When a child is being assessed specifically for neuro conditions and a pupillary light reflex is necessary, how can I check them if the infant or toddler refuses? AND is there something to the effect that if the child closes his/her eyes to the light they are somewhat normal? If a child's eyes are dilated for ICP, for example, will he child not repond this way or in fact be more sensitive to light? help me out here.
How to check pupillary reflex on toddle who tightly closes eyes
- Thread starter drpickles
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Good advice above, but your post bolsters my belief that the angry 15 month old is the hardest exam in medicine. I don't care how smooth or strong you are, if that kid honestly and truly doesn't want to be examined, there's nothing you can do.
I think most pediatricians will sympathize with this.
I think most pediatricians will sympathize with this.
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well said!!
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Yep. But one of my mottos is that a child who hates you but loves/is comforted by their caregiver, is probably a healthy child.
You eventually get pretty good at assessing a child on multiple levels. It's nice to be able to see the kid's eyes, but not always possible. There are still other useful ways to eval. And never ignore it when the caregiver says 'he's just not acting himself.'
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I'm responsible for getting measurements, temps, fingerstick Hg, etc. on kids from newborns through teens. A good parent is your best friend - I mean one who will gently hold down an angry 15-month old and not stand there with a dumb smirk while he goes ape ****. Don't be afraid to ask the parent to hold the child for you. Peds nurses are great at knowing how to hold a child for immunizations and strep swabs, and these holds might work for pupil checks too. Remember that you're in charge. If you try a couple times and the child goes nuts and won't let you examine, get the parent or a nurse to hold him appropriately.
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I'd be cautious using sedation to get a pupillary light reflex exam - if you have an high enough index of suspicion for increased ICP/imminent herniation that you just have to get a pupillary exam right this minute, you have a sick enough kid that you need to be in the PICU (or a trauma room) and be ready to intubate if the sedation leads to apnea.
I'm highly skeptical, by the way, that a kid that sick would be fighting the pupillary exam that much, anyway.
I'm highly skeptical, by the way, that a kid that sick would be fighting the pupillary exam that much, anyway.
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Surely this poster was joking. And, yes, I just called you "Shirley"
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100 mcg/kg/min of the white milky michael jackson juice please! 🙂
In all seriousness, to look at ears which is along the same lines, I personally like (if the parents have no idea what works best for their child) to have them put the child on the bed. Have mom sort of lay her shoulder and upper arm over the belly and keep control of the arms. I can usually control the head myself if I don't have arms or legs to worry about. the other option is while sitting to have mom give the child a hug, kids legs between her knees, one arm holds and the other arm holds the head against their chest. Sometimes you have to get sorta almost nose to nose with mom, but that works... again these are looking in ear options, but also an important skill for pediatricians...
In all seriousness, to look at ears which is along the same lines, I personally like (if the parents have no idea what works best for their child) to have them put the child on the bed. Have mom sort of lay her shoulder and upper arm over the belly and keep control of the arms. I can usually control the head myself if I don't have arms or legs to worry about. the other option is while sitting to have mom give the child a hug, kids legs between her knees, one arm holds and the other arm holds the head against their chest. Sometimes you have to get sorta almost nose to nose with mom, but that works... again these are looking in ear options, but also an important skill for pediatricians...
