Examination by Age

For infants and young children, the examiner must create an atmosphere of trust. Friendly advances dur­ing history-taking or while the child is at play allay initial fears and anxiety.

As the parent gradually undresses the child, gen­tle touch and tickling or funny sounds with a smile help to maintain relaxation and to facilitate hands-on examination. Inspection and palpation of body parts and gentle movements to examine tone are performed at this point. The examiner should be prepared to improvise if the child shows increasing anxiety.

The actual hands-on examination, consisting of bodily handling and manipulation, is the last stage; anxiety-provoking or painful tests are deferred to the end. If the examination requires placement of the child on a table, the mother can sit at the end and let the child’s head rest in her lap. With anxious chil­dren, performance of gross motor activities, such as sitting, crawling, standing, or walking, also can be conducted through the parent. One should note the quality of movements, postures, weakness, incoordi­nation, asymmetry, or reflex abnormalities that reflect a motor deficit. Range of motion, deep tendon reflexes, or primitive reflexes that need physical manipulation should be examined after evaluation of active mobility. Tests that require instrumentation, such as sensation, fundoscopy, otoscopy, and oral function, conclude the examination.

Giving choices involves the preschool child in the examination. For example, the examiner may ask, “Should we look at your arm or leg now?” On the other hand, questions such as “Can I look at your arm?” should be avoided because if the child says “no,” con­frontation results. Parents can often bring out many capabilities of their children without the examiner touching them.