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Date Posted: 07:28:00 02/03/14 Mon
Author: Knut Holt
Subject: Secret trends in medical examination of children

Modern Trends in Well-child and Well-teen Assessments - as They Manifest in Certain Areas in th World
By Knut Holt
http://www.abicana.com

A yearly well-child health assessment is standard in many societies. This assessment includes typically an assessment of general bodily development. In addition there is often a genital and a rectal check that may be more or less thorrough depending on the age of the child and depending on the standard in the particular society. In many societies this check is totally omitted, or it constitutes only of outer palpation with fingers, retraction of foreskin for boys, spreading of labia for girls and spreading or the buttocks for both sexes.

There is however a growing tendency in many societies to call in children at specific age levels for a more thorrough development and intimate exam in addition to the ordinary well-child physical. This thorrough assessment is typically performed in a health center or in a hospital, and takes typically 2-4 hours.

The elected age levels for this type of exam tend to be 6-7, 11-12 and 15-16. The following is a survey of the types of specific exams that probably will be included in this special exam session within few years in many societies around the world.

In some societies the procedures decribed are allready semi-standard, performed at so wide indications that around 30% of all kids go through it, most typically at the age 11-12, and they seem to be repidly developing into standard exam protocol for all kids.

The following information is based on extensive polls made about the exam types people in various countries experience at specific age levels, and on facts regarding the technological development in examination equipment. The details specified are only meant as a documentation of an ongoing development. They are not meant as some kind of advice about what type of exams children should go through, or as any judgement weather this development is good or bad.

At no place are absolutely all of the procedures listed in the following done. Any place that perform such extensive ordeals on children will choose some of these procedures, but which of them that each site selects, seems to be somewhat arbitrary.


EXAM INITIATION

In some societies the parents will be instructed not to give the child food after some time the day before and to give the child some laxative agent to make his stomach empty.

This special exam is likely to start with an structured interview with both the parent and the child, and with cognitive tests. During this part the child will be fully clothed, but in a light way, so that the staff can assess bodily reactions to posed questions. At the end of this preliminary part the child will be clothed down to underwear.

The exam is likely to proceeed with anthropomorphic measurements with an assessment of the growth patern. This stage will include measurement of weight, height, leg length, and circumferance of all body parts. There will also be measurement of subdermal fat thickness. After this part the chilld is likely clothed down to only briefs around the genitals.

Then there will be assessment of body functions like gait, active flection, ballance, coordination of limb movements and muscular strength. Now there will also be a neurological assessment where the sensitivity in all body parts will be assessed by gentle stimulations. The neurological assesment will end by the lower underwear taken off so that the child is totally naked and the sensitivity of the outer pelvic areas tested. The child will remain without ordinary clothes for the next stages of the examination, but will be offered a gown or carpet to warm and shield when total nakedness is not necessary.

ORTHOPEDIC EXAM

This stage to come now will be a thorrough orthopedic examination, where the shape, flexibility, function and development status of all muscles, joints and bones in the body will be assessed, including the whole pelvic area and the muscles in the pelvic floor. This examination wil include:

-A check of spine curvature to diagnose scoliosis or other deformities, performed with the child in standing and foreward bent posisions.

-Checking of flexibility in the schoulders, armes, spine and hip with the child in standing and sitting posision.

-Assessment of leg and hip joint flexibility with the child laying, performed by probing all possible modes of bending and twisting of the legs.

- A general inspection of the pelvic structure with the legs bent up and spread, including assessment of the alignment of the rectal opening, symmetry of the buttocks, and symmetry of the outer genital structures.

-Ultrasound examination of the major joints in the body, especially the hip joints, knees and shoulder joints.

-Additional ultrasound check of body areas where the forgoing examinations have revealed symptoms of possible problems.


ANESTHESIA

In many societies the child will be given some degree of anesthesia for the rest of the exam, most likely only some calming medication through the mouth or light sedation through an intervenous catheter, or with gas through a mask. The intention of the anesthesia is to make the child calm and relaxed, and to hinder the child from remembering much of the more intimate parts that follow.


ASDOMINAL EXAM

After the orthopedic examination there one will perform an outer abdominal assessment whith the following procedure

. Manual palpation and percussion all over the abdominal and renal region with the child laying on the back and laying at the sides with the legs flexed, to assess the shape of the abdominal organs, detect any tissue changes, painful points, muscular tension, masses, fluid accumulation and abnormal accumulation of intestinal content.

