Clinical evaluation at the oral level is of great
importance, especially in pediatric surgery because it will depend on the age
of the patient and the confidence he has in the medical team, most of the
children will have difficulties to be evaluated orally because initially Most
children do not like to be examined by strangers, even if it is their doctor or
When a pediatric patient becomes anxious, the
administration of treatment can be especially difficult. The situation can be
emotionally stressful not only for the child, but also for their parents and
often, for the nurse and the caregiver.
Since our little patient enters the consultation we can
see the presence he has, from that moment we are doing a first extraoral
exploration. Once we hear it we must give confidence, and we must move on to a
thorough exploration. Starting from the outside of the oral cavity and then
analyzing its interior with all its structures. Always following a systematic
approach when exploring the patient. Example an extraoral exploration,
intraoral exploration, dental exploration, periodontal exploration.
In the extraoral examination, symmetries and facial
asymmetries should be evaluated in the mid sagittal plane, superciliary plane,
sub nasal plane and submental plane. Do not forget to examine the lymph nodes
in search of adenopathies without forgetting that we must lose the consent of
the parents who accompany the patient, educate them and explain why we are
doing all the steps in their children to complete the evaluation. The palpation
should be done methodically with the patient’s head relaxed, but remember that
being in the pediatric area depends on the patient’s age and cooperation, and
for that reason it is better that we can do it as a game to distract the
A good oral exam requires the examiner to use
most of their senses. The inspection by direct or indirect vision must be done
with good lighting, it is advisable to use a magnifying glass to increase the
size of the anatomical structures or if there are some injuries. The palpation
with the fingertips must be done with gloves, it can be digital or bidigital.
Olfaction helps us diagnose some diseases that have a characteristic odor.
In the preparation of the child for this type of
examination or any other physical exam that will be performed, we must emphasize
the patient’s age. It is not the same to examine a child about one year of age
compared to a teenager who turns out to be easier in the latter. Distraction is
a method that the pediatrician or pediatric nurse will have in a stress-free
environment to reduce discomfort for the child, as well as being a room with
adequate temperature and environment without medical instruments that
especially scare children, such as injections or needles.
If the child does not allow the examination,
depending on the clinical case, we must talk with the parents and allow them to
make a previous evaluation at home to meet with the doctor so that at the next
appointment patients feel more comfortable because they know that is part of
the game that was previously done from their homes. This is highly valued
especially in the dental evaluation where children and only hearing the noise
of dental machines will be uncomfortable, but if they know that it is a game
they could be more relaxed and allow the evaluation by the dentist. Remember
that these professionals have training in this type of patient where patience
will be the secret of oral evaluation.
How to reduce the anxiety of younger patients in stays
where they provide health:
Anxiety is contagious; it is usually evident in your
voice and body language. A health care provider who shows anxiety only serves
to increase the nervousness of young patients and their parents.
2-Speak through experience
Many times, pediatric patients are anxious because they
do not know what to expect. The best way to mitigate your fears is by
recognizing and communicating with them. Include children in the conversation
as appropriate for their age and level of understanding.
The power of music as an agent against anxiety has been
studied for decades. By playing soft and relaxing music, either in the exam
room or through the headphones that are given to the patient, can offer a quick
anxiety relief to a fearful child.
Get involved by asking about the school, your favorite
television shows, your pets and your friends. Encourage them to share stories.
The more they concentrate on these issues, the less they will inhabit their
5-Offer a gift
Few things can help children shift gears faster than presenting
a reward. Pediatric patients are hyperactive, giving them the opportunity to
choose a small toy from a treasure chest.
One of the best ways to change a child’s perception of
the hospital is to arouse their interest.
7-Make physical comfort a top priority
One of the main reasons why children fear the hospital is
because they are afraid of feeling pain. Even if the reason for your visit is
causing them a greater amount of pain than any discomfort caused by an
injection or blood draw. Applying an instant topical anesthetic will not only
help improve patient comfort, but knowing that you will feel less pain can help
calm the nerves of patients.1,2,3,4