Article Text

Supine positioning of toddlers for throat examination
  1. JONATHAN O’B HOURIHANE,
  2. ELIZABETH J LAMBERT
  1. University Child Health
  2. Mailpoint 803
  3. Southampton General Hospital
  4. Southampton SO16 6YD
  5. Friarsgate Practice
  6. Friarsgate Medical Centre
  7. Winchester, Hants SO23 8EF
    1. YVONNE M d’ART
    1. University Child Health
    2. Mailpoint 803
    3. Southampton General Hospital
    4. Southampton SO16 6YD
    5. Friarsgate Practice
    6. Friarsgate Medical Centre
    7. Winchester, Hants SO23 8EF

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      Editor,—Many toddlers are intimidated by the approaches of a doctor who wishes to view the throat. In contrast to the conventional sitting position used for throat examination by paediatricians,1 dentists use a less threatening approach, with the child lying semirecumbent on the parent’s knee.2We have compared the acceptability of the two positions in a prospective, randomised case-control study .

      With verbal parental consent 36 children (10 in general practice, 26 in hospital) were randomised to the ‘supine’ or ‘sitting’ group (17 sitting , 19 supine, giving 17 case-control pairs).The supine position required the mother to lie the toddler supine on her lap with his head resting either on her knee, or on the doctor’s knees. With the child supine throat examination took place in a fashion akin to a dental examination or a neonatal intubation.

      Only four children—two in either group—had not had their throats examined before. There was no difference in examination time in either position (sitting mean (SD) 17.3 (9.4) sec, supine 16.9 (6.7) sec, unpaired Student’s t test, p=0.85). Cooperation was equally common in each group (p = 0.28). 12 of 15 (80%) in the ‘supine’ group who had been examined before thought the supine position was better than the sitting position used previously.

      The supine position for throat examination is at least as acceptable and well tolerated as the sitting position. Explanation of the unfamiliar, supine position takes longer than normal. Once the child is supine the examination usually takes 2 or 3 seconds and does not require the doctor to crouch or peer to view the throat adequately. Positioning of toddlers supine makes throat examination more acceptable to parents and, in our experience, much easier to perform than the traditional sitting position.

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