PEDIATRICS Vol. 45 No. 6 June 1970, pp. 962-963
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EVALUATION OF THE ROUTINE PHYSICAL EXAMINATION OF INFANTS IN THE FIRST YEAR OF LIFE: REVIEW

Thomas C. Peebles M.D.1

1 Departments of Pediatrics, Harvard Medical School and Massachusetts General Hospital, Boston

This paper focuses attention once again on the appropriate role the pediatric assistant, nurse-practitioner, or pediatric associate may play in relieving the physician of some of the routines of physical examination. The relatively low yield (1.9%) of significant abnormalities detected by pediatricians in the course of routine physical examinations is studied during the first year of life. The assumption is made, but not documented, that, with appropriate training, paramedical personnel could detect these abnormalities.

The cost-effectiveness aspects of this question can no longer be ignored because of pressing necessity to reduce overall cost of pediatric care generally and to spread the administrative talents and diagnostic skills of the pediatrician to encompass the greater needs of health care in the United States. Purposely ignored here is the role of the physician in parent and early childhood education, support for parental anxiety, and reorientation of abnormal behavior in parents and infant. All of these are important issues and must not be neglected in the overall picture of care delivery. Yet, these aspects of routine care can perhaps be adequately met by a carefully planned and supervised program of reading, group discussions, and audiovisual education, together with appropriate referral by paramedical personnel on specific indication of parental or child need for physician attention. It is also apparent that the high yield in physical abnormalities is on examination during the newborn period and the first or second month. These may be the times for the pediatrician to establish personal contact with parents and baby so that delegation of the succeeding, more routine examinations to other members of the closely cooperating team may be effected as is appropriate to the physical and emotional situation.