Clinical Tip: Easy as 1-2-3

March 1, 2005

Examining the pharynx and tonsils of a 2-year-old is often challenging. I start by checking the teeth. While the child holds his mouth open, I put the tongue blade vertically on one cheek in a nonthreatening way and count 1. Then I insert the blade inside the other cheek and count 2. Finally, I quickly flip over the blade on the tongue, depress it, and count 3.

Examining the pharynx and tonsils of a 2-year-old is often challenging. I start by checking the teeth. While the child holds his mouth open, I put the tongue blade vertically on one cheek in a nonthreatening way and count 1. Then I insert the blade inside the other cheek and count 2. Finally, I quickly flip over the blade on the tongue, depress it, and count 3.

This strategy has always worked, even with difficult children. I don't ask very young patients to say "Aah" because most of them have had a traumatic experience with that request in the past.

Kala Reddy, MDPigeon, Mich.