title: Examination of the Acute Abdomen in Children.
abstract: The history and physical examination (H&P) on a child with an acute abdomen is an opportunity to build a solid relationship with the child and parents. Building confidence and trust under fraught circumstances requires a genuine affection for children, and sympathy for the anxiety of the parents. Arrival of a surgeon is a signal that the illness is serious and not likely to respond to the usual remedies. The surgeon therefore must have a gentle, unhurried approach. Obtaining the history should be non-directive and allow both parent and child to describe the entire timeline of the illness without interruption. The physical examination should be done without hurting the child, first observing how the child moves about in bed and undresses, then having the child control palpation by holding the examiner's hand and pulling it away should undue pain be elicited. Even though a diagnosis and a plan for surgery may already have been made, exiting the exam room after the H&P to review lab and radiological images gives the family time to regroup information. The diagnosis and decision for operation require simple and direct explanations that communicate patience, have a tone of reassurance, and affirm repeatedly that parents understand what is being said. The message is that surgery is a shared decision, and safety and the child's wellbeing always foremost. To the child three points have to be paramount: They won't feel pain during or after the procedure; after the operation they will feel better; and they won't be alone. The goal is to build a trusting relationship so that the child has some calm in departing to the operating room and the parents willingly see them leave.
authors.affiliation: Pediatric Surgery, Sacred Heart Medical Group, Pensacola, Florida. Electronic address: don.nakayama@shhpens.org.
authors.forename: Don K
authors.initials: DK
authors.lastname: Nakayama
mesh_terms: D000006:Abdomen, Acute / Q000601:surgery*; D002648:Child; D003142:Communication; D003657:Decision Making; D006801:Humans; D008487:Medical History Taking; D010347:Patient Care Planning; D010808:Physical Examination; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D035502:Trust
keywords: Communication; Professionalism; acute abdomen in children; acute appendicitis; communication; physical examination; surgeon patient relationship