Clinical Tip: Nervous patient? Start with "Good-bye"

February 1, 2006

For some anxious children, the happiest moment of a visit to the doctor is when it ends. If I sense that a child is fearful, I start the visit by announcing that it is finished, saying good-bye to the parents and child, and even shaking their hands. Then, as I turn to leave the room, I look back at the child and say, "Wait. Before I go, I have to count your fingers," or, in the case of a little girl, "I have to see if you painted your fingernails." Once they are "almost leaving," most children don't mind showing me their hands so that I can count the fingers with them or comment on the painted fingernails. As I win the child's trust, I can say, "Finished. But before I go, let me see the color of your eyes." By this point, the child usually doesn't protest while I gather more data for the physical exam-and generally allows me to complete the exam without showing fear.

For some anxious children, the happiest moment of a visit to the doctor is when it ends. If I sense that a child is fearful, I start the visit by announcing that it is finished, saying good-bye to the parents and child, and even shaking their hands. Then, as I turn to leave the room, I look back at the child and say, "Wait. Before I go, I have to count your fingers," or, in the case of a little girl, "I have to see if you painted your fingernails." Once they are "almost leaving," most children don't mind showing me their hands so that I can count the fingers with them or comment on the painted fingernails. As I win the child's trust, I can say, "Finished. But before I go, let me see the color of your eyes." By this point, the child usually doesn't protest while I gather more data for the physical exam-and generally allows me to complete the exam without showing fear.

Elias Milgram, MDAventura, Fla.