I totally ruined the last post with my humor-cum-neurotic antics. So back to the difficulties in examining pediatric patients.

The whole “take a good history and physical” mantra kind of goes out the window when the human you’re trying to help doesn’t do that whole “talking” thing or that whole “sitting up” thing, or especially the “can you do what I’m asking you to do” thing. It really makes you hone your ability to draw conclusions from limited information and to use tricks to get the information you need. A couple things I’ve picked up (post yours in the comments!):

Checking reflexes requires the patient to relax their joint, but it’s a tough sell on a squirming infant. Even distracting them doesn’t always work.
“Follow my finger” to check eye movements can be tough. Following a toy or a face seems to be much easier.
Use the parent. They can soothe the savage beast, and keep the child’s attention while you’re busy poking and prodding them. Plus, they’re usually all you’ve got for the history, if the kid’s too young to talk.
Let kids see your instruments before you use them. Makes them less scary. Warning: the hyperactive children will throw your reflex hammer, and may almost hit a nurse in the eye. Keep instruments away from them.
Get on the child’s level. You’re much less intimidating there.

Other tricks, my medblogging colleagues?

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