Assessing children in a paediatric eye clinic is something I really enjoy. Assessing children with complex needs is even more rewarding as it requires more creativity and ‘thinking outside the box’. It may not always be possible to achieve sustained cooperation and fixation from children, and therefore, good preparation is key.
Practice
It may sound obvious, but practice makes perfect. The more often a skill is practised, the more proficient the practitioner will become. It can be tempting to only reach for the retinoscope or binocular indirect ophthalmoscope when you have no other option. Practitioners may skip these assessments and instead rely on auto-refraction, previous test results, fundus photos and OCT for the majority of patients. However, by routinely practising their clinical skills, practitioners are better prepared when they encounter children with short spells of fixation and cooperation.
Preparation
Is your room child-friendly? It can be helpful to look at your consulting room through a child’s eyes: Are there any things lying around that could upset them (e.g., eye drops, scary equipment)? Are there a lot of things within reach that they are not allowed to touch? Are there any tripping hazards? Have you got some toys?
What do you know about the child? It is a good idea to familiarise yourself with the case notes, referral letters and any other information that is known about the child before you ask them to come into your room. Other staff members may have observed behaviours that could potentially make the sight test more challenging, and this is valuable information. The parents may have informed the practice about communication preferences or neuro-diversity. It is important to take note of these things.
Priorities
Who is your priority during a paediatric consultation? The child! But are you giving the child priority by addressing them directly? Or do you engage in lengthy discussions with the parents about the child?
What examinations should be prioritised? You may not always be able to perform every test due to the child losing concentration and focus. Therefore, it is wise to decide which tests are most important given the case history and reason for the assessment, and to perform the most relevant tests first.
Is the child ready for the assessment?
Children cooperate better when there are no obvious unmet needs, such as hunger or fatigue, and when they feel relaxed. Some assessments (retinoscopy and ophthalmoscopy) can be performed whilst the child is asleep. When active cooperation is required, the practitioner needs to build a rapport with the child. A child is more likely to cooperate when they trust the adult and when they are having fun.
Are you ready?
Have Fun!!!
