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MAKING FRIENDS

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  • A good aphorism is: never examine the child until you have made the mother laugh.

  • Establish rapport in the waiting area with children—show interest, use considerable eye contact and make favourable comments.

  • Ask them what they like to be called.

  • Have special stickers to put on the backs of their hands, T-shirts, etc.

  • Take time to converse and/or play with them.

  • Have interesting toys for them to handle while listening to their parents.

  • Compliment the child on, for example, a clothing item or a toy or book they are carrying.

  • Ask them about their teacher or friends.

  • Try to examine them on their parent's lap.

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DISTRACTING CHILDREN

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Children are sometimes difficult to examine but can be readily distracted, a characteristic the general practitioner can use effectively in carrying out the all-important examinations.

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In the consulting room, a small duck with a rattle inside it can be used for palpating the abdomen of young children. This seems more acceptable to them, as it becomes a game and you obtain the same information as if you had palpated with your hand.

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Another method of examining the abdomen in an upset child is to use a soft toy to play a game on the abdomen and then slip your other hand under the toy for closer assessment.

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Alternatively, use the diaphragm of your stethoscope (preferably one with a small soft toy attached) to apply pressure, starting lightly and then pressing harder while watching the child's reaction. Rebound tenderness can also be tested.

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Perhaps the best abdominal palpation method is to use the child's hand under yours to palpate.

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When performing painful procedures, a recommended technique for infants (especially under 3 months) is ‘the three Ss’ method:

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  • swaddling for firm containment

  • swaying (where appropriate)

  • sucking using a pacifier (dummy) with 15–50% sucrose.

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Another way of diverting a child's attention, especially if giving an injection, is to blow up a balloon in front of them and let the air out slowly through a narrow opening to make a high-pitched ‘squealing’ sound—or let it go and ‘shoot’ around the room.

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When examining the ears of young children sitting on their mother's lap, difficulty is encountered when the child follows the auroscope light and moves his or her head. A small rabbit or other animal on the desk, which, at the press of a button under the desk, will play a drum, distracts the child sitting to the right and enables you to get a good look into the left ear.

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Similarly, over the examination couch, a clockwork revolving musical toy will distract the child for examination of the ear. It is also a distraction for the examination of children on the couch, and can become a most useful instrument.

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