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

  • make allies with parentals

 

  • 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

  • a baby with a soother will not be crying

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

 

 

Instruments

  • demystify the instruments: get them to play with the stethescope, etc
  • make the different tests a game: play through them

 

Otoscope:

  • 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.

 

 

Components of Exam

checking out the mouth:

  • slide tongue depressor along side of mouth, then twist, gag, and look

 

resp exam:

pretend you're blowing out my fingers

 

 

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

  • heart and lungs
  • abdomenal exam
  • work down
  • then do head

 

head and neck

  • fontanelle
  • red reflex

 

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)

  • web-based tool
  • virtual cases with opportunities to refine
  • differential diagnosis along the way
  • test questions along the way, with immediate feedback
  • some video links

good to do for family medicine

 

Important skills

How to restrain the child during examination

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