Lesson 14 — Pediatrics Assisting
All procedural steps, PURPOSE rationales, and topic content below are verbatim from MedCerts HLT420A Storyline modules. Quiz items have been normalized to multiple-choice format with verbatim source rationales. Reference textbook: Niedzwiecki & Pepper, Kinn's The Clinical Medical Assistant, 15th ed., Chapter 29. No outside material added.
- Discuss growth and development of the pediatric patient
- Define colic and failure to thrive
- Classify common pediatric respiratory, infectious, and inherited disorders
- Explain the schedule of immunizations, administration, and documentation
- Demonstrate pediatric assessment and measurement of pulse, respiration, and blood pressure
- Classify normal and abnormal findings with measurement of pediatric vital signs
- Summarize the medical assistant's responsibilities with the pediatric examination
Document Immunizations
Goal: To document accurately the administration of a pediatric immunization.
- Patient's record
- Vaccine administration record (VAR)
- Parent's immunization booklet (if used in the medical practice)
- Vaccine Information Sheet (VIS) for hepatitis B
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Gather the necessary forms.
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Make sure the provider obtained informed consent from the parent, that the hepatitis B VIS form was given, and that all the parent's questions were answered before the vaccine is dispensed and administered.Purpose
To follow risk management practices.
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After dispensing the vaccine dose and before administering it, complete the information required on the VAR, including the name of the vaccine, the date given, the route of administration and site, the vaccine lot number and manufacturer, the date on the VIS form, the date it was given to the parent, and your signature or initials.Purpose
To meet the legal requirements of the National Childhood Vaccine Injury Act.
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Administer the vaccine intramuscularly.
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In the parent's immunization booklet, record the date of administration, the name and address of the physician's practice, and the type of vaccine administered.Purpose
To maintain an accurate and comprehensive parental record of childhood immunizations for school and/or day care purposes.
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After administering the HBV vaccine, record the following details in the child's health record: Date the vaccine was administered, Vaccine's manufacturer, batch and lot numbers, and expiration date, Type of vaccine administered and dose, Route of administration and exact site if an injection was given, Any reported or observed side effects, Publication date of the VIS form given to the parent (on the bottom of the form), Parent education about possible side effects of the vaccine, Name and title of the person who administered the vaccine.
Pediatric Growth Charts
Goal: To obtain accurate measurements of an infant's head circumference, length, and weight and plot the results on the patient's growth chart.
- Patient's record with appropriate growth chart
- Flexible disposable tape measure
- Age- and gender-specific growth chart
- Pen
- Infant scale with paper cover
- Examination table paper
- Pediatric length board (if available)
- Gender-specific infant growth chart
- Biohazard waste container
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Sanitize your hands.Purpose
To ensure infection control.
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Identify the patient by name and date of birth. If he or she is old enough, gain the child's cooperation through conversation.Purpose
To alleviate anxiety and gain the child's trust.
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Place an infant in the supine position, or the infant may be held by the parent. An older child may sit on the examination table.
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Hold the tape measure with the zero mark against the infant's forehead, slightly above the eyebrows and the top of the ears. Ask the parent for assistance if necessary.
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Bring the tape measure around the head, just above the ears, until it meets.
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Read to the nearest 0.6 cm or 1/4 inch.
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Record the measurement on the growth chart and in the patient's health record.Purpose
A procedure is not done until it is recorded.
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Dispose of the tape measure.
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Sanitize your hands.Purpose
To ensure infection control.
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Sanitize your hands, identify the child by name and date of birth, assemble the necessary equipment, and explain the procedure to the infant's caregiver.
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Undress the infant. The diaper may be left on while the length is measured, but it must be removed before the infant is weighed.
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Cover the examination table with smooth, flat paper. Ask the caregiver to place the infant on his or her back on the examination table.
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If the table is a pediatric table with a headboard, ask the caregiver to hold the infant's head gently against the headboard while you straighten the infant's leg and note the location of the heel on the measurement area.
