#ir #peds
Figure 1: Additional Tips & Tricks
General
Always undress.
Eyes
If trying to get a newborn to open their eyes, holding the infant’s head and dipping it down will cause
them to open their eyes.
Never try to pry a baby’s eyes open when they are crying as you will not be able to over power them and
will just anger them more.
Infants should fi x and follow a moving object with both eyes by 3 months of age. Use bright objects or
noises to help assess extraocular movements.
Ears
If having a hard time looking in the ears, hold arms above head.
If unable to turn their head, wiggle the otoscope light in front of their eyes and then move it to the
opposite side of the ear you want to look in. The child will often track with the light and turn their head
so their ear is then right in front of you.
Have parent stabilize the head. Use one hand to grab the pinna while holding the otoscope with the
thumb and index fi nger and using the little fi nger and heel of the hand to stabilize the otoscope against
the side of the face (See Figure 2).2
Mouth/Throat
Wetting the tongue depressor makes it taste better.
Have the child pant like a dog when doing a throat swab as it helps prevent gagging.
Heart
If worried about murmurs, gently and briefl y blow in the face of a neonate which slows down their heart
rate momentarily so that you can better ausculate for murmurs.
Lungs
If you want them to take a deep breath, can have them blow out the light on the otoscope or can ask
them to pretend to blow out the birthday candles.
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Tricking Kids into the Perfect Exam: Tips for Evaluating the Pediatric Patientsed oral intake and urine output. On
exam, the patient is febrile and appears
uncomfortable.
Performing a good abdominal exam is
critical for the assessment of this patient,
but can often be challenging. Children
<span>Figure 1: Additional Tips & Tricks
General
Always undress.
Eyes
If trying to get a newborn to open their eyes, holding the infant’s head and dipping it down will cause
them to open their eyes.
Never try to pry a baby’s eyes open when they are crying as you will not be able to over power them and
will just anger them more.
Infants should fi x and follow a moving object with both eyes by 3 months of age. Use bright objects or
noises to help assess extraocular movements.
Ears
If having a hard time looking in the ears, hold arms above head.
If unable to turn their head, wiggle the otoscope light in front of their eyes and then move it to the
opposite side of the ear you want to look in. The child will often track with the light and turn their head
so their ear is then right in front of you.
Have parent stabilize the head. Use one hand to grab the pinna while holding the otoscope with the
thumb and index fi nger and using the little fi nger and heel of the hand to stabilize the otoscope against
the side of the face (See Figure 2).2
Mouth/Throat
Wetting the tongue depressor makes it taste better.
Have the child pant like a dog when doing a throat swab as it helps prevent gagging.
Heart
If worried about murmurs, gently and briefl y blow in the face of a neonate which slows down their heart
rate momentarily so that you can better ausculate for murmurs.
Lungs
If you want them to take a deep breath, can have them blow out the light on the otoscope or can ask
them to pretend to blow out the birthday candles.
cannot developmentally pinpoint the
location of abdominal pain until they are at
least four years old, and perhaps not even
then. With symptoms and an exam that are& Summary
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