Of new people, the baby has fears,
And if you want to look in the ears
With tricks of propriety
Avoid stranger anxiety
You can do it, in the absence of tears.
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and, honoring a 1-year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska. Since the pandemic, I worked telemedicine, a COVID-19 clinic, a VA clinic, and spots Texas, Iowa, and Pennsylvania. I am back in Iowa, circuit riding rural clinics.
I walked into the exam room. I kept a visual barrier (in this case a copy of American Family Physician) between me and the 10-month-old patient, while I interviewed the parent.
My med school peds rotation taught us how to restrain children to examine their ears, but when I did an externship on the Northern Cheyenne Reservation in Montana in 1979, I saw an older locum physician dismiss a nurse about to hold down the baby, and touching the otoscope to the kid’s arm and shoulder, said, “See, this doesn’t hurt here, or here, or here…,” and got to look at the ears of a calm patient, not twisting or screaming. Then she (the doc) straightened up and said to me, “If the child screams, the face turns red, and if the face turns red, the eardrums turn red.”
When I got my own children I figured out that babies so desperately want to learn to talk that they’ll freeze if you touch a part of their body and name it. Of course, with short attention spans, the immobility only lasts about 3 seconds.
With that start, and taught by my kids, along with some very interesting reading here and there, I built up a repertoire of maneuvers based on the patient’s developmental age.
On Sunday, I took care of a lot of peds at an Urgent Care in another state.
It takes humans 10 months to figure out the difference between family and not family, and as soon as they do, they develop stranger anxiety.
We can see at birth, but it takes us 9 years to learn how to organize visual information coming from our eyes to our brains. The 10-month-old in question, I knew, could tell faces but didn’t perceive the rest of people’s bodies as important. (Think of kindergartners’ family portraits with arms and legs coming from heads.) For that age group, I keep a visual barrier between me and the patient while I talk to the parent.
In this case, I didn’t put down my magazine till I sat, facing away from the patient, seated on the parent’s lap, facing to the parent’s left, then I rotated towards the back of the child’s head, keeping one hand up to avoid eye contact before diving in with the otoscope.
More important than the color of the eardrums was finishing the exam without making an enemy of the patient.
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