Clincial Tip: To calm anxiety, play the physical exam by ear


Before approaching an anxious preschool or early school-age child to perform a physical examination, I tell the child that I need help because sometimes I forget where to listen with the stethoscope. I ask the child if he (she) knows where to listen. Most children reply that they don't know. I "listen" to the foot and ask if that's the right place. A subtle negative shake of the head is the usual response. Then I "listen" to the middle of the forehead, which usually makes the child laugh. After that, the child generally points to the chest or belly and happily cooperates with the examination.

Adam Keating, MDWooster, Ohio

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