Performing Pediatric Physical Examination

  • Performing Pediatric Physical Examination
    • Perform the examination in an appropriate, nonthreatening area:
      • Have room well-lit and decorated with neutral colors.
      • Have room temperature comfortably warm.
      • Place all strange and potentially frightening equipment out of sight.
      • Have some toys, dolls, stuffed animals, and games available for the child.
      • If possible, have rooms decorated and equipped for different-age children.
      • Provide privacy, especially for school-age children and adolescents.
      • Provide time for play and becoming acquainted.
    • Observe behaviors that signal the child’s readiness to cooperate:
      • Talking to the nurse
      • Making eye contact
      • Accepting the offered equipment
      • Allowing physical touching
      • Choosing to sit on the examining table rather than the parent’s lap
    • If signs of readiness are not observed, use the following techniques:
      • Talk to the parent while essentially “ignoring” the child; gradually focus on the child or a favorite object, such as a doll.
      • Make complimentary remarks about the child, such as about his or her appearance, dress, or a favorite object.
      • Tell a funny story or play a simple magic trick.
      • Have a nonthreatening “friend” available, such as a hand puppet, to “talk” to the child for the nurse.
        • If the child refuses to cooperate, use the following techniques:
      • Assess reason for uncooperative behavior; consider that a child who is unduly afraid may have had a traumatic experience.
      • Try to involve the child and parent in the process.
      • Avoid prolonged explanations about the examining procedure.
      • Use a firm, direct approach regarding expected behavior.
      • Perform the examination as quickly as possible.
      • Have an attendant gently restrain the child.
      • Minimize any disruptions or stimulation.
      • Limit the number of people in the room.
      • Use an isolated room.
      • Use a quiet, calm, confident voice.
    • Begin the examination in a nonthreatening manner for young children or children who are fearful:
      • Use activities that can be presented as games, such as test for cranial nerves
        • I. Olfactory Nerve
        • II. Optic Nerve
        • III. Oculomotor Nerve
        • IV. Trochlear Nerve
        • V. Trigeminal Nerve
        • VI. Abducens Nerve
        • VII. Facial Nerve
        • VIII. Auditory, Acoustic, or Vestibulocochlear Nerve
        • IX. Glossopharyngeal Nerve
        • X. Vagus Nerve
        • XI. Accessory Nerve
        • XII. Hypoglossal Nerve
      • Use approaches such as Simon Says to encourage the child to make a face, squeeze a hand, stand on one foot, and so on.
      • Use the paper-doll technique:
        • Lay the child supine on an examining table or floor that is covered with a large sheet of paper.
        • Trace around the child’s body outline.
        • Use the body outline to demonstrate what will be examined, such as drawing a heart and listening with a stethoscope before performing activity on the child.
      • If several children in the family will be examined, begin with the most cooperative child to model desired behavior
        • Provide choices, such as sitting on table or in parent’s lap.
        • Allow the child to handle or hold equipment
        • Encourage the child to use equipment on a doll, family member, or examiner.
        • Explain each step of the procedure in simple language.
        • Examine the child in a comfortable and secure position:
          • Sitting in parent’s lap
          • Sitting upright if in respiratory distress
      • Proceed to examine the body in an organized sequence (usually head to toe) with the following exceptions:
        • Alter sequence to accommodate needs of different-age children
        • Examine painful areas last
        • In an emergency, examine vital functions (airway, breathing, and circulation) and injured area first
      • Reassure the child throughout the examination, especially about bodily concerns that arise during puberty.
      • Discuss findings with the family at the end of the examination.
      • Praise the child for cooperation during the examination; give a reward such as a small toy or sticker.

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