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If there is no headboard, ask the caregiver to gently hold the infant's head still while you draw a line on the paper at the back of the baby's head and at the heel after extending the leg.
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Measure the infant's length with the tape measure and record it.
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Document the results in either inches or centimeters, depending on office policy, on the infant's growth chart, in the progress notes, and in the caregiver's record if requested.
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Complete the growth chart graph by connecting the dot from the last visit.
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Sanitize your hands, identify the child by name and date of birth, assemble the necessary equipment, and explain the procedure to the infant's caregiver.
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If the scale is not a digital model, prepare the scale by sliding weights to the left; line the scale with disposable paper to reduce the risk of pathogen transmission.
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Completely undress the infant, including removing the diaper.Purpose
It is important to get the most accurate weight possible and a diaper, especially a wet one, will add to the total weight.
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Place the infant gently on the center of the scale, keeping your hand directly above the infant's trunk for safety.Purpose
To protect the infant from possible injury.
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If the scale is not a digital model, slide the weights across the scale until balance is achieved. Attempt to read the infant's weight while he or she is still.
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If the scale is not a digital model, return the weights to the far left of the scale and remove the baby. The caregiver can rediaper the baby while you discard the paper lining the scale.
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If the scale became contaminated during the procedure, follow Occupational Safety and Health Administration (OSHA) guidelines for use of gloves and disposal of contaminated waste. Disinfect the equipment according to the manufacturer's guidelines.
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Sanitize your hands.Purpose
Infection control.
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Document the results in either pounds or kilograms, depending on office policy, on the infant's growth chart, in the progress notes, and in the caregiver's record if requested.
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Complete the growth chart graph by connecting the dot from the last visit.Purpose
A procedure did not occur if it is not documented.
Apply Urinary Collection Device
Goal: To apply a pediatric urinary collection device properly.
- Patient's record
- Pediatric urine collection bag
- Labeled laboratory urinary container
- Laboratory test request form
- Antiseptic wipes
- Biohazard waste container
- Disposable examination gloves
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Assemble all needed supplies. Identify the child by name and date of birth.Purpose
To manage time efficiently.
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Sanitize your hands and put on gloves.Purpose
To ensure infection control.
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Ask the parent to remove the child's diaper, or place the child in a supine position on the examination table and remove the diaper.
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Cleanse the genitalia with antiseptic wipes. Male: Cleanse the urinary meatus in a circular motion, starting directly on the meatus and working in an outward pattern. Repeat with a clean wipe. If the child has not been circumcised, gently retract the foreskin to expose the meatus; using a fresh wipe, cleanse the area around the meatus and return the foreskin to its natural position. Cleanse the scrotum last using a fresh wipe. Female: Hold the labia open with your nondominant hand; with your dominant hand, cleanse each side of the inner labia, from the clitoris to the vaginal meatus, in a superior to inferior pattern, using a fresh wipe for each side. With a third wipe, cleanse directly down the middle over the urinary meatus. Discard all wipes in a biohazard container.Purpose
To prevent contamination of the urine specimen with surface pathogens.
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Make sure the area is dry.
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Unfold the collection device, remove the paper from the upper portion, place this portion over the mons pubis, and press it securely into place. Continue by removing the lower portion of the paper and securing this portion against the perineum. In male children the penis and scrotum should be in the opening of the collection bag. Make sure the device is attached smoothly and that you have not taped it to part of the infant's thigh.
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Rediaper the infant or, if the parent is helping, have the parent rediaper the infant at this time. The diaper will help hold the bag in place.
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If allowed, suggest that the parent give the child liquids (or nurse the infant if breast-feeding); check the bag for urine at 15-minute intervals.Purpose
Increasing intake helps increase output.
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When a noticeable amount of urine has collected in the bag, put on gloves, remove the device, cleanse the skin area where the device was attached, and rediaper the child.
