EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE: OBSERVATIONS

Studies of the kind Dr. Anderson has reported are important because of the issues they raise—issues that only time, social change and further study will finally resolve. The issues are both direct and indirect or inferential. The direct issues apply only to young children who are receiving continuing comprehensive health care from a single medical source regardless of how the source is financed, and to the "routine" examination of such children to discover new somatic conditions in need of care. Dr. Anderson's findings challenge the rigidity of current American health supervision routines. They raise questions, not only about the extent to which other "examiners" can select (not diagnose or treat) children who require the pediatrician's special attention but also about the frequency, content and timing of such examinations, regardless of who carries them out. The indirect issues are more sensitive and more difficult to deal with. They revolve around the questions which Dr. Webb has phrased so feelingly in terms that will be understood by many pediatricians: the nature of the pediatrician's expectations and the satisfactions he derives from his work; his ability to work with and through others rather than in simple one-to-one relationship; the numbers, training, and roles of other workers associated with him; the relative importance of "routine" physical examinations as compared to other aspects of his work; the acceptability of any change in routines to his patients; and the need to "sell" services in a competitive market subject to greater consumer control. Statistical projections must always stumble over if's and but's.

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EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE: REVIEW

PEDIATRICS ◽

10.1542/peds.45.6.960 ◽

1970 ◽

Vol 45 (6) ◽

pp. 960-962

Author(s):

Clarence H. Webb

Keyword(s):

Public Health ◽

Life Review ◽

The Other ◽

First Year ◽

Considerable Part ◽

Professional Career ◽

The Road ◽

The Past ◽

Routine Physical Examination ◽

First Year Of Life

In view of the fact that this reviewer has spent a considerable part of his professional career rendering the type of service which Dr. Anderson decries as unnecessary, it is difficult to review the article without doing what the author found difficult to avoid, which is to be swayed by preconceptions. It is hoped that the author will temper his bias with the reviewer's bias to bring conclusions and recommendations out of the study which the figures justify and which are nearer the middle of the road. There are physicians in pediatrics who consider regular examination of infants and children to be desirable and productive; there are physicians who prefer that a variety of methods be used in pediatrics until it is fully demonstrated that one is superior to the other and do not wish to be forced into a "new pediatrics" unless it is demonstrably better; and, there are parents who bring their babies to pediatricians for reasons other than those mentioned, i.e., for treatment or prevention of abnormal conditions. Their babies are precious commodities and they wish to know that the babies do not have abnormalities but also want reassurance that they are caring for the babies properly, affording them attention and supervision which is not just good but is superior, and being good parents who are helping their babies in every way to develop the best of their potentials. Herein lies an innate difference between public health and private health in pediatrics which seems to have been highly desirable to pediatricians and parents in the past.

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Assessment of Thoracic Abnormalities in Premature Infants

Asian Journal of Pediatric Research ◽

10.9734/ajpr/2021/v7i430224 ◽

2021 ◽

pp. 63-69

Author(s):

Celina Elias D’souza ◽

Mandar Malawade

Keyword(s):

Premature Infants ◽

Prolonged Mechanical Ventilation ◽

First Year ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Factors Associated ◽

Physical Examinations ◽

Major Congenital Malformations ◽

First Year Of Life ◽

Shoulder Elevation

Background: There is a large incidence of congenital thoracic abnormalities that manifest as deformities and or defects of anterior chest walls. Thoracic abnormalities in preterm infants may also be associated with malpositioning in the incubator in the presence of respiratory disease and prolonged mechanical ventilation. Immaturity of respiratory and musculoskeletal system need to compromise biomechanical function of thorax. Thus, the purpose of the study is to access the thoracic alteration and the factors associated with its abnormalities in the infants born prematurely. Objective: Assess thoracic alteration in premature infants. Methods: This was an observational study with infants in first year of age, born prematurely with birth weight < 2000g. Exclusion criteria were: major congenital malformations as defined by the centers for disease contol and prevention, grade III/IV intraventricular hemorrhage or preventricular leucomalacia. Physical examinations were performed independently to assess shoulder elevation and thoracic alterations. Results: 34 infants born prematurely were included for the study according to the inclusion criteria from which 20 infants (58.8%) showed thoracic abnormalities and remaining 14 infants (41.1%) were without abnormalities. Conclusion: The prevalence of thoracic abnormalities was high in infants born prematurely, and was associated with pulmonary disease, and may also have compromised the growth rate of these infants during the first year of life.

