CLINICAL

  pediatrics

A Child’s View

How children see the eye doctor and how to put them at ease

LEONARD J. PRESS, O.D., F.A.A.O., F.C.O.V.D.

Remember going back to the house you grew up in and being amazed by how much smaller everything looked to you? Even if all you did was drive by, you probably had that perception.

Keep in mind that perception is reality, and for children everything is magnified. Yes, children are smaller than adults, making all they see appear larger. But, this is also true when it comes to their experiences because much of what they go through is new. So, it is not surprising that a trip to any kind of doctor can provoke anxiety, and eye doctors are certainly no exception.

Anxious children may not only make the eye exam process a challenge, but render results that reflect added stress. Something else to keep in mind: If young patients find visits with you stressful, they may protest so strongly against future visits that their parents stop taking them to see you.

For all these reasons, it’s imperative we put our young patients at ease. Here are some ways to accomplish this.

1 Have books on hand

Consider asking parents to present to your office earlier than usual, so they can read one of the several books available to assuage the child’s fear about the eye doctor. In addition, having such books on hand may make the child excited to see you when his or her name is called for the exam.

Some examples of books: Halley the Nearsighted Hippopotamus, I Need Glasses: My Visit to the Optometrist, Arlo Needs Glasses and I Can See Just Fine, to name a few. I Can See Just Fine, for example, is about a girl named Paige who insists she doesn’t need to go to the eye doctor, despite the fact that she has trouble seeing the chalkboard and anything else. Her parents decide to take her to the eye doctor’s office, where she achieves clear vision and goes through a fun frame selection process.

2 Ditch the white coat

The apprehension that children have about their initial visit to the eye doctor is one reason we doctors don’t wear white coats, and the staff doesn’t wear what looks like nurse uniforms.

Early in my career, when I walked in to the examination room in the Pediatric Unit of The Eye Institute at the Pennsylvania College of Optometry, a young child began sobbing uncontrollably. His mother volunteered that he was afraid of doctors. I told his mom I’d be right back. I went in to my office and took off the coat. When I returned to the young patient without it, he was fine. Though I generally wore the white coat due to institutional policy, I resolved not to wear one when in private practice.

3 Put parents at ease

Very young patients will take cues from their parents as to how to respond to you. So, the more relaxed you can make mom or dad, the more the child is likely to be reassured that you’re okay.

When I sense that the parent is generally apprehensive, I demonstrate to the parent first many of the procedures that I’m going to do, so that both the parent and the observing child know it isn’t anything to be concerned about. In addition, this enables the parent to reassure the child as needed.

4 Create a safe environment

The old adage about patients not caring about how much you know until they know how much you care is true even through a child’s eyes. To create a safe environment for the young patient, I’ve seen colleagues adopt a goofy approach, in which they act silly, speak in a high voice, meander about like a cartoon character or do magic tricks. Personally, I want my patients to view me as a kind and understanding parent or grandparent figure. In other words, someone who genuinely cares about them and can also be fun during the encounter. To accomplish this, I’ll often turn the exam around and let the child do a procedure on me, or I’ll do it to myself first. For example, I will look through a lens or prism while looking at the patient to show nothing “bad” happens. And, if a patient is worried about a drop in the eye, I’ll put a drop on my finger and say, “See? It’s wet; it’ll feel like a raindrop in your eye.”

Make them want to return

Your interaction with children makes a lasting impression. Although we see many children in our practice on an ongoing basis for vision therapy, even patients you haven’t seen for a year may ask you to recreate the magic you did with them the prior year. The fun may be something as simple as the chair going up or down, or making a fixation bird across the room tweet with a hidden button on your control panel. OM

DR. PRESS IS THE OPTOMETRIC DIRECTOR OF THE VISION & LEARNING CENTER IN FAIR LAWN, N.J. HE SPECIALIZES IN PEDIATRIC VISION. HE COMPLETED HIS RESIDENCY PROGRAM IN PEDIATRIC OPTOMETRY AT THE EYE INSTITUTE OF THE PENNSYLVANIA COLLEGE OF OPTOMETRY, AND SERVED AS CHIEF OF THE PEDIATRIC UNIT OF THE EYE INSTITUTE. ALSO, HE’S A DIPLOMATE OF THE AAO AND HAS WRITTEN THREE TEXTBOOKS ENCOMPASSING PEDIATRIC OPTOMETRY AND IS A DIPLOMATE IN THE PEDIATRIC OPTOMETRY/BINOCULAR VISION AND PERCEPTION SECTION OF THE AAO. E-MAIL HIM AT VISIONLECTURE@GMAIL.COM, OR VISIT TINYURL.COM/OMCOMMENT TO COMMENT ON THIS ARTICLE.