Pediatrics Examination

[Madox Valdivia]

TheCertifying Examination in General Pediatrics is given once a year in the fall at Prometric testing centers located throughout the United States, Canada, and abroad. The computer-based examination will consist of four sections with optional scheduled breaks between each section. The examination is seven hours in length; additional examination appointment time is necessary for registration.

Most Prometric testing centers in the United States and Canada have resumed testing at either full or limited occupancy. Masks must be worn for the duration of your time in the Prometric test center. All Prometric staff will wear masks, and test centers will operate with enhanced cleaning protocols. Exam candidates who are ill on the day of their scheduled exam appointment should contact the ABP and should not go to the test center. Please refer to Prometric website to determine what to expect at your testing center.

A new applicant for any initial certifying examination, is an individual who has never before applied for that specific certifying examination, or whose application was previously disapproved for that examination.

Applications for all certifying exams are available only via the American Board of Pediatrics (ABP) website. Applicants may apply during the exam-specific registration periods only. Application payments are payable only via credit card (American Express, MasterCard or Visa). If you experience a technical difficulty, you must contact the ABP the same or next business day.

Refer to your online portfolio to monitor the status of your application. You can print a receipt of payment from the online portfolio. You can also view items missing from the application (if any), acceptance letters and the results of the exam. Although reminders of missing material will be sent by email, it is your responsibility to frequently review your portfolio to ensure the required material is received by the ABP by the published deadlines and to notify the ABP of email and mailing address changes.

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Red reflex testing is an essential component of the neonatal, infant, and child physical examination. This statement, which is a revision of the previous policy statement published in 2002, describes the rationale for testing, the technique used to perform this examination, and the indications for referral to an ophthalmologist experienced in the examination of children.

This policy statement revises a previous statement on screening of preterm infants for retinopathy of prematurity (ROP) that was published in 2013. ROP is a pathologic process that occurs in immature retinal tissue and can progress to a tractional retinal detachment, which may then result in visual loss or blindness. For more than 3 decades, treatment of severe ROP that markedly decreases the incidence of this poor visual outcome has been available. However, severe, treatment-requiring ROP must be diagnosed in a timely fashion to be treated effectively. The sequential nature of ROP requires that infants who are at-risk and preterm be examined at proper times and intervals to detect the changes of ROP before they become destructive. This statement presents the attributes of an effective program to detect and treat ROP, including the timing of initial and follow-up examinations.

The document provides guidance on performing a physical examination on pediatric patients. Key points include examining the patient from head to toe, altering the order as needed for compliance, and having a parent present for young children. Vital signs like temperature, pulse, respiration and blood pressure should be measured and plotted on growth charts. The head, eyes, ears, nose, mouth, throat, heart, lungs and abdomen should all be carefully examined. Specific abnormalities to watch for in each area are outlined. The document emphasizes a thorough but gentle examination tailored to the child's age and cooperation level.Read less

The "Description of Specialty Practice" for each specialty area serves as the basis for the specialist certification exams and is a valuable aid in determining your readiness for specialist certification.

ABPTS Specialty Councils develop minimum eligibility requirements for certification and recertification in a specialty area based on ABPTS guidelines, and when required screen applicants for eligibility to sit for exams and for recertification. Specialty Council members are responsible for developing the examination instruments in consultation with the ABPTS testing agency and approved consultants.

Although some of the principles of examining children are similar to adult examination, there are important differences in both outline and detail. Children are not just small adults, and the pattern of disease, the approach to the examination and content of the examination are quite different in children.

The examination also changes as children develop and get older. Eventually it is similar to examination in adults. The following outline aims to highlight the important differences, give some general principles and provide an outline of the examination in different age groups.

Approach the child at their level; if necessary, kneel on the floor. It may be impossible to examine pyrexial, irritable children without provoking crying and they should be carefully observed before attempting closer examination.

Make the examination fun to help with their anxiety. Sometimes a toy may help, either one that the child has brought with them or something in your consulting room. Even a pen torch or an ear speculum rattling in a urine container can be a useful distraction.

Note respiratory rate and movement of the diaphragm and chest wall with quiet breathing and with stronger respiratory effort (requested from an older child, or with crying in a baby). Assess the work of breathing - is there intercostal or subcostal recession, or use of accessory muscles?

Breath sounds and additional noises can be difficult to interpret in the very young. Noises vary from fine high-pitched to low and coarse depending on the site and nature of the obstruction and the narrowness of the aperture.

Crepitations (fine crackling noises on inspiration) can occur in apparently normal babies on careful auscultation. Persistent and bilateral crepitations in a distressed toddler usually suggest bronchiolitis or, rarely, left heart failure.

Wheezing occurs when the mid-airways are narrowed, and may be bilateral in asthma or viral wheeze, or unilateral in airway obstruction - for example, by a foreign body. It is usually expiratory.

To examine the ears of a young child, it is best to sit the child sideways on the parent's lap, with one of the parent's hands holding both the child's hands and the other holding the child's head with one ear against the parent's shoulder while you examine the other one.

To view the throat of a defiant toddler, insert a tongue depressor into the gap between clamped teeth and cheek. The teeth may briefly open allowing you to deftly insert the tongue depressor. This is often best left to the end of the examination.

Enquire if there is any tenderness and if possible watch the child's face while you palpate the abdomen. If tenderness is present, and the child is systemically unwell, before palpating, ask the child to puff up their stomach ('like a balloon'). This may elicit rebound, without touching and unintentionally hurting the child.

Assess the child's hydration, particularly if there is a history of diarrhoea or vomiting. If dehydration is developing, the eyes may look dry and sunken, the lips dry and cracked, in young babies the fontanelle may be depressed and there may be reduced skin turgor.

During the consultation consider whether the child has normal development in motor functions, speech and language and social interaction. Note whether there are any specific concerns stated by the parent/s.

Examination will be outlined in different age groups. These are not intended to be exhaustive checklists but aim to highlight important aspects of the examination in these selected age groups, particularly where there are notable differences to adult examination. The emphasis and detail of any examination will be determined by the particular aims and purposes of the examination outlined above.

A distinctive feature of paediatric examination is that normal parameters change with growth and development.2 This is illustrated in the table below by the example of pulse, blood pressure and respiratory rate in different age groups.

The assessment and examination of the newborn and neonates (under 4 weeks) often require a specific and detailed series of checks, observations and measurements supplemented with detailed history from the parents. Babies are routinely checked and examined at birth and at between 6 and 8 weeks. This is covered in the separate Newborn Screening article.

The "PEDIATRIC NEUROLOGIC EXAM: A NEURODEVELOPMENTAL APPROACH" uses over 145 video demonstrations and narrative descriptions in an online tutorial. It presents the neurological examination of the pediatric patient as couched within the context of neurodevelopmental milestones for Newborns, 3 month-olds, 6 month-olds, 12 month-olds, 18 month-olds, and 2-and-a-half year-olds. Use the Table of Contents on the left to access these tutorials.

Obtaining developmental milestones is an important reflection of the maturation of the child's nervous system, and assessing development is an essential part of the pediatric neurological examination. Delay in obtaining developmental milestones and abnormal patterns of development are important indicators of underlying neurological disease.

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