For the last month, I have been rotating at a Pediatric Emergency Department. One of the many things I learned during this rotation is how to do a Pediatric physical exam effectively. Infants and toddlers tend not to be very cooperative during the physical exam and sometimes even during the whole encounter. I have learned a few tricks that will make the physical exam easier for the child, the parent, and the examiner.
- First thing in any encounter should be observation. We can learn a lot from careful inspection before we walk in and disturb the child. Is the child grunting or retracting? Is he/she active and playing? How are the parents interacting with the child?
- Distracting the child with a pacifier or toy is helpful. Especially during the eye exam, play with the light before shining it in their eyes. They are much less likely to squint and cry. If there is no toy around, blow up a glove balloon. If the child is older to understand you, talk to them during the exam. Ask them about the Spiderman on their shirt or if they can count how many fingers they have.
- Parents are an invaluable resource. Not only are they the primary source of information but they can also help with the physical exam. Children are more comfortable when a parent holds them. It is much easier to listen to the heart and lungs when the child is calm in the parent’s arms. Sometimes the parent might be able to palpate the stomach to help assess for softness and tenderness of the abdomen.
- One of the most difficult parts of the exam is checking the tympanic membranes and the posterior oropharynx. The best way to do the exam is with the parent holding the child. The parent will sit with the child on his/her lap holding the child’s legs between his/her legs. Depending on the direction the child is facing, the arm closest to the parent’s body will be tucked underneath the parent’s armpit. The parent will hold the other arm of the child by wrapping an arm around the child. And finally the parent will use the free arm to hold the head still.
I’d love to hear any other tricks and methods that make the pediatric physical exam easier. Feel free to add them in the comments.