August 2005

A child's first check‑up ‑‑ The examination

by Dr. Ogi Ressell

Okay. You've done the consultation with her child, and mom was cool about the whole thing ‑‑ even if you weren't. That's what an anti‑perspirant's all about, isn't it? So what if your shirt's soaked inside? Everybody gets nervous at times, but why now? It's just a child.

What makes it worse is that the mother of the child you're about to check appears to be really calm and relaxed while you're totally embarrassed that you can't get out the words you want to say. Here you are, a grown up, with a college education and a degree, yet you feel totally intimidated by this very short and cute seven‑year‑old girl in front of you.

To make matters worse, she asks straight out, "why are you sweating?"

Here's where you, a rational, well‑adjusted adult ‑‑ one who's spent years studying the art and science and philosophy of chiropractic ‑‑ start to babble defensively.

Have I missed anything?

This seems to be a common scenario for many doctors who aren't accustomed to seeing children. Relax. It gets better the more children you see ‑‑ like anything else! That's why they call it practice.

So, you're ready to start the examination. Make certain that you're well‑equipped to see children. Your little patients should be gowned in their own cool gowns! This speaks well of you and your office.

Have a very flexible doll close at hand in case you need to explain what you mean by the forces of delivery and the role they play in causing vertebral subluxations. This doll is also very handy in showing mom the stresses on baby in cases of in‑utero constraint where, in the last trimester of pregnancy, the baby may be "trapped" in the uterus and have nowhere to go. Make it as graphic as is needed to make your point without evoking any fear. I'd hold the doll horizontally, facing the mother for instance, and bend the doll in such a way that it shows a definite spinal curve, in order to explain a "transverse lie" to mom. I haven't yet met a mother who doesn't get the idea that to correct a spine that's been trapped in such a position might take a bit of time.

The important thing here is to make mom understand what you see and what you find, a very difficult thing to do we're told. Nonsense. It's not that difficult at all. All you need to do is place yourself in the parent's shoes.

How would you like to be talked to? As an equal? Absolutely. With technobabble? No!

How would you, as the child, like to be handled? With great respect? Yes. At his or her level? Of course!

As I mentioned last month in the introduction of this series, I suggest that you ask the child's permission to examine her or him before you begin your examination. Here's what I say: "I'm going to check to see if your Power is On. Would that be okay?" The child will most often say "okay," and you can begin. Notice the words I use, most often. Sometimes not. Sometimes you may need to reschedule the exam until he or she's okay with it. C'est la vie!

Please remember that the "Power On‑Off" approach works well with 2‑to‑12‑year olds. Don't try it with someone who's 14. You'll be labelled as a loser, a jerk, pathetic, and totally uncool ‑‑ not a good way to build trust!

Now, you're ready to begin. The cute seven‑year‑old is standing on the floor, in her gown ‑‑ with her mother ‑‑ waiting for your direction. Have the child stand in front of you with her back to you ‑‑ you're right behind her. Make sure her mom is behind you so that she can see what you see ‑‑ this is crucial! In front of the child, mounted on the wall and in mom's line of sight should be the postural chart from Professional Design Group (800‑353‑3082) entitled, "Would Your Child Pass This Test?" It shows parents postural changes they may see in their child and assigns those changes a numerical value. If the total scores are added up and are over five, it indicates that there may be a problem ‑‑ a great way of imparting reality.

Be able to demonstrate any obvious postural deviations this child may have. Low shoulder, low ear, high hip, obvious curvature, knee extension, Erector Spinae spasm, etc. It's important that mom can see what you see and that it becomes her reality. What's most important, however, is that she's in agreement!

(Chiropractors who do mall screenings or health fairs often try to convince a parent that his or her child has a low shoulder, for example, asking, "Can you see the low shoulder?" The parent usually says, "No. Not really." To which the DC replies, "Really? It's really low on the left side. See?" The parent capitulates and says, "Well, maybe a little.")

Many of you reading this are thinking that this child is not starting care anytime soon. You're right! The reason is that there's no reality ‑‑ and no agreement.

I'll continue my ruminations next time...

(Dr. Ogi Ressel, author, researcher and an x‑ray and pediatric specialist, teaches The Practice Evolution Program, the "fastest‑growing coaching program on the planet." Visit online at www.practiceevolution.com and take the Practice Health Mini‑Checkup. Dr. Ressel may be contacted by e‑mail at drogi@practiceevolution.com or by calling 800‑353‑3082.)