Making a game of the pediatric exam

Key Points

A new pediatric patient mixed into the middle of a busy comprehensive ophthalmology practice often is a schedule-breaker.

First-time pediatric patients frequently are reluctant to be examined. Fear exists-of eyedrops, of a shot or some other painful procedure, of the examination room with all of its very strange-looking instruments, of the people (aka, strangers), often wearing the dreaded white coats, who work in the practice.

Unfortunately, convincing a young patient that there is nothing to fear can be very difficult, especially on a first visit, when you probably will use eyedrops. If you or the parent force the issue, the reluctant and frightened child often will start to scream and cry, creating a huge scene in the otherwise serene waiting room.

How can you avoid creating a negative experience and make a pediatric patient feel welcome and the parents feel secure about the eye exam? A few minor modifications can make a huge difference to everyone.

Building blocks of an exam

The patient doesn't think of the eye exam in its component parts. The receptionist, the technician or assistant who begins the examination, the nurse who instills the eyedrops, and the ophthalmologist who performs a fundus exam all are "the eye doctor" to a young patient. The parking area, the waiting room, and the exam room are part of the same eye-exam experience for the patient.

Waiting rooms can be great places for kids. Some offices have a special computer loaded with video games for older children to play or hand-held computer games that older children check out from the receptionist. An area with a flat-screen monitor that shows movies and cartoons, or a large fish tank with tropical fish (very colorful) are popular sources of entertainment for all ages.

A simple change of seating arrangements also can be helpful. Replace a few single chairs with small love seats or couches, allowing families to sit together. Where a family of two parents and two children would use four chairs in a standard waiting room, they might choose to sit together on a small couch instead, leaving more space for other patients.

Game time

Calling the patient from the waiting room to the exam room is an opportunity to ask the child how to say his or her name and talk about things the child likes to do and "the games" he or she will play. You can comment on an interesting feature of the child's clothes, such as, "It looks like you have new shoes. Do they make you run faster?" Being a little silly sometimes breaks the ice.

Say, "Let's go play some games." Even though an older child might be skeptical, he or she often will ask a follow-up question: "What kind of games?" You get an opportunity to introduce some of the tests before you and the patient even get to the exam room. This is also a great time to answer the inevitable question about shots. Saying, "We don't give shots here" is a good way to reduce fear for the patient.

Tests for stereopsis can be fun for children. The Randot Stereo Tests are "magic" because one only can see the picture when wearing special "magic glasses." The red/green glasses for the Worth 4-dot test are like "stop and go" glasses for the magic flashlight. If you have moving fixation targets or movies for distance fixation, you can teach the magic of the "captain's chair." If the child is sitting in the exam chair, a wave or shout from the patient will "wake up" the animals or turn on the movie. Talking directly to the patient also is helpful. Young children are very literal, however. If you have a stereo test with a picture of a fly, ask whether the wings look as if they stick up in the air. When you ask whether the wings stick up, some older children may say no even if the wings appear in 3-D, because they know that the wings don't really stick out of the pages.