THE PEDIATRIC EXAMINATION PART 1: RESPECT AND EXPLANATION

A 16 month old presented with pain in the scalp. The examiner was not able to localize it further because the child was uncooperative and crying. What now?

To localize pain in a toddler, we need the child’s cooperation. There are three ways to achieve this. The first approach is to win rapport and trust.

Introduction: I start with a proper introduction to the child on eye to eye level. If they are old enough to understand, I might say “I am the guy who fixes owies.” (sometimes followed by a comical search for “owies” well away from the affected area).

Non-clinical touch: The first touch should be non-threatening. I sometimes do a formal handshake for humor, or a pat on the back, or a light touch of the foot as I say hello.

Say his or her name:

Use his or her first name frequently to enhance familiarity.

Anticipatory Guidance

Demonstrate the exam on yourself or on the child’s mother first. This is really important with the otoscope. The best model is a cooperative older sibling.

If this works, great! Sometimes it does not. Read my next post for the second approach, on distraction and play.

Take Home Points:

-Treat kids like little adults: With respect. Introduce yourself, use an age-appropriate physical greeting, and address them by their name.

-Explain things in advance: model the examination on yourself or a family member.

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