This is the 54th #WILTW

A little chap who presented with a rash this week allowed me to capture some video footage I’ve wanted to obtain for some time. In lots of paediatric consultations it’s important to look in the throat of the child. This, as most junior doctors and parents will attest to, can be challenging. The secret is more in the technique of the parents than the doctors though and for some reason this isn’t well shared. This is a shame as Paediatricians can be quite judgemental of the poor quality throat exam performed by other specialties but never explain how they managed to visualise the tonsils.

A good opportunity arose when we had a little guy who wasn’t too fussed about opening his mouth but was still realisticially fidgety! Mum also had natural experience and huge thanks to her for consenting to demonstrate this video.

The key point is that the child’s back should be parallel to the chest of the parent (to be fair in this video this hasn’t quite happened). The parent then puts one arm around the child’s chest AND both the child’s arms and the other arm around their forhead. This should be quite a comfortable position at rest but as you can imagine you do need a decent grip for the squirming toddler.

This position is basically dependant on the confidence of the parent and the knowledge of the doctor to set them up in this position. I therefore share this as it constantly suprises me how often not knowing this results in a failure to visualise the throat properly.

For the child who won’t open their mouth levering the tongue depressor between the almost universal cross-bite that exists between the molars towards the back of the mouth often does the job.

A few viewings and a comment “oh – that’s how you hold…” proved it’s not all common knowledge but apologies to those for whom this is bread-and-butter clinical practice.

Many thanks to David for volunteering to examine and to the family for consenting to share the film in this way.

What did you learn this week?