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The first year of life: routine examination of the newborn.

BMJ ◽

10.1136/bmj.280.6207.91 ◽

1980 ◽

Vol 280 (6207) ◽

pp. 91-94 ◽

Cited By ~ 1

Author(s):

H B Valman

Keyword(s):

First Year ◽

Routine Examination ◽

First Year Of Life

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A Comparative Study of Child Health Care in Urban and Suburban Children

Clinical Pediatrics ◽

10.1177/000992287301201107 ◽

1973 ◽

Vol 12 (11) ◽

pp. 644-648 ◽

Cited By ~ 15

Author(s):

Festus O. Adebonojo

Keyword(s):

Health Care ◽

Predominantly White ◽

First Year ◽

Child Health Care ◽

Predominantly Black ◽

Health Maintenance ◽

Comprehensive Health ◽

Life Threatening ◽

Black Poor ◽

First Year Of Life

The health care received in the first two years of life by 113 children from a predominantly white, affluent, middle-class, suburban community under a prepaid health plan was compared with that of 85 children from a predominantly black, poor, urban ghetto under a comprehensive health services for Children and Youth (C & Y). Some similarities in utilization pattern were apparent but there were some striking and important differences. The ghetto child was seen for illnesses as often as his suburban counterpart, but he had fewer well-child and health maintenance checkups, especially in the first year of life. The ghetto child failed to keep four times as many scheduled appointments as the suburban child. The ghetto child was sick more often, and had more serious and life-threatening illnesses.

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EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE

PEDIATRICS ◽

10.1542/peds.45.6.950 ◽

1970 ◽

Vol 45 (6) ◽

pp. 950-960

Author(s):

Frederic P. Anderson

Keyword(s):

Health Care ◽

Physical Examination ◽

The United States ◽

First Year ◽

Routine Physical Examination ◽

A Prospective Study ◽

First Year Of Life ◽

Effective Use ◽

Routine Infant

Because of the critical shortage of professional manpower to deliver child health care in the United States, new programs are being developed involving paramedical personnel for the provision of much of the routine health appraisal services traditionally accomplished by the physician. It is difficult to anticipate the effect of such programs Upon the health care of children without knowing what contribution is presently made by the existing system. In an effort to assess the role of the routine physical examination in the health care of the infant under the age of 12 months, the results of 6,668 such examinations by 83 private pediatricians were evaluated in a prospective study. One hundred and thirty significant physical abnormalities (1.9%) were discovered, many of which probably could have been detected by a specially trained nurse or physician's assistant because of their inherent visibility or susceptibility to identification by simple screening procedures. It is concluded that more effective use of the physician's time could be accomplished by the relegation of a major portion of the routine infant physical examination to a paramedical person.

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The Development of Swallowing Respiratory Coordination

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd18.1.19 ◽

2009 ◽

Vol 18 (1) ◽

pp. 19-24

Author(s):

Maggie-Lee Huckabee

Keyword(s):

Cortical Activation ◽

First Year ◽

Healthy Children ◽

Nasal Airflow ◽

Single Session ◽

Primary Finding ◽

Patterns Of Behavior ◽

Cortical Modulation ◽

First Year Of Life ◽

Swallowing Apnea

Abstract Research exists that evaluates the mechanics of swallowing respiratory coordination in healthy children and adults as well and individuals with swallowing impairment. The research program summarized in this article represents a systematic examination of swallowing respiratory coordination across the lifespan as a means of behaviorally investigating mechanisms of cortical modulation. Using time-locked recordings of submental surface electromyography, nasal airflow, and thyroid acoustics, three conditions of swallowing were evaluated in 20 adults in a single session and 10 infants in 10 sessions across the first year of life. The three swallowing conditions were selected to represent a continuum of volitional through nonvolitional swallowing control on the basis of a decreasing level of cortical activation. Our primary finding is that, across the lifespan, brainstem control strongly dictates the duration of swallowing apnea and is heavily involved in organizing the integration of swallowing and respiration, even in very early infancy. However, there is evidence that cortical modulation increases across the first 12 months of life to approximate more adult-like patterns of behavior. This modulation influences primarily conditions of volitional swallowing; sleep and naïve swallows appear to not be easily adapted by cortical regulation. Thus, it is attention, not arousal that engages cortical mechanisms.

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