Tips for interviewing/examining pediatric patients

Started by seanth
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seanth

Junior Member
15+ Year Member
Hey guys,

I am starting my peds rotation and I was wondering if you have any tips for making kids feel comfortable and making the experience as fun/painless as possible for them.

Thanks!
 
Approach them slowly. Apply the stethoscope to mom or dad. Then to baby/child. Let them become comfortable with the stethoscope by letting them play with it a bit.
 
I let them listen to my heart, and then their own. Then I ask to listen too. "show and tell" goes a long way with little ones. Depending on age, try starting at their feet and working up. It's less intimidating. Or examine them sitting in mom/dad's lap. So much depends on age and patient. Learn to "read" your little ones and their parents.
 
Play with them, be happy, talk with the parents too. And realize that there are times when you can't get them to cooperate and just have to hold them down. This generally applies to the 1-3 yo's. Don't default to this as a med student though unless you have kids of your own and know when to cross the line to force them into ear and mouth exams. Also, at least in emergency and inpatient medicine, if it's at all possible to time your physical exam to after they get tylenol/motrin for the febrile kids, they'll be a lot more cooperative.
 
There is no such thing as a patient not cooperating with an exam. You are bigger than them
 
Auscultate everything first while they're still calm.

Give them your stethoscope to play with.

Distract, distract, distract.

I successfully used the otoscope on a 1 yr old once and they didn't start crying. It was a miracle.
 
Do the ear exam last... then after they start crying use the opportunity to look in their mouths.
 
Try to make it a game. Examine mom/dad/sibling first to make them comfortable if anxious. Examine them wherever they are happiest whether its on moms lap or on the floor, if you try to move them away from that spot its not going to result in an easy exam. Save the worst for last. Get the heart/lung ascultation done before anything else if you think there's a risk of crying. Get mom/dad to restrain (babies/toddlers) if necessary, it freaks them out if you are holding their kid down even if you aren't hurting them at all.
 
start with heart and lungs, on mom's lap if you need to. (or on the floor or under the desk or under the exam table, etc) Then if not crying yet feel the belly. Then start at the head and work your way down. Ears 2nd to last, gets em crying and then you can look in the mouth...

and if you're on the inpatient floor/NICU/Nursery and find that it's dirty, change it!! Just don't forget to find out if the nurse is measuring I/O's
 
Tell them a ravenous monster lives in the cabinets of the exam room and, if they misbehave, it will come out and eat them.

Tell them if they act up they're going to get a shot. Then give them one anyway.

If they still won't behave and you can't complete your exam, just tell them they're adopted and leave.
 
interesting trick i picked up this last month while dealing with kids in the ED. I tell them there are monsters/dinosaurs/elephants that may live in their ears and I need to make sure they're not there. They suddenly sit still, weirdiest thing. The elephant one had a tail and at trunk in one ear, so I had to check the other ear for a peanut...
seriously, I made it up and didn't think for a second it would work. Kid ate it up.
 
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