When examining toddlers, most will be reluctant. But do not look them in the eye and divert their attention by making a mouth noise. I will make a medium-pitch “boop boop” noise as I work my stethoscope up, maybe touching the parent or the child’s leg. And while doing the exam, I will make a clicking sound. But don’t look the child in the eye! It works most of the time to keep children consoled. — RHONDA HERTWIF, PNP, Hendersonville, N.C. (201-6)



These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.