Need advise on how to do physical assessment on the wiggling 2 year old who cries?

[rainbowbright2]

You know the typical child who is frightened of strangers and cries and wiggles like crazy? How do you do a physical assessment effectively and help build parents trust when this is all happening? Do you go in and try to play with the child for a few minutes and then do the assessment after you build some repertoire in the child? I need advise please

[netglow, ASN, RN]

Whats worked for me in Peds rotation was to simply start a game. Monkey see monkey do. "This is a stethoscope I can hear your heart with it, and you can hear mine. Why don't you tell me if you can hear my heart first. Then, do you think I can hear yours too? What about your mommy's heart." Stuff like that.... can you show me where your nose is? Where is your belly button..... you get it.

[oguesswhat]

Hope they are sleeping. Sorry that's my only help. Oh or see if the parent can help. For example does child calm down when parent holds them? Then listen to their heart then. Ect

[gonzo1, ASN, RN]

I go into the room and say "who's the patient", usually everyone laughs. Sit down and start talking to the parents about what is needed. Usually the child settles down.

Then do the "monkey see" thing. Let parent hold child as much as possible.

The majority of my child examination is from eyeballing.

Is the child playfull, pink, laughing?

How does their breathing look etc.

As the last thing I listen to lungs and belly

Also, have stickers or stuffed animals etc to give

[Forever Sunshine, ASN, RN]

My peds instructor told us for smaller children to do the assessment on a doll(either theres or one you found from the playroom) first. Listen to the dolls heart. Have them listen to the dolls heart and your heart.

I never had the experience to do this cute little assessment in peds though.

[PICNICRN, BSN, RN]

An assessment on a kid this age can rarely be done in a textbook head to toe fashion.

First off, you can learn alot from a few feet away while the kid warms up to you. Start by talking to the parents while the baby is in mom or dad's arms- small talk or history/physical whatever. While you are chatting.... make an assessment on the kid... are they playful, and content, crying, agitated, flailing, or floppy? How about respirations? Do they seem to be breathing comfortably? Any noise- grunting or stridor or audible wheezing? Do you see retractions, tugging, flairing? How is their color? Flushed, sweaty, pale?? You can count respirations at this time too! Then.... WHILE STILL IN THE PARENTS LAP- use all of your games and tricks to get the kiddo to let you lay a stethescope on them- mostlikely, they will start screaming but thats ok. Always start with the least invasive- maybe check pulses and perfusion first, then try to listen to them, then come out with the thermometer and b/p cuff.

Remember- you can always go back and sneak a b/p cuff on them or get a temp while they are sleeping- this is also a great time to get a good listen to lung/heart sounds. Sometimes I just tell the parents- "He's not going to give me a b/p now, so could you please put your call light on when he falls asleep so that I can try again?" They are more than happy to do so. If you have good pulses, good perfusion, and UOP- you don't need to worry so much about obtaining a b/p just to document it on an uncoperative kid.

Be creative!

[vampiregirl, BSN, RN]

As an emt, I use many of the techniques suggested by other posters. One variation I had success with at times is to first perform the assessment on the parent or whoever is holding the child. This works great on things like pulse oximetry, bp, ascultation of lung sounds etc. I also try to provide a brief age appropriate description (noises or how it will feel) or analogy for what I'm doing. Other times distraction works great. Limited choices can also help in some cases - which finger you would like me to put this (pulse oximetry) on. In all, I'v discovered no one trick works for every child and with some kids no tricks work!