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Tips for children's better cooperation during the examination of the head and neck: A Delphi method
Jacques E Leclerc1, Anne-Sophie Julien2, Louis David Leclerc3
1Department of Otolaryngology - Head & Neck Surgery, Centre Hospitalier Universitaire de Québec, Quebec City, Canada.
Insights
Seven expert-approved tips can improve head and neck examinations in children aged 2-6. Prioritizing eye contact, mood assessment, and a gentle approach ensures a better patient experience and examination success.
Area of Science:
- Pediatric Otolaryngology
- Clinical Practice Guidelines
Background:
- Effective head and neck examinations in young children are challenging.
- Standardized, evidence-based approaches are needed to improve examination success and patient comfort.
Purpose of the Study:
- To identify and rate expert-recommended strategies for conducting head and neck examinations in children aged 2 to 6 years.
- To establish consensus on the most effective tips for pediatric otolaryngologists.
Main Methods:
- A two-round Delphi study surveyed 13 pediatric otolaryngologists from North America and Europe.
- Tips were rated on frequency of use and usefulness using a 1-6 scale.
- Statistical analysis, including Wilcoxon signed rank tests and Bonferroni correction, identified "Top Tips".
Main Results:
- Forty-three tips were evaluated, with seven achieving top consensus (p ≤ 0.001) across all age groups.
- Key successful tips focused on initial engagement: eye contact, mood assessment, approach behavior, and strategy.
- Six additional tips were found satisfactory for specific age groups.
Conclusions:
- A consensus was reached on seven essential tips for examining 2- to 6-year-old children.
- Establishing initial eye contact and assessing the child's mood are crucial for a successful examination.
- A gentle approach, explaining procedures, and minimizing pain are vital components of effective pediatric head and neck examinations.
Objective:
To obtain and rate tips for the head and neck examination in children.
Methods:
A two-round Delphi method study was conducted to survey 13 practising paediatric otolaryngologists (PO) in North America and Europe to obtain tips on how to approach a 2- to 6-year-old child for head and neck examination. The tips were rated by the PO according to their frequency of utilization and usefulness on a scale of 1 (high) to 6 (low). One-sample Wilcoxon signed rank tests were used to evaluate each tip according to frequency of use and success rate. "Top Tips" were identified when both their Wilcoxon p-values were still significant, after a Bonferroni correction. An exact chi-square test for equality of proportions was used to determine the age groups for which satisfactory tips are to be favoured.
Results:
The panellists rated forty-three tips. Seven tips obtained a p-value ≤0.001 for the frequency of use and usefulness in all age groups with an emphasis on the initial moments: eye contact, mood assessment, approach behaviour and strategy. Six more tips proved to be satisfactory for specific age groups without reaching the top tip significance level.
Conclusions:
Seven tips to approach a 2- to 6-year-old child reached a top consensus between the experts. Initial eye contact with the child and mood assessment are essential for a satisfactory outcome. The use of a gentle approach with explanation of each step of the physical exam and avoidance of pain are also important.
