Clinical evaluation at the oral level is of greatimportance, especially in pediatric surgery because it will depend on the ageof the patient and the confidence he has in the medical team, most of thechildren will have difficulties to be evaluated orally because initially Mostchildren do not like to be examined by strangers, even if it is their doctor ornurse.
When a pediatric patient becomes anxious, theadministration of treatment can be especially difficult. The situation can beemotionally stressful not only for the child, but also for their parents andoften, for the nurse and the caregiver.Since our little patient enters the consultation we cansee the presence he has, from that moment we are doing a first extraoralexploration. Once we hear it we must give confidence, and we must move on to athorough exploration. Starting from the outside of the oral cavity and thenanalyzing its interior with all its structures. Always following a systematicapproach when exploring the patient. Example an extraoral exploration,intraoral exploration, dental exploration, periodontal exploration.
In the extraoral examination, symmetries and facialasymmetries should be evaluated in the mid sagittal plane, superciliary plane,sub nasal plane and submental plane. Do not forget to examine the lymph nodesin search of adenopathies without forgetting that we must lose the consent ofthe parents who accompany the patient, educate them and explain why we aredoing all the steps in their children to complete the evaluation. The palpationshould be done methodically with the patient’s head relaxed, but remember thatbeing in the pediatric area depends on the patient’s age and cooperation, andfor that reason it is better that we can do it as a game to distract thepatient.
A good oral exam requires the examiner to usemost of their senses. The inspection by direct or indirect vision must be donewith good lighting, it is advisable to use a magnifying glass to increase thesize of the anatomical structures or if there are some injuries. The palpationwith 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 ofexamination or any other physical exam that will be performed, we must emphasizethe patient’s age. It is not the same to examine a child about one year of agecompared to a teenager who turns out to be easier in the latter. Distraction isa method that the pediatrician or pediatric nurse will have in a stress-freeenvironment to reduce discomfort for the child, as well as being a room withadequate temperature and environment without medical instruments thatespecially 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 tomake a previous evaluation at home to meet with the doctor so that at the nextappointment patients feel more comfortable because they know that is part ofthe game that was previously done from their homes. This is highly valuedespecially in the dental evaluation where children and only hearing the noiseof dental machines will be uncomfortable, but if they know that it is a gamethey could be more relaxed and allow the evaluation by the dentist. Rememberthat these professionals have training in this type of patient where patiencewill be the secret of oral evaluation.How to reduce the anxiety of younger patients in stayswhere they provide health:1-Practice calmAnxiety is contagious; it is usually evident in yourvoice and body language. A health care provider who shows anxiety only servesto increase the nervousness of young patients and their parents.2-Speak through experienceMany times, pediatric patients are anxious because theydo not know what to expect.
The best way to mitigate your fears is byrecognizing and communicating with them. Include children in the conversationas appropriate for their age and level of understanding. 3-Play musicThe power of music as an agent against anxiety has beenstudied for decades. By playing soft and relaxing music, either in the examroom or through the headphones that are given to the patient, can offer a quickanxiety relief to a fearful child.
4-Use distractionsGet involved by asking about the school, your favoritetelevision shows, your pets and your friends. Encourage them to share stories.The more they concentrate on these issues, the less they will inhabit theirfears.5-Offer a giftFew things can help children shift gears faster than presentinga reward. Pediatric patients are hyperactive, giving them the opportunity tochoose a small toy from a treasure chest.
6-Be educationalOne of the best ways to change a child’s perception ofthe hospital is to arouse their interest.7-Make physical comfort a top priorityOne of the main reasons why children fear the hospital isbecause they are afraid of feeling pain. Even if the reason for your visit iscausing them a greater amount of pain than any discomfort caused by aninjection or blood draw. Applying an instant topical anesthetic will not onlyhelp improve patient comfort, but knowing that you will feel less pain can helpcalm the nerves of patients.1,2,3,4