October 29, 2019 | POSTED BY | Articles, Clinical Pearls, Optometry School
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Many prospective optometry students lean toward pediatrics as an initial “specialty.” I admit, I am one of those students. Reality did hit hard, though, when my shins got the brunt of a youngster’s kick because of a fear of eye drops. Pediatric eye exams are much more complex than one might imagine!

What does it take to examine a child’s eyes?

To examine a child’s eyes, one must have a creative and determined outlook. Quick and accurate skills with swift movements, capable of dodging small-‘n-mighty limbs and an assortment of theatrical voices and facial expressions are also necessary. Shiny, noisy, light-up or colorful toys that can easily hide in a white coat pocket, along with energy by the gallon, will also serve you well. But, you must have one of the most fundamental requirements of a pediatric eye doctor: patience.

Rushing children during the exam will not gain you trust. As a pediatric doctor, one must coax the tiny patient to smile and laugh, interact with you, and tell the truth. The sequence of a pediatric exam is not set in stone. Observe the patient’s responses and be flexible with his or her comfort zone.

The exam chair isn’t always necessary, so hopefully your floor is clean and comfy. Think of your exam room as more of a playground than a lane, and the equipment as fun toys rather than scary instruments. Children’s songs should be first up in your musical repertoire. Give the kids a chance to have fun and gently guide the exam to get the data you need.

Hot Tips for Icy Situations

The dynamic of a pediatric exam is expanded to include you, the patient, and the family. Family can mean mom and dad, and maybe all of the siblings, too. Perhaps grandma, grandpa, or a relative as the guardian. Get the relationship info at the beginning when you introduce yourself. The opinion of you by the family members matters an incredible amount – the patient would not be seeing you without them.

Every family has a different personality to offer once in your exam lane. Helicopter adults will likely take up more chair time. Precede their questions in your patient education. Explain a tidbit more about the future effects of their child’s conditions. Discuss what improvements can be done at home. Ensure that their efforts of bringing in the child are much appreciated. Always leave your door open (metaphorically) and allow them to contact you any time with concerns. Then, expect one or two more questions because there are always more.

Unattached adults can be a challenge as well. These are the people you have to rely on when you put the ball in their court, like having to get the child to wear the prescribed glasses, putting prescribed medication in a child’s eye, or putting on the eye patch every day. Pediatric doctors must be able to convey the utmost importance of the treatment plan; without the guardian’s aid, the patient will be fighting a losing battle. And you will be frustrated when they are lost to follow up, or come back and have forgotten your meticulous instructions. Gain their attention. Give them the tools; have parents repeat the plan back to you and hand out step-by-step instruction sheets. Use fun phrases that are easy to remember, like “If the glasses aren’t on your face, they’re in the case!”

Even with all these tools, sometimes the kids are just not cooperative; the infant is tired and grouchy, the toddler is not interested in any of your toys or the pre-teen is upset about something else and does not care about their eyes at this point. Best advice – truck on the best you can. You can only do so much. Try to find the patient’s motivating factors, appease their anxiety with positive reinforcement, maybe even offer a bribe of candy. Be firm with your agenda, but not so pushy that you scare them. If special needs or other factors become too strong of a blockade, reschedule or refer for a sedated exam. It may seem extreme, but these exams are very important to complete successfully. Do not excuse misbehavior and monitor in a year – there may be an underlying problem that you are unable to assess.

What about the dilation drops?!

Before instilling any drops, make sure to explain to the guardian why they are necessary. Dilation is recommended with every eye exam – adult or child. One reason is for eye health. We make sure the cable from the eye to the brain is healthy, and the retina shows no signs of swelling, bleeding, holes or tears. Another reason for children is for their glasses prescription. Children are really good at focusing, and tend to overuse their accommodation muscles. The dilation drops relax all of these muscles, so we can assess their eye’s true prescription. With a larger pupil, retinoscopy is much easier and we can use a light and loose lenses to determine the glasses. Thus, no need for a response from the little ones.

Pediatric dilation is one of the most heart-wrenching moments in any optometrist’s career. Fend off tears by withholding any sense of fear yourself. You must be calm, jolly, and quick. Have the patient sit on the guardian’s lap. Drop both eyes very quickly, if possible. Don’t stand over the patient waiting; they will sense any bit of hesitation. If siblings are in for an exam, drop the older one first; they are more aware of the situation and usually have a stronger demeanor. Infants can be restrained, if necessary. At any age, you will likely have to pry a child’s eyelids open – just do it quickly! Then, distract them with a song or toy and the worst is over.

Why Pediatrics Is Your Niche

Working with kids can be overwhelming. But with some practice, it all becomes more routine. Overall, your services are highly rewarding and the benefits of children’s eye exams are immense. You detect and treat strabismus and amblyopia. You can rule out optic nerve edema and ocular inflammations when a patient complains of headaches. You enable faster learning abilities with vision therapy. You foster positive self image with personalized frame selects and contact lens fittings. You make an impact on the child’s entire future – school, work, and socialization. You give children a new life, one they could not imagine beforehand. Take advantage of this influential opportunity!

 

Interested in pediatrics, but don’t have the patient volume?

  • Volunteer with educational services for kids, offered by your state’s Optometric Association (RealEyes in Ohio)
  • Become InfantSee certified, a program supported by the American Optometric Association
  • Integrate school screenings at community events
  • Meet-and-greet with local pediatricians and give them your referral information
  • Talk with all parents in your chair about the importance of vision care in children