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The Approaches to Examining a Toddler: Tactical Tips for Toddlerology
The “Parent First” or “Watch [Parent] Do It” Strategy: employing the philosophy of having a taster for monarchs because if [parent] does not die after you look in their mouth then it must be okay.
The “Toy Checkup” Strategy: only useful if the kiddo brought their own toy, generally, but kind of fun to show them how you will listen to their chest or check their ROM or look in their ears… (can be combined with the “You Try” strategy–see below)
The “You Try” Strategy: Hand over your stethoscope or your otoscope or reflex hammer or tongue depressor or whatever. Let them touch it and understand it’s not threatening. (WARNING: Toddlers are gross and indiscriminate with their bodily fluids, so be prepared for an unexpected goober/booger/vomit and ALWAYS, ALWAYS clean/dispose between patients!). If going for combo of “Toy Checkup” + “You Try” or “You Try” + “Parent First”, show the kiddo how to do the maneuver for their turn, then it is your turn to check on them, etc.
The “Taking Advantage of Developmental Imagination” Strategy: Stethoscope = special heart, lung, and tummy telephone. Otoscope = lava checker/sucker; otoscopy = checking for [cute or silly thing] inside ears (I tend to accompany this with, “Hello? Are any [cute/silly thing(s)] home? Nope! No one is home. Maybe they’re on the other side?”). Abdo exam = “Did you eat [silly thing]? Maybe I can find it in your tummy!”, or “Did you know that your tummy is also a drum? Listen here! *proceed to percuss*”, or “Where are the [silly/cute thing(s)] hiding in your tummy? Let’s find them…”
The “FOMO” Strategy: Younger kiddos often want what their older siblings have… if you’ve got a cooperative older sibling, examine them first with the little one watching. They usually want what their older siblings have, so they might even be eager for their turn to have their ears checked…
The “Sound Effects” Strategy: Anything you need to palpate or make general contact with in the toddler’s sphere of personal space should have a sound effect. Personally, I’m a fan of “boop boop”. Other kids really like singing and music…
The “Kindasorta Bribing” Strategy: …this one I find is pretty hit-or-miss, but sometimes the thought of a reward will get a bit of cooperation. Always remember that our little friends love stickers.
The “Monkey See, Monkey Do” Strategy: Sometimes you kinda just walk in there, wave at the kiddo and make funny faces at them and get them to warm up to you, and then do the stuff you want them to do and they just… do it. I find it SUPER cute when I do this for MSK exams to check neurovascular status after an injury or for neuro exams, particularly finger-to-nose testing… it’s just so magical.
The “Smoke and Mirrors [and Additional Screentime]” Strategy: I cannot stress enough how powerful distractionis…
The “Yeah… You’re Just Not Having It So Let’s Get This Over With” Strategy: …you just do the thing and you do it as quickly as possible and GTFO. The kid’s already crying, screaming, and trying to get away from you by any means possible so you might as well make it short.
(Sometimes I have so much fun with these that I come home and tell my significant other all about these exams and re-enact them on him and he just sits through the whole thing and laughs at me but is also like, “Wait did you come up with that on the spot?”, to which the answer is usually “yes, and I love doing it” or “at some point but since then I just do the same thing depending on the kid” and he just laughs and then I realise that he doesn’t see a single beanerino during his workday and I am immediately sad for him because that is really sucky.)