Tips for children's better cooperation during the examination of the head and neck: A Delphi method

ObjectiveTo obtain and rate tips for the head and neck examination in children.MethodsA 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.ResultsThe 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.ConclusionsSeven 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.