I still recommend having a mask available in your pocket in case you are asked to do a strep test or something where you will be really up close to a sick patient. I say this from experience because I once did a strep test without a mask and the kid (that tested positive for strep throat) sneezed all over my face while I got the sample.
Study Materials to Use on your Pediatrics Rotation
- Lactmed Database — Lactmed is a great (free) resource by the NIH to see the recommendations medications that infants and breastfeeding mothers can take.
- Fpnotebook.com – I love FPnotebook and didn’t find it until I was half way through clinicals. It is a free resource with conditions, symptoms, presentation, diagnosis, and treatment. It reminds me a lot of some other resources that are not free. Since it is open source (which allows it to be free), I would be careful when using it as a guideline for the actual treatment of a patient, but it is a great learning tool.
- WikEm – This is another great (and free) resource that has conditions, presentation, diagnosis, and treatment pertaining to more emergent conditions and emergency scenarios. I know that some pediatric rotations include the pediatric ER, so this would be a useful resource for that.
- Rosh Review – Rosh questions were so helpful in preparing for the end-of-rotation exam and for evaluating what I needed to study better.
- First Line Guide – The review book that I used for every rotation and PANCE prep. There isn’t a ton on specific treatments for children, but it is great for reviewing various conditions. This book is great for studying rashes because there are pictures of every rash when it describes the rash.
- Epocrates – There is a free version and paid version. In school I used the free version and liked it. You can see all information about every medication on the market, including dosing and indications. It is especially useful to look up if the medication is safe for children as well as the specific dosing for children.
- MDCalc — MDCalc is a great resource to have on your phone that has different guidelines and make calculating different scores very easy.
- Some podcasts for Peds: Pediatric Emergency Playbook, The Cribsiders, AAPA Rotation Crash Course, Physician Assistant in a Flash (14 parts, all around 15 min each with questions for practice)
Other Rotation Guides You May Be Interested In
This is about all that I have about pediatric rotations in PA school! Please let me know if you have any questions in the comments below!
If you need tutoring while in PA school, I offer tutoring on an online platform. Feel free to contact me on the tutoring platform I use if you are interested in any tutoring sessions!
Thank you for reading!