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.
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.
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.
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.
Perhaps the best abdominal palpation method is to use the child’s hand under yours to palpate.
When performing painful procedures, a recommended technique for infants (especially under 3 months) is ‘the three Ss’ method:
swaddling for firm containment
swaying (where appropriate)
sucking using a pacifier (dummy) with 15–50% sucrose.
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.
When examining the ears of young children sitting on their parent’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.
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.
An excellent method to distract upset or uncooperative children is to blow bubbles for them. Have a bubble blowing kit on hand for this.
Another technique when giving an injection is to get the child to take a deep breath followed by a series of rapid blowing, during which the injection is given.
Then there is the ‘cough trick’ whereby the child is asked to perform a ‘warm up’ cough of moderate intensity, followed by a second cough to coincide with the vaccine needle puncture.