PHYSICAL EXAMINATION
Every child should receive a complete systematic examination at regular intervals. One should not restrict the examination to those portions of the body considered to be involved on the basis of the presenting complaint.

Approaching the Child
Adequate time should be spent in becoming acquainted with the child and allowing him/her to become acquainted with the examiner. The child should be treated as an individual whose feelings and sensibilities are well developed, and the examiner's conduct should be appropriate to the age of the child. A friendly manner, quiet voice, and a slow and easy approach will help to facilitate the examination.

Observation of the Patient
Although the very young child may not be able to speak, one still may receive much information from him/her by being observant and receptive. The total evaluation of the child should include impressions obtained from the time the child first enters until s/he leaves; it should not be based solely on the period during which the patient is on the examining table. In general, more information is obtained by careful inspection than from any of the other methods of examination.

Sequence of Examination
Skill, tact and patience are required to gather an optimal amount of information when examining a child. There is no routine one can use and each examination should be individualized. Ham it up and regress. Get down to the child's level and try to gain his trust. The order of the exam should conform to the age and temperament of the child. For example, many infants under 6 months are easily managed on the examining table, but from 8 months to 3 years you will usually have more success substituting the mother's lap. Certain parts of the exam can sometimes be done more easily with the child in the prone position or held against the mother. After 4 years, they are often cooperative enough for you to perform the exam on the table again.

Wash your hands with warm water before the examination begins. You will impress your patient's mother and not begin with an adverse reaction to cold hands in your patients. With the younger child, get to the heart, lungs and abdomen before crying starts. Save looking at the throat and ears for last. If part of the examination is uncomfortable or painful, tell the child in a warm, honest, but determined tone that this is necessary. Looking for animals in their ears or listening to birdies in their chests is often another useful approach to the younger child.

If your bag of tricks is empty and you've become hoarse from singing and your lips can no longer bring forth a whistle, you may have to turn to muscle. Various techniques are used to restrain children and experience will be your best ally in each type of situation.

Remember that you must respect modesty in your patients, especially as they approach pubescence. Some time during the examination, however, every part of the child must have been undressed. It usually works out best to start with those areas which would least likely make your patient anxious and interfere with his developing confidence in you.

18 Months-Examination of Child