Doctor Patient Relations

Children Patients: Engage the Child in the Exam and Build a Family Practice

By Teresa Narayan, OD

If you relate wellto children patients–and their parents–you can bring entire families into your practice. Their loyalty over time is the key to sustained success.

Manysuccessful eyecare practices are built on providing eyecare services to an entire family. To achieve this,you need to reach the gatekeepers of health care for the family, namely the mother and father.They will bring in their children for annual examinations, if first you educate them on the importance of regular eyecare for children. Further, once you have an entire family in your office, you must demonstrate an ability to work well with both parent and child.

Gain Referrals of Children Patients

We are an optometry/ophthalmology practice, established 25 years ago. Each month, our practice sees 75-100 patients under the age of 18.The pediatric population is less than the older population, but it’s growing. We have many avenues of referrals: primary care doctors, school referrals, and insurance panels are big sources. But we also have many family groups–usually this starts with a parent or grandparent patient who eventually gets the whole family to come in. We have been proactive about generating more younger families, and we benefitted when a large local employer switched to a vision plan that we accept.

Educate Parents on Importance of Eyecare for Children

I don’t think the general public has a great understanding of the importance of comprehensive or routine exams for children. Countless numbers of parents come themselves year after year but only bring their child in if they fail a school screening. I try to take a proactive approach when I know a patient has children. I’ll ask if the kids have had an exam recently (or ever) then I’ll usually have to explain why a school screening is not as thorough as an exam.

I explain that not only can kids easily “cheat” on a screening but there are many things that can interfere with eye development but that are often missed in a screening. Latent hyperopia, muscle imbalances, and most ocular diseases commonly go undetected without a comprehensive examination. I also mention amblyopia and the importance of catching any decreased vision as soon as possible.

Have Parent in Exam Room? Depends on Parent-Child Relationship

Some kids need their parent in the room to be comfortable. And, actually, many parents would be uncomfortable sending their child in alone. I usually have the parent come back to the room at least initially so I can get a good history and hear their concerns. If the exam would work better without the parent, it’s usually apparent during those first few minutes. If that’s the case, then after the history I’ll say that that’s all I need from them and send them to the waiting room. Or I might ask them to move to a chair in the back corner where the child can’t see them. But I do think it’s helpful to have the parent in the room at least at the beginning of the exam.

Don’t Talk Over Child’s Head

In your communication with children, no need to reach them on their leveland avoid talking down to them. It helps to keep the parent in a corner where the child can’t see them. If a parent keeps interrupting, then I’ll wait for a good stopping point between tests and might ask them to go to the waiting room for a bit and promise to bring them back in at the end. It’s sometimes a little tricky to do this, but phrasing it in diplomatic terms helps.

Reconcile Varying Stories from Parent and Child

Fairly often, we hear varying stories from parent to child. These fall into two situations. The first is that the child has complaints, but the parent thinks everything is fine. This may be because the child really wants glasses so they exaggerate their problems. There are many tips and tricks to get a child to give useful subjective answers. Encouragement goes a long way. Putting plano lenses in a trial frame and having the child read the chart is an old trick that works well. You may have to mostly rely on objective tests (e.g., retinoscopy, cover test) in some cases.

Bringing the child back for a second day of testing to confirm results can also be helpful. It may also be the case that the child really does have a visual problem but the parent does not recognize it. This is harder to deal with and it really just comes down to good patient and parent education. Here it becomes vital to explain the potential long-term consequences of ignoring the problem.

The second situation, where the parent seems to have a long list of complaints, but the child says everything is fine, is also tricky. Of course you first just need to do a very thorough examination and then determine if the child really does have a problem or not. If there is a need for glasses or treatment, the child will probably resist because they think they have no problems.

I try to put myself in their shoes and think back to when I first got glasses when I was 8 years old. I remember puttingon that first pair and being amazed at how clearly I could see. I never even knew what I was missing! A trial frame with the child’s Rx can help demonstrate this. Listen to the child’s concerns and try to be empathetic. Explain why the treatment or glasses you are prescribing will help them be healthier or see better. If the exam shows that the child actually sees well and is healthy, then it’s usually just a discussion with the parent that their concerns are valid but that currently no treatment is necessary.

“Hey, isn’t this cool?”

Letthe child get familiar with the instruments. I’ll let them push a button on the auto-refractor, shine the transilluminator on the ceiling, hold a high plus lens or a prism and let them look through it. I approach this as, “Hey, look at this, isn’t it cool?” And after they get a chance to look at it, they give it back to me and I’ll say, “Now can I look?” ThenI turn around and do the testing that I need to do. Making things a game also helps. I’ve found that being at ease with the child and letting them participate helps make the exam more fun and less scary.

Overcome Parents’ Hesitancy to Spend on Children’s Eyewear

There are parents who will settle for nothing less than the best, regardless of cost, but I think most tend to spend significantly less on their children’s eyewear than on their own. Usually this is because parents are worried that their child will break or lose their glasses, which is certainly a valid concern. However, the importance of well fitting glasses that the child actually likes cannot be underestimated. Kids simply don’t wear their glasses if they don’t fit or are bent or are just a style that they don’t like, especially if they didn’t want glasses to begin with.

I always take the time to explain the importance of full-time wear and amblyopia risk (if applicable). I mention that a child is much more likely to wear glasses that they picked out themselves. I also briefly touch on the benefits of scratch resistant and anti glare coatings, something that parents often choose for themselves but don’t think to get for their children. The optician will then take it from there and hopefully find the right pair for the child at the right price point for the parent.

Hire or Train Opticians to Work Well with Children

Our opticians are great with children. They really try to get the child involved in the frame selection process. The optician should let the child pick out a couple pairs of frames by themselves first, without regard to size or fit yet. Once the optician gets an idea of the style that child likes, they can direct them to frames that will work well. If the child needs some help getting started, asking their favorite color can be a starting point. Again, getting them involved rather than just letting the parent take charge really makes the process easier for the child.

Offer at Least a Corner of Reception Area for Children

We have a corner of the reception area with smaller chairs and a large selection of children’s magazines and a few toys. The dispensary has a smaller wall dedicated to only children’s frames and the boards and mirrors are set lower to cater to kids. I think having this separate area makes them feel special and helps them get involved which is crucial.

Related ROB Articles

InfantSEE: Bring Whole Family Into Your Practice

Improve Communication in a Pediatric Eye Exam

Make Your Practice Teen-Ready

Teresa Narayan, OD, is an associate at Shoreline Eye Associates, P.C., in East Haven and Guilford, Conn. To contact: teresanarayanod@gmail.com

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