In the previous post we talked about using proper greetings and explanation to win rapport and trust. We talked about a 16 month old with scalp pain that could not be localized. Often efforts at rapport and trust do not work. What do you do next?

For straightforward presentations there is nothing wrong with physical restraint and looking in the ears against resistance etc. William Carlos Williams has a short story “The Use of Force” where he makes this into a morally ambiguous act about subduing another person. Nonsense! Tell the child that you help kids feel better and you are going to check for owies. If you see resistance, have the parent hold the kid and proceed.

But sometimes the presentation is not clear and we need skill in winning a child’s compliance.


Use objects in the room for distraction but these do not always work. Blowing up a glove into a balloon and drawing a happy face works pretty well. Having the glove talk to them is even better. Smartphone photos are great, the child is usually mesmerized.


You might tell them a story; “there is a mouse on the loose in here, have you seen the mouse?” The mouse story, if it works, is good because the mouse can run to wherever you want to examine. “Let me check your ears for the mouse.”

Other forms of play might be to state your commands in ways that captivate the child’s imagination; “pant like a dog” elicits better compliance for oropharyngeal examination than “say ah.” For the abdominal examination, say “let me check your abdomen and see what you had for lunch.”

Take Home Points:

-Use distraction to help localize tenderness

-Use imaginative play to make the examination more fun



  1. Very useful techniques for working with children, after all the occupation of a child is centered around play. I am an Occupational Therapy student who just finished a pediatric rotation. I used dress up games, such as doctor to engage kids during an ADL dressing session. I found this to be the best way to maintain their attention. Example- buttoning fine motor skills are addressed by donning the “doctors lab coat”. I enjoyed reading a pediatrician point of view. -AC


    1. emphysicaldiagnosis

      Good point. This is even more important for your specialty than mine because your encounter requires so much more cooperation and your physical interactions are much more extensive. I appreciate your taking the time to write – Jim


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