Examining Children

Tricks to Examination

80% of the time you will be successful, 20% you won't...

get moms and dads to play important roles in the exam: examine on the parent's lap if appropriate

try to get to know the child before jumping in to the exam
come up to the child at eye level
make the kid know they are the most important person in the room
carry stickers!
if the child becomes very frightened, or has a tantrum, it can be ok to step out for a minute or two
if they have no stranger anxiety, checking them out on the bed is a good thing, otherwise leave them on the parent's knee
never ask "do you want to..." rather say, do you want to sit on the table or mom's knee?" or, "do you want me to examine your left ear or right ear first?"

infants

school-aged kids

never talk down to them - aim a few years higher than they are
respect school-aged children's modesty
explain what you're about to do; can start telling them about medical information
ask if they want parents or family in the room during the exam

shine the light through their finger, then ask if you might be able to shine the light through their head
get the kids to blow out the candle
know how to do good restraint with parents: if examining right ear, get parent to hold head with left hand.

checking out the mouth:

resp exam:

pretend you're blowing out my fingers

don't go top to bottom - save the hard parts (ears and mouth) for last

head and neck

A child is not a small adult; they are growing!

www.comsep.org - council on medical student education in pediatrics

A child is also integrally connected to a family unit.

Computer-Assisted Learning in Pediatrics Project (CLIPP) - put together through COMSEP

http://www.clippcases.org/login.htm

Sarah Shea is the coordinator here; she audits it (can find out how long we spend)

good to do for family medicine

How to restrain the child during examination

Getting in and out quickly with the tongue blade to help see the tonsils