BC Children’s Hospital, Vancouver, British Columbia Correspondence: Dr David F Smith, BC Children’s Hospital, 4480 Oak Street, K1-125, Vancouver, British Columbia V6H 3V4. Telephone 604-875-2130, fax 604-875-3021, e-mail docdfsmith@aol.com Accepted for publication January 28, 2013 Physicians, both men and women, can appear imposing or even frightening to some children. I’ve found that an initial discussion with the parents, preferably while seated and with the youngster playing with toys in the room, works best as a start. Acceptance of your presence by a child requires time. Once the examination is about to begin, I’ll have a parent hold a toddler on his or her lap to provide the child an initial sense of security. If the child is a bit older, I’ll often have the parent place the child in an upright seated position on the side of the examination table to avoid, initially, putting the child in a recumbent position. Children usually feel more in control in a sitting position and are less inclined to cry. I tend to avoid standing initially; I’ll move on an office chair with wheels over to the side of the examination table. This puts me on the same level as the child and is less threatening to the youngster than standing over him or her. I’ll start with an examination of the feet while the youngster dangles them over the side of the table. There’s a lot to be learned clinically from the feet. They are also the most distant body part from the head, which, in turn, is usually the area of greatest examination concern for the child. Once the foot examination is completed, you can remain seated and still examine the heart, listen to the chest, check the legs, arms and hands and then, finally, stand up to examine other areas. If there’s been no crying up to this stage, then the remainder of the examination usually goes smoothly. Don’t forget to check the scalp. Even in our best Vancouver (British Columbia) schools, lice checks usually result in a discovery rate of at least 1% to 2%. In addition, there may be the odd old head laceration, reflecting past injury, which will appear as a whitish scar in the scalp area. I once saw a 12-year-old youngster from the British Columbia interior for a failure to thrive assessment. His scalp examination revealed 30 old scalp lacerations, none of which were apparent on initial inspection. On questioning his mother, she reported him as being “clumsy”. I telephoned the child’s local hospital to obtain his emergency records, and discovered that no medical care had ever been provided for any of his full-thickness scalp lacerations. After his subsequent permanent removal (by provincial authorities) due to long-standing child abuse, his growth and mood improved significantly.