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Date Posted: 04:28:39 01/30/17 Mon
Author: Knut Holt
Subject: Modern abusive trends in well-child and well-teen health assessment

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 body 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. Some avatguardistic societies even seem to hospiralize the child for a couple of days or have a hospital department within schools where the children stay for a coiple of days for this type of examination.

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 those type of exams that tend to be included in these special exam sessions.

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.

PREPARATIONS BEFORE THE EXAM

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.

In societies that arrange tha most thorrough version of these development exams, one or two nurses from the community might visit the child AND hisher family the day before the exam. They will speak with the parents and the child to prepare them all for the examination the next day.They will also take all the needed vitals of the child. They will then let the child take off all clothes and let himher go to bed. Then they will perform a simple orthopedic examination and a manual inspection of the genital and rectal zones.After that tehy will take specimens of secretions and microbial speciments from all the body openings of the child with sonds or suction pumps inseried at some dept into the nose, throut urinary opening, vagina and rectal opening.

After that the child will typically be asked to stay in bed, the rest of the day and until next morning. Before leaving the nurses will catheterize the child and fix electrodes and sonds at various points in hisher body. The electrodes will be connected to a small recording device that the child will wear on a belt around hisher wait or similar. The purpose of these arrangements is to monitor the vital values of the child throughout the nigh an next morning.

The purpose of this preliminary and intitial exam, is also to plan better the more thorrough exam the day after, and assess the reaction of the child and the parents upon intimate handlings of the kind. The purpose is also to prepare the child for the type of exam that will occur the day after and to make the child accept what shall happen and cooperate.

The child will then be fetched to the exam center in some kind of ambulance.

EXAM INITIATION

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 or given a gown or some light exam clothes that are easy to open or remove.

The exam is likely to proceeed with anthropomorphic measurements with an assessment of the growth patern. This stage will include measurement of weight, height, limb 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 stimulation and assessment of reactions by such neurological exams are traditionally done by manually touching with pointed objects. But there is a growing tendency to use electronically stimulating sonds combined with electrodes connected to a computer device to assess reactions

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.

EXAMINATION THROUGH THE NAVEL

In the original post, I told that endoscopic exams through the urinary opening, the anus and the vagina i steadily more often performed on children and teens. In certain areas this is so often done at the age of 6-8 and 11-14, that it constitutes a semi-standard procedure that a selected and great persentage of children will go through.

In the reacent time I have got several indications that another new examination mode in the lover body of children often is done in addition to, or instead of these endoscopic procedures.

This new mode consists of making a small perforation in the botton of the navel, incerting a thin flexible endosocpe and inspecting the inside of the belly with this. It is most often done under anesthesia or one takes the opportunity to do the exam when the child is under anesthesia for other reasons, like dental work or tonsillectomies.

In either case, the technological development has now got so far that such an exam can be done with little discomfort and risk, even when only local anesthesia is used, although one prefere the child to be sleeping.

Ths child will often wake up with some plaster on his belly bottom after dental procedure or the like and wonder what has been going on.

Sometimes one also takes tissue samples during this exam, or even takes out the apendix.

SOME HISTORICAL ACCOUNTS

The type of exam program described here, is nothing new. It has been attempted from time to time in various soiceties arpund the world at least from the end of the second world war. In most of these societies, a certain persentage of children seem to have been chosen for the program, typically 10%.

By Knut Holt

http://www.abicana.com

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