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Emergency Medicine News:
doi: 10.1097/01.EEM.0000432261.18664.0c
Second Opinion

Second Opinion: The Road Runner Theory of Pediatric Care

Leap, Edwin MD

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Dr. Leap is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, and of his own blog.

I've learned a few things about children over the years. Most of them have come from raising children, and the rest have come from caring for them as patients. My knowledge of kids makes it easier for me to take care of them in the emergency department, and knowing their hearts and their ways gives me great joy. I like to think that I become more like them as I know them better, and that my time on earth may not be any longer for it, but it may be richer.

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Here are my tips for taking care of children when they are your patients. Walk into the room, look at them, and smile. Don't give them that condescending smile you learned in medical school interviews. Just smile. Watch them because sometimes they'll smile back.

Move purposefully but slowly. No barging in, slamming down charts, jerking open cabinets, or yanking things off the wall. Modulate your voice. Don't yell if you need the nurse to get something. Say it softly, the way you say to your cat, “Let's go to the vet to get your shots.”

Sit down and talk to the child and the parents. Let your attention be a pendulum that moves between them. They both have things to tell you. First, compliment hi. Tell him you like his name or the stuffed hedgehog he is clutching. See what he is watching on television. It is useful to have at least a passing knowledge of cartoons so that you can tell them what your favorite is, or at least what it used to be. The Road Runner will likely always be with us. At the right age, video games or sports (or in certain locales, deer season) make great conversational topics to put the child at ease and show that you are not actually a monster.

Ask him, “Can I check you out?” Ask mom or dad to help if he says no. But again, move gently and carefully. Pretend you are trying to examine a frightened puppy. Odds are, things will go all right. The child will scream if you aren't kind, and the screaming and kicking and fighting will get squarely in the way of your exam and assessment.

If the screaming and fighting persist, be firm and have the parents and nurse hold the child in something reminiscent of the World Wrestling Federation while allowing plenty of air to pass in and out of lungs. Children, like small animals, are not always rational, and must sometimes be told and shown that they aren't in charge (despite endless empowerment talks from experts). You are smarter and bigger.

Cultivate that thing we don't discuss in medical school as you assess them; practice loving them. Imagine them at home playing, in the yard running, in bed snuggling. Imagine them well, and pray that you can return them to that state as quickly as possible. Unlike many adults, children have zero desire to be in the hospital, and disability means nothing except sitting in bed while other kids play.

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FastLinks

* Find all of Dr. Leap's books at www.booklocker.com.

* Visit Dr. Leap's blog at www.edwinleap.com/blog and follow him on Twitter.com/edwinleap.

* Read his past columns at http://bit.ly/LeapCollection.

* Comments about this article? Write to EMN at emn@lww.com.

© 2013 by Lippincott Williams & Wilkins

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