- Ultrasound examination of the abdomen with special attention at the bladder and the renal area.


GENITAL AND URINARY EXAM

Then there will be a more specific genital assessment with the child laying on the back with the legs flexed up and separeted. The exact posision will vary according to the development stage of the child. For girls this will include:

- Manual palpation of the outer genital area

- Separation of the labia to inspect the inner area of the genitals.

-.Taking specimens form the outer urethra and vagina to analyse secretions and microbeal content.

- Inspection of the vagina with an optical scope.

- For girls in puberty vaginal ultrasound exam.

For boys the genital exam will include

- Manual palpation of the penis, scrotum, testicles and the area down to the anus.

- Retraction of foreskin and spreading uretral opening for inspection.

- Taking specimens form the outer urethra to analyse secretions and microbeal content.

- Taking specimen of prostate fluid with a tube inserted into the urethra, and if necessary with a massage of the prostate with a finger inserted through the anus.

- Palpation of the prostate with a finger inserted through the anus.

- Ultrasound exam of the scrotum, testicles and the area down to the anus.


The child will then undergo cystoscopy where one inspects visually the inside of the urethra and the bladder, and possibly also takes small specimens from the inside walls. For boys there will be a thorrough inspection of the prostate area during this examination. Traditionally cystoscopy has been a difficult examination to undertake, but modern flexible instruments ha made it to an easy and very quick examination. Therefore this type of exam that sounds very intrusive is very likely to be included. During this exam the bladder will be filled with fluid and in that shape also assessed with an outer ultrasound sond.


EXAM OF THE RECTUM AND COLON

The physical assessment concludes with the rectal inspection, which will include

- Examination of the anus and interior room with an inserted finger

- Opening of the anus with a speculum for visual inspection and taking specimens.

- Taking specimen from the rectum with an inserted instrument while the speculum is in place

- Flushing the rectum and lower colon clean out content with by means of an inserted tube.

- Internal ultrasound exam to visualize the organs around in the posterior pelvic zone.

- Inspection of the deeper parts of rectum and terminal colon with a flexible optical scope

The instruments used in most of these examinations will take pictures and measurements that are transfered to a computer, stored there and later taken forth for further inspection and diagnosis.

By Knut Holt

http://www.abicana.com

---------------------------------------------------------------------------------------------------------------

Development Assessment and Pelvic Inspection as Standard Well-child Procedures - Documentation of an Ongoing Development





A yearly well-child health assessment is standard in many societies. This assessment includes typically an assessment of general bodily development. In addition there is often a genital and a rectal check that may be more or less thorrough depending on the age of the child and depending on the standard in the particular society. In many societies this check is totally omitted, or it constitutes only of outer palpation with fingers, retraction of foreskin for boys, spreading of labia for girls and spreading or the buttocks for both sexes.



There is however a growing tendency in many societies to call in children at specific age levels for a more thorrough development and intimate exam in addition to the ordinary well-child physical. This thorrough assessment is typically performed in a health center or in a hospital, and takes typically 2-4 hours.



The elected age levels for this type of exam tend to be 6-7, 11-12 and 15-16. The following is a survey of the types of specific exams that probably will be included in this special exam session within few years in many societies around the world.



In some societies the procedures decribed are allready semi-standard, performed at so wide indications that around 30% of all kids go through it, most typically at the age 11-12, and they seem to be repidly developing into standard exam protocol for all kids.



The following information is based on extensive polls made about the exam types people in various countries experience at specific age levels, and on facts regarding the technological development in examination equipment. The details specified are only meant as a documentation of an ongoing development. They are not meant as some kind of advice about what type of exams children should go through, or as any judgement weather this development is good or bad.



At no place are absolutely all of the procedures listed in the following done. Any place that perform such extensive ordeals on children will choose some of these procedures, but which of them that each site selects, seems to be somewhat arbitrary.





EXAM INITIATION



In some societies the parents will be instructed not to give the child food after some time the day before and to give the child some laxative agent to make his stomach empty.



This special exam is likely to start with an structured interview with both the parent and the child, and with cognitive tests. During this part the child will be fully clothed, but in a light way, so that the staff can assess bodily reactions to posed questions. At the end of this preliminary part the child will be clothed down to underwear.



The exam is likely to proceeed with anthropomorphic measurements with an assessment of the growth patern. This stage will include measurement of weight, height, leg length, and circumferance of all body parts. There will also be measurement of subdermal fat thickness. After this part the chilld is likely clothed down to only briefs around the genitals.



