Effect of developmental status on the approach to physical examination

A certain mystique surrounds pediatric clinicians, many of whom appear to have a magical touch with children. Admittedly, there are a few true masters of the art who invariably seem to bring calm to even the most frantic of patients. But for the most part, this magic can be learned by attending to the lessons provided by the study of normal child development. The science of knowing what to concentrate on, what to expect, and how to interpret findings, and the art of sequence, pace, and distraction are equally derived from on-going attention to the patient's stage of affective, cognitive, and physical development. When the stage-related approach is modified by individual circumstance (e.g., child's temperament, acuity of illness), the magic success can become a routine expectation for the vast majority of pediatric clinical encounters.