When attempting an abdominal exam on an older child or adolescent who is ticklish, ask the patient to place his (her) hand on top of yours and press down with you. You can put your other hand on top of the patient's hand to help. This maneuver seems to "fool" the patient's body into thinking that the pressure is from his own hand, reducing the tickling sensation. Both you and the patient will be amazed at the results, which include a softer abdomen for you to examine.
Kathlene S. Waller, MD, MPHFort Collins, Colo.