When is it appropriate to ask a parent to leave when examining a pediatric patient? Do you have any advice on how to do this diplomatically? — Tamara Aguilar, FNP, Chico, Calif.

The answer to this question largely depends on the age and development of the child and the extent of the intended physical exam.

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Generally speaking, both parents and prepubertal children are comfortable remaining in the room together during the physical exam. However, this can change as children enter puberty and begin to develop a sense of privacy. There is also the consideration of when a practitioner should begin providing confidential services to adolescents and what the reason for the exam is.

Finally, you must remember that examination of reproductive organs requires a chaperone for the safety of the patient and the clinician. In more than 20 years of experience, I have only had one parent refuse to allow me some private time with a patient, as long as a chaperone was present when the purpose was explained. The American Academy of Pediatrics has published a wonderful resource for providing quality care for adolescents. — Julee B. Waldrop, DNP (186-2)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical question, submit it here.