My first experience in pediatric ward is totally different as compared to the elderly population. It was not quite similar to what we deal regularly in our clinics. During internships, students will have the opportunity to explore new places, people and all.
By day one, as I entered the department we have to report to the in charge and the senior ophthalmologist. As usual they issued some protocols. I was very interested to explore cases, procedures, interpretation and diagnosis. But everything turned to be upside down. Toddlers often feel anxious, fearful or overwhelmed in unfamiliar environments and during invasive procedures. At that time one familiar informant usually sits beside them for history taking which is the clue for diagnosis. The frequent complaints we often hear are watering, swelling, discharge, milky white appearance of pupil, adopting a different head posture, squint, eye shaking, sitting closer to digital devices.
The main part in examination is refraction (power check), where optometrist shine light directly to the pupil to view the light reflex. In that case, for ex, a 1 year old will not gaze at a distant object. Mostly babies and toddlers will be fear of switching the light off and examing them. A change in the gaze, will lead to a false power result. That was a challenging to many optometrist to gain the toddler attention. A spectacle prescription is the key solution for many ocular problems. A small error can lead to disruption in the visual system of the pediatric group.
Second part is the intraocular pressure check. It can be both automatic and manual with topical anesthesia. Manual is the best option in case of glaucoma. A small device is kept in contact with cornea and readings are measured. The risky one is corneal abrasion if the toddler or child shakes lightly.
The third part is fitting contact lens to pediatric group. They are prescribed for refractive error correction, therapeutic contact lens etc.
Not all kids are similar those who enter the clinics. Normal child, disabled, neurological defect children, dyslexia child etc. Procedures vary according to the conditions present.
CONCLUSION:
The key to smooth examination is welcoming the child with laughter, deviating them with attractive toys for examination, flash cards, optokinetic drum and virtual system for visual examination.
A mixed emotions we see in our clinics. Laughing, smiling, clapping, beating, dragging, vomiting child etc.
As a professional we have to be energetic and kid friendly in dealing them for every visits. A cross check with seniors is mandatory to avoid issues.
This my experience for a year in pediatric optometry department.
Do you have any experience in the pediatric department ? Share your experience
MBH/PS