• 9 Tips and Tricks to Successfully Examine Kids (and Have Fun While Doing It!)

    Whether you are a comprehensive ophthalmologist or a super subspecialist, you’re going to have young humans come into your office at some point. Examining children can often be anxiety-provoking; however, there are a few key things you can do to make your pediatric exams successful and even fun.

    1. First and foremost, leave your anxiety at the door.

    If you are anxious, children will feed off that and become uneasy themselves.

    2. Make children feel like they are the most important people in the room.

    When you first go into the room, greet the child and show a genuine interest in him/her. Get down to their level and address the child by name. Comment on his/her cool Paw Patrol shoes or sparkly mask. Ask age-appropriate questions about his/her favorite class in school or what he/she likes to do with friends.

    3. Listen to parents and get them to help.

    Parents know their kids better than anyone else. You should not only listen to parents’ concerns about their children’s eyes but let them help you get a good exam. They will know whether their kids will do better sitting on their laps or sitting on a chair by themselves. They can also let you know what toys/shows will grab their kid’s attention.

    4. Be flexible, and don’t be afraid to switch up the steps in the child’s health exam.

    Although it can be useful to have a systematic exam when you are evaluating adults, you need to be more malleable when examining children. You may only be able to get a few key exam points, so make sure to do the most important things first. This will be different for every patient, so flexibility is the name of the game.

    5. Provide stickers, cartoons and toys to help you in the exam.

    For up-close attention, stickers are great. To get kids to fix their vision in the distance, use cartoons. Toys are useful for getting kids to look around during an indirect exam. Remember — one toy, one look! Have a few different toys on hand so that kids don’t get bored.

    6. Explain what you are doing, show them the equipment you are using and use simple language.

    One of the easiest ways to lose a kid's trust is by surprising him/her with something unexpected. Make sure to tell them before you do anything. The more you explain things, the less anxious the patient will be. You should also use simple, fun language to familiarize the child with the equipment you are using. Here are some examples:

    • Retinoscope = Flashlight
    • Indirect ophthalmoscope = Silly hat or “VR goggles”
    • Polarized glasses = Magic glasses
    • Slit lamp = Microscope with bicycle handles
    • Lenses = Magnifying glass or windows

    7. Be creative using your equipment.

    Slit lamp exams are notoriously difficult for children because it is hard to get them positioned in a standard slit lamp. A portable slit lamp may seem like a reasonable alternative, but it is tough to get a kid to sit still enough to get a reasonable view. Plus, most kids do not like you getting that close to their faces.

    Because of this, the retinoscope and indirect ophthalmoscope are your best friends. The retinoscope is not just for checking cycloplegic refraction. It is also a fantastic way to look for corneal changes and media opacities. It is especially great to use on kids who do not want you in their personal space since you can use it from several feet away. 

    The 20-diopter lens with an indirect ophthalmoscope can be used to get a more magnified view of the lashes and anterior segment. You can add this seamlessly to your posterior segment exam without the patient even knowing.

    8. Be persistent.

    It can sometimes take multiple attempts before you get a good exam on a child. Be willing to attempt different strategies throughout your examination to get the information you require. If you do not get everything the first time you see a patient, don’t worry. Bring them back and look again or give the child a 5-10 minute break and go see another patient

    9. Finally, stay positive and have fun!

    Give kids lots of praise throughout the exam and try to keep things lighthearted and fun. Just like the rest of us, children want to do a good job and will cooperate better if they think their efforts are being appreciated. 

    Don’t be afraid to be silly: Sing songs, pretend you can see things (what they had for breakfast or their favorite cartoon character) in the back of their eyes and make ridiculous noises. The kids will find it hilarious, and parents will appreciate your efforts. You can also use the instruments to guess their birthday, right eye tells you their birth month, left eye tells you their date. This buys you time to do your exam as you narrow it down from a month in the winter, to December. No one outside the room will ever have to know!

    The Academy’s YO Info Editorial Board is collaborating with YO leaders from our subspecialty society partners and thanks the American Association for Pediatric Ophthalmology and Strabismus’ YO Committee Chair Smith Ann Chisholm, MD, for contributing this article.

    About the author: Smith Ann Chisholm, MD, is an assistant professor of ophthalmology at the Medical College of Wisconsin, where she practices pediatric ophthalmology and oculoplastic surgery. She is the current chair of the American Association for Pediatric Ophthalmology and Strabismus YO Committee.