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Pour the urine carefully into the laboratory urine container, and handle the sample in a routine manner.
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Dispose of all used equipment in a biohazard waste container.
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Remove your gloves, dispose of them in a biohazard container, and sanitize your hands.Purpose
Infection control.
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Document the procedure in the patient's record.Purpose
A procedure is not done until it is recorded.
Knowledge-check items
Click an answer to lock it in — you'll see the rationale below. Reset any time to re-attempt. Items originally formatted as true/false, fill-in-blank, or drag-and-drop have been normalized to multiple choice; the source format is noted in the eyebrow.
L14-01 · Document Immunizations
"After dispensing the vaccine dose and before administering it, complete the information required on the VAR, including the name of the vaccine, the date given, the route of administration and site, the vaccine lot number and manufacturer, the date on the VIS form, the date it was given to the parent, and your signature or initials."
The VAR is the specific form used to record all required vaccine details to meet legal requirements of the National Childhood Vaccine Injury Act.
"In the parent's immunization booklet, record the date of administration, the name and address of the physician's practice, and the type of vaccine administered."
The source documentation example shows 'Administered second dose of Hep B IM to left vastus lateralis per Dr. Flint's order,' establishing the correct injection site for pediatric hepatitis B vaccination.
"Make sure the provider obtained informed consent from the parent, that the hepatitis B VIS form was given, and that all the parent's questions were answered before the vaccine is dispensed and administered."
The VIS form is a required document that must be provided to parents before vaccine administration as part of informed consent and risk management practices.
L14-02 · Pediatric Growth Charts
"Place an infant in the supine position, or the infant may be held by the parent."
The supine (lying on back) position is the standard position for safely measuring an infant's head circumference and other measurements.
"If he or she is old enough, gain the child's cooperation through conversation."
Conversation is used to alleviate anxiety and gain the child's trust, making the measurement process safer and more accurate.
"Hold the tape measure with the zero mark against the infant's forehead, slightly above the eyebrows and the top of the ears."
The tape measure must be positioned at the forehead to ensure accurate and consistent measurement of head circumference.
"Record the measurement on the growth chart and in the patient's health record. PURPOSE: A procedure is not done until it is recorded."
Measurements must be documented on both the growth chart and in the health record to maintain an accurate medical record and track growth patterns over time.
"The diaper may be left on while the length is measured, but it must be removed before the infant is weighed."
The diaper can remain during length measurement for modesty and comfort, but must be removed during weighing to obtain the most accurate weight, especially if wet.
"Place the infant gently on the center of the scale, keeping your hand directly above the infant's trunk for safety. PURPOSE: To protect the infant from possible injury."
The caregiver's hand must be positioned above the infant's trunk to prevent the infant from falling or rolling off the scale during the weighing procedure.
"Document the results in either pounds or kilograms, depending on office policy, on the infant's growth chart, in the progress notes, and in the caregiver's record if requested."
Weight is recorded in either pounds (imperial) or kilograms (metric) based on the medical office's standard documentation policy.
L14-03 · Apply Urinary Collection Device
"Cleanse the genitalia with antiseptic wipes."
Antiseptic wipes are the specified cleaning agents for cleansing the genitalia prior to urine collection to prevent specimen contamination.
"If allowed, suggest that the parent give the child liquids (or nurse the infant if breast-feeding); check the bag for urine at 15-minute intervals. PURPOSE: Increasing intake helps increase output."
Increasing fluid intake encourages urine production, allowing a specimen to be collected more quickly and efficiently.
"Male: Cleanse the urinary meatus in a circular motion, starting directly on the meatus and working in an outward pattern."
The urethral meatus (opening of the urethra) must be thoroughly cleansed to prevent contamination of the urine specimen with surface pathogens.
"Dispose of all used equipment in a biohazard waste container."
All contaminated equipment used during the urinary collection procedure must be disposed of in a biohazard waste container to maintain infection control standards.