Going into this Pediatrics rotation, I was extremely excited because I would be back in an inpatient setting that I had been out of since late March. However, I was a bit nervous because to this point I was only really accustomed to treating adults. In my Family Medicine and Ambulatory Care rotations I came across a few pediatric patients, but certainly not enough to make me feel confident walking in to this rotation. Upon arrival to QHC’s Pediatrics Administration office, I found that the first two rotations would consist of three 12-hour shifts per week in the pediatric emergency department, followed by a week in the pediatric clinic, and finally a week in the neonatal intensive care unit (NICU).

I enjoyed my time in the pediatric emergency department; the clinicians I worked with were great and eager to teach. Unfortunately, the patient volumes were pretty low due to the pandemic. Still, there were several interesting cases that I was able to discuss with the clinicians, and I was able to discuss common conditions and broad topics like “fever” and how we work them up. I was also grateful for this time because I was able to practice venipuncture, splinting, and IV starts on pediatric patients, which I had not had much exposure with previously. The most exciting part for me was the pediatric psychiatry cases. Whenever a pediatric patient is brought in for a psych complaint (most commonly agitation in the two weeks I was there), it is up to the medical side to first clear the patient, so we served as almost a first line of defense in getting the story from these patients and whoever brought them in, but also making them feel safe and welcome. I think this was an area I was strong in; I found it very important that these children who might be feeling hopeless or angry came in and knew they were being cared for in a meaningful way. I think (hope) this reflected to the patients and their parents.

In terms of learning normal versus abnormal development in children and really locking in the important “how to care for your baby information,” the pediatric clinic was definitely the most valuable portion of the rotation. The primary care visits were almost repetitive in a way in that we were looking for the developmental milestones, assessing growth curves, and interpreting the vaccination schedules. This was great because each “normal” visit made it easy to spot the “abnormal.” I was also extremely lucky during this time to work in the clinic with a few of the specialists, including the endocrinologist, geneticist, adolescent specialist, and pulmonologist. On those days I was able to really see the “high-yield” topics we learned about in class firsthand. I think that is really the best way to learn and really encode that information for the long-term.

I particularly enjoyed my evening with the adolescent specialist, Dr. Lee. Upon meeting me, she brought me to her office in the time before her first patient arrived and gave me a quick intervention about adolescent medicine and how it differs from general pediatrics. I really liked this day because this is an age group I enjoyed (puberty-21). I think due to my own age I can relate well to this age group and perhaps allow for the development of an easy rapport. Even more so, I really liked how adolescent medicine integrates all the areas of medicine I am currently interested in: primary care, sexual health, and psychiatry. As a somewhat young adult at 23, I like the idea of easing these young adults through the transition from childhood to adulthood where their relationship with the world begins to change and they become more independent.

The NICU portion of this rotation was definitely the most interesting portion overall. The diversity of cases ranging from the extremely premature neonates to those with chronic genetic conditions like Cystic Fibrosis and Turner Syndrome was incredible to see. I was able to also go to the Cesarean sections and high risk vaginal deliveries to do the neonatal assessments with the nurse practitioner or PA working that day, which was an amazing experience because my OB/GYN rotation was pushed to the end of the year as a result of the pandemic, so I was excited to get this early exposure since that is an area I am really interested in, too. I was able to cut a few umbilical cords (which was not at all like I expected it to be from the movies where it looks like it is a simple 1 snip!) with one of the NPs, too! This week of the rotation was extremely valuable for me in the end-of-rotation exam because so much of what we were doing there every day was directly applicable to the vignettes given.

Overall this was a great experience. At first, I was not sure if I would enjoy pediatrics at all because the possibility of missing something or doing something wrong with a child scared me. This experience, particularly with the infants and adolescents has started to change my mind because of the possibility of continuity of care and building relationships, which is something I feel I excel at.

One thing I definitely need to work on in the pediatric population is not being afraid. It was so difficult for me to really go ahead and hold an upset toddler down to look in their ears or draw blood or start an IV in an infant because I felt really bad for doing it. One of the providers in the pediatric ED told me that the children are not going to break and it is okay to do these things because they are necessary. That helped me a bit, especially going into the clinic, but I definitely need to keep that in mind in the future. Should I even find myself in pediatrics I will keep those words in mind and also remember that it is more important to perhaps inconvenience the child for a moment than potentially miss something major that could later impact their health. I also will try to remember that the parents probably expect this from the provider because they probably know better than anyone how sturdy children are and that it must be done.

One experience I will cherish from this rotation (of which there are many) was the first time I held a neonate in the NICU. As a 23-year-old with no children and whose friends are not yet having children, I have not been around very many infants, I was absolutely terrified when the NP I was working with sat me down and placed this neonate in my arms to feed. I couldn’t help but be amazed at his tiny fingers. This was not an experience that was related to his care or medicine at all, but it was really special for me and I was so glad it happened.