Getting comfortable with pediatric, adolescent gynecology. (Expert Opinion).

BIG SKY, MONT. -- With the American College of Obstetricians and Gynecologists gearing up for a major campaign to encourage members to incorporate pediatric and adolescent gynecology into their practices, here are some clinical tips regarding this area.

The tips were offered by Dr. Joseph S. Sanfilippo at an ob.gyn. update sponsored by the Geisinger Health System.

* Physical examination of a child. Don't use the dorsolithotomy position that's standard in adults. Instead have the child assume a frog-leg position, he pointed out.

After finishing this segment, have her turn over and assume the knee-chest position, take a deep breath, and then bear down to induce a Valsalva response.

"You can probably see the cervix. And even if you can't, that's okay, because the lower one-third of the vagina is where virtually all the vulvovaginitides will occur in this age group, said Dr. Sanfilippo, professor of ob.gyn. at the University of Pittsburgh.

* Document Tanner stage in your record. It looks much more professional should you eventually refer the patient to, say, a plastic surgeon for definitive treatment of a breast abnormality Tanner Stage 1 is a nipple with no palpable underlying breast tissue, typical of preadolescence. Stage 2 features a breast bud. In stage 3, the contour of the areola is not separated from that of the breast. In stage 4, the areola and nipple form a secondary mound. Stage 5 is a mature adult breast.

* Polythelia. This congenital condition, which is marked by extra breast nipples located along the milk line from midclavicle to labia, affects 2% of the population. In the great majority of cases, it's best left alone. When the condition is too physically irritating, plastic surgery is the solution.