Then there will be assessment of body functions like gait, active flection, ballance, coordination of limb movements and muscular strength. Now there will also be a neurological assessment where the sensitivity in all body parts will be assessed by gentle stimulations. The neurological assesment will end by the lower underwear taken off so that the child is totally naked and the sensitivity of the outer pelvic areas tested. The child will remain without ordinary clothes for the next stages of the examination, but will be offered a gown or carpet to warm and shield when total nakedness is not necessary.





ORTHOPEDIC EXAM



This stage to come now will be a thorrough orthopedic examination, where the shape, flexibility, function and development status of all muscles, joints and bones in the body will be assessed, including the whole pelvic area and the muscles in the pelvic floor. This examination wil include:



-A check of spine curvature to diagnose scoliosis or other deformities, performed with the child in standing and foreward bent posisions.



-Checking of flexibility in the schoulders, armes, spine and hip with the child in standing and sitting posision.



-Assessment of leg and hip joint flexibility with the child laying, performed by probing all possible modes of bending and twisting of the legs.



- A general inspection of the pelvic structure with the legs bent up and spread, including assessment of the alignment of the rectal opening, symmetry of the buttocks, and symmetry of the outer genital structures.



-Ultrasound examination of the major joints in the body, especially the hip joints, knees and shoulder joints.



-Additional ultrasound check of body areas where the forgoing examinations have revealed symptoms of possible problems.





ANESTHESIA



In many societies the child will be given some degree of anesthesia for the rest of the exam, most likely only some calming medication through the mouth or light sedation through an intervenous catheter, or with gas through a mask. The intention of the anesthesia is to make the child calm and relaxed, and to hinder the child from remembering much of the more intimate parts that follow.





ASDOMINAL EXAM



After the orthopedic examination there one will perform an outer abdominal assessment whith the following procedure



. Manual palpation and percussion all over the abdominal and renal region with the child laying on the back and laying at the sides with the legs flexed, to assess the shape of the abdominal organs, detect any tissue changes, painful points, muscular tension, masses, fluid accumulation and abnormal accumulation of intestinal content.



- Ultrasound examination of the abdomen with special attention at the bladder and the renal area.





GENITAL AND URINARY EXAM



Then there will be a more specific genital assessment with the child laying on the back with the legs flexed up and separeted. The exact posision will vary according to the development stage of the child. For girls this will include:



- Manual palpation of the outer genital area



- Separation of the labia to inspect the inner area of the genitals.



-.Taking specimens form the outer urethra and vagina to analyse secretions and microbeal content.



- Inspection of the vagina with an optical scope.



- For girls in puberty vaginal ultrasound exam.



For boys the genital exam will include



- Manual palpation of the penis, scrotum, testicles and the area down to the anus.



- Retraction of foreskin and spreading uretral opening for inspection.



- Taking specimens form the outer urethra to analyse secretions and microbeal content.



- Taking specimen of prostate fluid with a tube inserted into the urethra, and if necessary with a massage of the prostate with a finger inserted through the anus.



- Palpation of the prostate with a finger inserted through the anus.



- Ultrasound exam of the scrotum, testicles and the area down to the anus.




The child will then undergo cystoscopy where one inspects visually the inside of the urethra and the bladder, and possibly also takes small specimens from the inside walls. For boys there will be a thorrough inspection of the prostate area during this examination. Traditionally cystoscopy has been a difficult examination to undertake, but modern flexible instruments ha made it to an easy and very quick examination. Therefore this type of exam that sounds very intrusive is very likely to be included. During this exam the bladder will be filled with fluid and in that shape also assessed with an outer ultrasound sond.





EXAM OF THE RECTUM AND COLON



The physical assessment concludes with the rectal inspection and inspection of parts of the colon, which will include:



- Examination of the anus and interior room with an inserted finger



- Opening of the anus with a speculum for visual inspection and taking specimens.



- Taking specimen from the rectum with an inserted instrument while the speculum is in place



- Flushing the rectum and lower colon clean out content with by means of an inserted tube.



- Internal ultrasound exam to visualize the organs around in the posterior pelvic zone.



- Inspection of the deeper parts of rectum and terminal colon with a flexible optical scope



The instruments used in most of these examinations will take pictures and measurements that are transfered to a computer, stored there and later taken forth for further inspection and diagnosis.



By Knut Holt

http://www.abicana.com

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