Children’s examination

Watch and chat first
Observe the chest
Position calmly

Children will usually be wary of strangers so take some time to get their confidence in you, and their new surroundings, when you see them as patients

Watch and chat first

With children it often helps to observe first and chat to their parents as this gives them time to get used to the room and you. Direct questioning and early eye contact may unsettle the child and make examination much harder. Watching from a distance allows you to observe alertness and how active they are

Observe the chest

Asking the parent to remove the top layers, whilst you chat to the parents from a reasonable distance, is often acceptable by the child and allows you to check colour, rash, and breathing pattern This only leaves the stethoscope and otoscope to use once the child is settled

Check the chest first to gain confidence. Sometimes putting the stethoscope on the knee helps to reassure the child. Making it a game. Starting with the back of the chest with the child sitting and you keeping eye contact at the fronnt is a good way to start. A distraction such as your voice, facial expressions or an object/light helps

Position calmly

It helps to advise the parents on how to hold the child for ear and throat examination. There are different ways to do this and one outline is as follows. To look at the ears the child is cuddled sitting sideways. One hand of the parent holds the head so that their child can still see. The other hand holds the shoulders. It only needs a brief glimpse of the intact drum, but longer is good if the child accepts this.

It helps to warn parents their child may gag when you look at their throat. You can discuss whether or not it is necessary to check as well!  The child sits on their parents lap with their back towards them facing forward. One hand on forehead, one over the shoulders. Sitting upright gives the best view. With very young children laying them down on parents lap or the couch will be easier.

Don’t forget to check the urine if you can’t explain their fever or illness