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In my experience, toddlers and preschool-age children tolerate the otoscopic examination much better when they can predict how long it will last. Many physicians use a little game or song to help the child through the ear exam. I simply count softly, as slowly as necessary, to three. When appropriate, I count in Spanish. The child soon learns to anticipate how long the exam will last. By 3 years of age, most children know how to count to three, and many join in. The only difficulty I encounter is when an eager parent also joins in, counting more quickly than I intended-but when that happens, I can always continue counting if necessary. Although this trick doesn't always work with the first ear, it usually succeeds with the other ear and on repeat visits.
Another trick I use, when the otoscope itself greatly distresses the child, is to shine the light directly on my diamond ring. The child's delight at the sparkles this produces often calms her anxiety.
Laura R. Viehmann, MDPawtucket, R.I.