You ask. But what if they say no? Then you are stuck. And so, you instead (quickly) learn to ask a different but related question. "Should I look in this
ear or that
ear first?" And then your patient has the choice, and you have your pediatric physical exam.
Like many things, it'll take practice and you'll gain skills with experience, but you have to start somewhere. Just not necessarily at the head if it seems overly threatening to your pediatric patient. Assorted tips follow...
Be systematic, but tailor your approach to the pediatric physical exam depending on the age, what's going on with the child at the moment, what hurts (don't examine that first) and what doesn't, what you need to hear (when they are already quiet, do the things for which you need them to be quiet) , and what you need to see.
What you see is key... Be observant, take that mental snapshot of the oropharynx or the tympanic membrane that you just visualized because you won't get a particularly long look. Replay it in your mind. Your observational skills should be put to their full use.
Enlist the parent(s) in helping you. Help them help you.
And always demonstrate safety. For example, never leave that infant on the exam table without a hand there, or on inpatient place the safety bed rails back up whenever you leave the bedside, even if for a moment.
Here is a great video developed by my colleagues at COMSEP
, with the approach
to the pediatric physical exam. It's really all in the approach. And in this post
are links to several more pediatric physical exam videos.
Engage your patients by letting them touch that otoscope light while you hold it for them to explore, so they see it is not too hot or too pointy or too scary.
Engage them with a question. "Where is your heart?" See what they know and inspire them (maybe they'll be doctors or nurses someday) even while you swiftly move through your physical exam.
Be attentive. And close that diaper again before you get peed on.