I really enjoyed my pediatrics rotation because I was able to float through the pediatrics ER, NICU, and outpatient clinic. It was in the ER (first three weeks) where I learned how to identify pediatric emergencies and how they may present differently compared to adults, it was in the NICU (4th week) where I got to see children at their earliest days of life and learn anticipatory conditions in a neonate given the risk factors of the mother, and finally it was in the  outpatient clinic (final week) where I learned more about pediatric routine visits and patient education on asthma, obesity etc.

I got to see pediatric patients in three different settings. I was comfortable with working in the ER from my first rotation and I could already see how much more proactive I was as a student. I was able to build upon my skills that I had established in the ER before and improve on working with more efficiency. The nurses allowed me to be more involved in their duties whether it was retaking vitals, conducting an oral challenge, taking viral swabs, collecting urine or blood etc. One particular part of the ER that was different from my previous experience was collecting the history from psychiatric patients. For almost all my shifts, there were at least 2 patients on the board with a chief complaint of “suicide attempt”. I learned that from an ER point of view, we were there to medically clear the child. I found myself conflicted when I received different stories from the child compared to the parents. I am looking forward to my psychiatry rotation to gain the skills in handling such situations. My NICU experience was an amazing and completely new experience for me. I mostly observed but was able to participate in the immediate post-care of the neonate after being born, including drying the baby off, determining APGAR score, suctioning the nose and mouth, and taking the appropriate measurements (head, chest, abdomen, length, weight). I was also able to assist in adjusting umbilical catheters. During my time in the outpatient clinic, I was pleasantly surprised that I was not only going to participate in pediatric well visits, but work with pediatric specialist in endocrinology, pulmonary, and cardiology. I got a more in depth learning on how to form an asthma action plan and perform a doppler ultrasound. I even got the chance to practice interpreting multiple EKGs. Patient education was crucial at every visit, including exercise and diet for obese children, how to use a spacer with inhaler for asthma exacerbations, immunizations benefits, developmental milestones etc.  

Patience and distraction were key skills to learn during this rotation. I had exercised patience in my other rotations which helped me with uncooperative children during the exam or in situations where the child was disruptive in the room while you are trying to talk to the parents. One time I even had to run after a child in the ER who was very scared about getting an IV placed. Understanding the environment you are in and acknowledging that it can be stressful for the child, who is already not feeling well, along with the parents can give you a little more empathy towards the situation. Mastering the art of distraction, especially among younger children, during procedures is also a crucial skill to have in creating a positive experience for the child. It reduces stress, increases cooperation, and provides better safety from adverse events occurring if the patient is moving. Videos, toys, reading, games can all be used as distraction tools. Another method that I found to be helpful was any participation that the patient can take part in helped increase cooperation. In the ER, I performed many many COVID-swabs. The child saw the swab and instantly started to retract away from me, remembering the days when the swab had to reach all the way back into the nasal cavity. However, given that we didn’t have to go that deep, I had the patient hold the cotton swab with me and together, we swabbed her nose. It worked almost every time ! 

When I first started my pediatrics rotation, it felt unfamiliar to move away from what I knew about adults and learn how lab values, medications, disease presentations, or simply regular check ups were different in children. An area that I particularly felt weak in was pediatric drug dose calculations. The providers would work so quickly and call out numbers at me that it was hard to follow at times. Safe medication administration in children is based on the child’s height and weight. I realized in studying drugs, I put more of an emphasis on the drug name and class, over the dosages. One application that I found particularly useful in helping me learn more about these drug dosages was epocrates. It breaks down the drug information in a clear and concise way. With some cases that I looked back on through my Epic access, I tried performing my own calculations with drugs such as Ibuprofen and amoxicillin. With more familiarity with the dosages of at least the most commonly prescribed drugs, I will be able to do these calculations more quickly. Though I may not pursue the pediatric specialty specifically, it is important to know how to properly dose children because I still may encounter them in another setting such as in the ER. 

Two of the most memorable moments of my rotation had to do with observing the ending of a life with my first child death and the beginning of one with my first vaginal birth. As a student, I knew that I could possibly encounter the experience of a death, yet I felt so unprepared when it happened. It was in my second week of being in the pediatrics ER when a unresponsive 13 month old child came in with a fever of 105 F. ACLS was performed unsuccessfully for an hour and he died from suspected hypovolemia and septic shock. The feeling of powerless and the grief felt for someone I barely knew was unlike something I’ve felt before. I think that compartmentalizing is almost a key survival trait for clinicians, but at the same time too much dissociation can cause a lack of empathy. It’s that middle ground that allows you to mourn for your patient but still maintain your professional role. Seeing my first vaginal delivery came with a whole new set of emotions. It was an amazing, emotional process that makes one appreciate the process of labor and delivery at a higher level. The mother was pushing so hard and though I knew the baby was coming out, part of me was convinced it just wasn’t going to work. The sight of the baby’s dark hair would come closer to the opening and then sink back in, but suddenly with a hard extended push, with guidance of the resident, slid out a fully developed baby. It gave a new meaning to changing someone life and making a difference beginning with bringing a new life into the world.