Source: Heather Collette and Jaideep Talwalkar; Yale School of Medicine

The key to a successful exam of a toddler or preschool-age child is building rapport and trust between them and the provider. Toddlers, in particular, may be wary of strangers and unwilling to cooperate with the physical exam, which is expected age-appropriate behavior. In order to provide good care and create a comfortable patient experience, clinicians need to tailor their interaction to the child's developmental stage. Ensuring positive medical encounters for children will increase their likelihood of seeking medical care as they age into adulthood. Clinicians must be creative and flexible as they work with children to achieve their care goals. Suggestions on how to facilitate these interactions will be covered in this video, with less of a focus on specific organ system components, as these are similar to other age groups.

Toddlerhood through preschool age is a time of significant physical and developmental growth. Progression of language, motor, and social skills is a reflection of children's brain growth and social environment. Normal development follows a typical progression, but exact time points for achieving developmental milestones can vary among children. Achieving a specific milestone a few months later than another child or based on a time point listed on a development chart does not necessarily indicate a problem. Providers must ensure that children meet developmental milestones as expected and, if not, refer them early for special services to promote the best outcome possible. 

1. Building rapport and empowering the patient

1. Start by sitting several feet away, giving the child time to become comfortable.
2. To build rapport with a young child, provide direct but non-threatening attention in the form of informal conversation or play. Such attention is not possible if a child is sleeping or very ill.
3. For toddlers and young children, avoiding prolonged direct eye contact during the initial part of the visit will allow them to observe and recognize that pediatrician