How to do a Pediatric Exam without Turning into a Crying Toddler
Welcome to fourth year, my little pumpkins.
I am currently knee-deep into my first externship rotation, which consists of ocular disease and pediatrics. Running in heels from advanced care to vision therapy certainly can keep one on their toes (literally)! The diversity of my days keeps me interested–although some of that can be attributed to the mild hallucinations triggered from lack of sustenance during 12-hour days.
By no means am I good at pediatric exams–or anything for that matter–but I decided to compile a list of tips and tricks I’ve amassed thus far to help newbies like me navigate their way into the terrifying mythical forest that is the pediatric/binocular vision sub-specialty.
Read these with a massive grain of salt. A small boulder, really.
1. Children, like grizzly bears, can smell fear. While seeing the latter may trigger your brain to adopt the “play dead” position, it is best to approach the child with blinding confidence. Do not allow them to witness your shaking hands or furrowed brow as you attempt to do MEM. Control the beads of sweat that are percolating on your brow. Botox was invented for a reason. If the parents ask you why you are crying, inform them the tears are merely a by-product of your excellent aqueous tear production.
2. Children are also masters of non-verbal cues. I find that it is very helpful to put your most terrifying piece of equipment on the counter and motion to it regularly when the child begins to act up. Your foreign body removal kit will do nicely.
3. Be assertive. While some colleagues are strong believers in the firm arm grip, I like to put my hand on their foreheads (first with the gentle pressure of someone taking their temperature, then like a metal clamp bearing down on them). Most adults also have the good fortune of being several feet taller than children, which naturally demands some sense of authority. I, unfortunately, look like their babysitter playing dress-up in a white doctor’s coat. You must work with what you have.
4. Keep your sentences short and sweet. While your ability to converse with anyone and complain about the weather and teenagers was a benefit in primary care, in pediatrics it is a detriment. Children will give you five minutes of unadulterated attention. Six minutes if you have a weird face. Do not waste that precious time engaging in an argument about SpongeBob Squarepants, no matter how convinced you are about the veracity of your argument. You will lose.
5. Lie. This one has gotten me far. Everyone wants to be told the truth. Everyone except a seven-year-old sitting in front of the air-puff machine.
6. Invite them to experience the bliss and contentment of the spa in your very own exam room. This can best be established by playing the dulcet tones of Finding Nemo in the background, which tends to enhance the tropicamide, cyclopentolate, phenylephrine spray. Tell them it opens up their pores (alongside their pupils), allowing their natural glow to radiate. See #5.
7. Snacks are always a good idea. A fed child is a happy child. Happy children allow novice optometry students to muddle their way through a pediatric exam with more lenience than their unhappy counterparts. Also, snacks force the child to be preoccupied with biting, gnawing, chewing and swallowing, allowing aforementioned clinician to panic without being noticed.
8. The LEA chart is your friend. And yes, it still counts if they call that weird shape an apple, a heart, a valentine, a bagel, a lady bending over, a pizza with a bite missing, or a cookie-shaped monster. I don’t have a good answer as to what that shape is supposed to be, and odds are, neither does LEA.
9. Invest in interesting targets to keep the child’s fixation. While the A on your stick may have set you back $10.95, it does not amount to much in the pediatric setting. Spend an afternoon cutting up stickers and pasting them on to tongue depressors. If you want to really excel, do research on the various age ranges and what interests them. A Popsicle stick with the faces of the boys from One Direction may be the most valuable equipment you own.
10. Fake it ’til you make it. In truth, much like the spider than dangles in your shower, they are more scared of you than you are of them. If you adopt the policy of being overly loud, aggressive, assertive, and unrealistically confident, pediatrics/binocular vision becomes a joy.
And once again, I am not in any way, shape, or form a good person to dispense advice–so you may immediately forget all that you’ve read. In fact, the only things I am an authority on is sour candy, celebrity gossip, and obscure Canadian history.
But if we are being real for a moment (as I am wont to do on occasion) binocular vision is a specialty that is exclusively within optometry’s realm. It seems like every other day, ophthalmology encroaches on our ability to manage disease and treat our patients medically, falsely believing we are not adequately trained to care for them ourselves. On the other side of the spectrum, some provinces now allow opticians to fit contact lenses and refract. And we are all guilty of being swayed by online retailers that give away the first pair of glasses for free.
If you want to carve a niche for yourself amidst all the noise, give pediatrics and binocular vision a second thought. You really do have the power to address issues that often go missed, and can change the course of a child’s future by allowing them to reach their potential. Many children get labeled with “ADHD” or dismissed as “bad students” when there’s really an issue with a CI, an AI, or an isometropic amblyope that’s preventing the the words from staying still and focused on the page. Take the time to give these kids a comprehensive binocular vision work-up, as you have been trained to do, and give them an opportunity to succeed where others haven’t. If this picture doesn’t tug your heartstrings… you are probably dead.
And yes, I do own a Popsicle stick with the faces of the boys from One Direction, which I may or may not have owned before coming to optometry school.