Dr. Jessica Lazerov, pictured here, writes:
“He’s an old soul,” an exhausted-appearing woman told me as I examined her 18 month old grandson.
His giant brown eyes had been fixed on me from the moment I had entered the exam room. And my eyes looked straight into his for much of the well child visit. I looked into his eyes
when I let him hold my stethoscope while I chatted with Grandma. As he remained on Grandma’s lap, I pointed to the Elmo sticker on my stethoscope and asked if Elmo could listen to him. I maintained eye contact when I let him touch the otoscope to show him that the light turns his finger pink and by the way, doesn’t hurt one bit. I also maintained eye contact when I pressed on his belly making funny noises while he giggled.
As medical professionals, we already know that making eye contact with your patients is important and allows a trusting relationship to blossom. But what about times when your patient is little and scared? I would argue that it is even more important at those times.Picture this:
Imagine that the world is a big, scary place while everyone tells you “no" constantly. It is confusing yet sometimes so exciting with so many new things to see and explore every single day. You are emotionally labile and get hungry and tired in an instant. You try to use your few words to convey that you have a belly ache and that the peas on your plate are not happening today, but no one seems to care much. Mommy seems to get frustrated often and you can’t seem to understand why. The toilet paper seems like the greatest toy ever, but no one lets you play with it, ever. Then one day Mommy takes you to a place that somehow seems familiar, but you remember not liking it much. Maybe it’s the crinkly paper on the table. Maybe it’s the smell of the room. Maybe it’s the baby crying down the hall. Maybe it’s the lady trying to measure you. You don’t like it one bit. They smile at you some of the time, invade your personal space, and then they make you take off your clothes and put on a gown that you are quite certain is evil. And mommy isn’t doing one darn thing to get these people away from you.Does this sound fun at all?
That’s often what toddlers are going through when you walk into the room to do your exam. If they have not enjoyed having their vital signs done, they are likely to be less than thrilled to have another “stranger” getting too close any time soon. As a toddler, if the last time you were here, someone held you down and “stabbed” you multiple times, you will likely start your revolt the moment you walk in the door.
I have found through the years that simple eye contact can ease much of this trepidation that toddlers face when coming to the doctor. The key is that you need to actually be genuine about your “friendliness.” Toddlers can sense quite well when you are rushed, when you are frustrated, and when you are having fun with them. Maintaining eye contact and talking to them directly is often the difference between getting to hear a murmur or not. Singing a popular kid’s song while you are washing your hands can replace some of their fear with curiosity. When they are lying down, playing peek a book behind their feet can make the difference in getting a child relaxed enough to perform a worthwhile abdominal exam. Using words like “toy” and “games” instead of stethoscope and exam help to distract a scared child from the reality of a place that can sometimes not seem so nice. Actually making much of your exam seem like a game helps even more. Plus it’s way more fun for us.
Granted, there will be times when you have tried every trick in the book and you just have to make your exam snappy while a not-so-happy toddler screams and squirms throughout the visit, but I find that wearing your kindness and compassion proudly on your sleeve gives you the best shot at making “The Doctor” an okay place to visit.