Caring for the Healthy Child
Your schedule is booked for the morning but the first visit looks easy peasy – a three year old Well Child Check (WCC). What can be easier than seeing a healthy kid?
When I first started in Pediatrics, I did almost exclusively WCCs. The idea was to become accustomed to healthy children, and then I could more readily recognize pathology. What I soon learned was that a quality WCC was not easy and can actually be some of your most complex encounters. You have to cover everything from head to toe – from eating to growing to social concerns, and you have to address and educate on any problems you find.
If the child has chronic health issues like asthma or diabetes, those are on the table too, with any accompanying school forms or notes to the school nurse for good continuity of care.
But soon Well Child Checks (WCCs) were my favorite visits. Wellness visits really allow you to connect with patients and their families.
Tips for a stellar WCC
- Make (or borrow) a good Template
- Be familiar with your state requirements
- Know your healthy development
- Pick your battles
- Don’t tackle everything
- Be an authority of vaccination
- Give parents tools
- Make (or borrow) a good Template
Normal child development is a fairly complex topic. “Is this normal?” “Is this okay?” are questions you will constantly need to address. A good WCC template will have the questions you should ask and hints to help you along for seamless documentation.
A word of caution – try not to just stare at the computer! Be sure to address your patient and look the parent in the eye when they are talking. WHen you turn to type, use a lot of Mmmhmmms and back checking;
2. Be familiar with your state requirements
If you accept Medicaid (and even if you don’t), you’ll want to be aware of state requirements. Texas has a pretty comprehensive guide here. You’ll want to know when you need to check blood work and what you are looking for. It’s also a good idea to look ahead and give parents and kids a heads up about what to expect with the next visit.
3. Know your healthy development
Anxiety is the name of the game for new parents. You are a source of authority and need to be well-versed in healthy development, variations, and when to refer.
4. Pick your battles
There might some things you do not agree are good choices for the health of your patient. Maybe you get the sense the parent is over-managing behavior with screen-time. Maybe the child is heading toward serious obesity. Maybe the parents are anti-vaccine or think car seat laws and helmet laws are over-reach.
Don’t tackle everything
It can get overwhelming for you, the child, and the parent if you tackle everything. Move through the systems but if there are multiple red flags or concerns (body weight, mood issues, behavior problems), start tabling items and planning for follow-up visits.
Be an authority of vaccination
Vaccination saves lives. One of my favorite nuggest of research is that views on vaccination can change over time. Keep recommending. Keep talkijng about it.
5. Give parents tools
I am the queen of handouts. I really like to give parents concrete tools to try to implement.
Healthy Eating
This, this, and this are good resources. Otra en espanol
Iron Rich Foods
This, this, and this are good resources
Screen Time
Medication Dosing
Musculoskeletal Exercises
Ages and Stages – I love this system but you need a subscription.
I also think it is important to know the local school district where you work. I would keep the Sports Physical forms for the local districts on my laptop, along with their specific Asthma Action Plans and school medication forms. If there is a school that many of your patients attend, send the school nurse an email and say hello.
Welcome to Mom, PA-C!
Welcome to Mom, PA-C – a space for moms, PAs, moms who want to be PAs, PAs who want to be moms, and moms who are rocking the PA gig and vice versa. I was inspired to create this site
What is a PA?
A PA is a Physician Assistant Here can learn more about PA here.
How do I go to become a PA?
How do I balance being an awesome PA and being an awesome mom?
That’s what we are here to discuss!
Anatomy Lab
My last day of Anatomy Lab was one the of the happiest days of my life. Truly. It’s up there with the birth of each of my children. When I heard that metal door slam behind me in that nondescript building on the street corner across from the main building where I took all my classes, I was awash in a sensation freedom I cannot adequately explain. I think I cried.
Anatomy lab was one of the most challenging parts of PA school for me and I think I still have a little PTSD from it. Looking back, I think I was just massively unprepared for the time and study that was going to be required for the class. When I entered PA school I had three small children, including an infant, was still breastfeeding, and was living– miles away.
Some people in my class had cadaver lab in undergraduate, and some had subsequently been TAs in those classes. So there were people in my class working on their third or fourth dissection. In my community college A&P class, we spent a few weeks dissecting a cat.
My dear friend wrote a beautiful article about Anatomy Lab.
Obviously A&P is essential to understanding medicine. I keep an anatomy book on my work bookshelf to this day.
How to Survive Anatomy Lab
1.Put in the time
You need time to navigate the bosy
2.Gather your Resources
You need some quality resources for anatomy. Again, the primary resources are your professors, lectures and notes. Don’t go broke buying a million things.
University of Michigan Medical School (google.com)
2.Study, Memorize, Repeat
Anatomy moves along systematically. Look over the basic information before you attend class. Try to stay engaged in class. Review that night.
3.Find Your People
Being alone in the anatomy lab is a little unsettling…but sometimes unavoidable. Better is to try to make a regular study date with some classmates. You do not have to study with your lab group, but you always can. I know some poeple but definitely try to spend a little time in the lab the week before a practical exam.
4.Make Connections
The best thing I did in anatomy lab was hire a tutor. There was a medical student at my school that even the professors referred to as “The King of Anatomy.” He was brilliant and funny and approachable, and had a wealth of resources at his fingertips.
5.Get In the Right Headspace
Anatomy lab will end. Don’t let it break you. Y
Continuing Medical Education
Physician Assistants are required by to log . State requirements vary but in Texas,
Many employers offer some CME reimbursement but if you use youralowance for licesnsure, professional memberships etc., you may find quickly that conferences with hotel stays, plane tickets and meals out but stretch your budget to thin. Plus there’s the added burden on the family of being away and having to arrange fro child care, reschedule afterschool activities, etc. Luckily there are some great options for the busy Mom PA-C
This little gem is the best CME deal I have found (besides Up to Date – see below). I’m a bit old school so I still get the print magazine, which surprisingly isn’t that much more than digital access. Every two weeks the great folks at AFP send you a thin magazine packed with practical articles. Your subscription comes with 24 annual issues and the ability to earn 130 CME credits. Every time I get one, I think, “Wow, I just had a patient with this issue this week.” It’s a little magical that way. As a APP you are eligible for “Allied Health Professional” rate about $100 than the cost for physicians. Subscription rates and details are here.
Say what? Earn CME for looking stuff up on the job? If you have a personal account for UptoDate that is exactly what you get!
I adore HIPPO. Back in PA school we negotiated a group discount for PANCE Board review. I would even use it in school to help understand a tough topic. There are a ton of options
Pri Med Conferences
Pri Med
Rosh Review
Diane Wagner
