My first patient at SJC hospital was an 8 year old male who was wheel chair bound. I was nervous because I have always had adult and adolescent patients. He seemed more fragile to me. He had a tracheostomy and a breathing machine because he was born without his left lung. He also had a gastric tube. These were two things I was not used to. “Good morning, my name is Ashleigh. I am the physician assistant student,” I say to the mother. I look down to the young boy and say “good morning” with a smile not even sure if he can even speak. He holds his arm out to shake my hand and greets me with a “Hello!” and a bright smile. After taking a history from his mother, it was now time to do a physical exam. I examined his head, eyes, ears, nose, and neck with no problem. I knew pulmonary, cardiac, and abdomen were going to be harder for me. He was fragile in my eyes and I felt he was too delicate to touch. I didn’t want to have him over exert himself during auscultation and I surely didn’t want to palpate his abdomen once I saw he had a gastric tube. “I have to press on your belly now okay? You tell me if it tickles or it hurts ok buddy?” He looks at his mom with weary eyes that made me more nervous. A giggle leaves his mouth and I start to become more at ease. I palpate more, “Ow, that hurts.” My first pediatric patient wouldn’t be my last pediatric patient to say “ow” or to cry. During my rotation at SJC, I would have many more children that would cry out in pain. All of these patients became fragile and delicate to touch in my time of care. In school, we learn to do a pediatric physical exam but you have to find your own flow of how you want to do your physical exam. Pediatric patients are different. They aren’t like adults, they don’t stay calm (most of the time), and they don’t understand that it will all be over in a mere few minutes. As delicate as they seem, a proper history and physical is critical for their health and for a correct diagnosis. It was hard to overcome the thought that I was causing them more stress and pain. It’s also not easy to hear heart sounds over a child that’s crying. Focusing in on those heart sounds or breath sounds, and performing a quick and thorough physical exam was something I had to adapt to. It’s not something that I mastered overnight, but something I gained experience in as the rotation progressed.