Many thanks to Theresa Frey, Pediatric Emergency Medicine attending from Cincinnati Children’s, for sharing this one with me. Note: I have embedded a couple of their videos, but the file sizes are large. You can also watch them on the Annals of Emergency Medicine website.

I remember when I was an intern, and I genuinely felt bad when a small child screamed at me. now, 15_ years and 3 children of my own later I understand, bit cognitively and innately that sometimes children will just not be happy with you. They are often scared, developmentally wary fo strangers, tired and sick or injured. That’s why this article from Krauss et al. in a recent edition of Annals of Emergency Medicine is such a good read for all of you who are new to the Pediatric Emergency Department or who want to brush up on tactics to approach the frightened and anxious child.

Krauss and Krauss. Managing the Frightened Child. Annals of Emergency Medicine, 2018.

Here are some techniques, highlighted in the article with links to video examples.

Keep your distance

Approaching the scared child too quickly is a sure fire way to get them to recoil from you. Begin your approach by keeping a wide boundary. Don’t just swoop in and examine them. Know where the child is in relation to the parent and take your cues from that positioning. More fearful children will be closer to the parent. If the child is playing independent of the parent it suggests that they will be more engaged with you earlier on in the clinical encounter.

Courtesy of Annals of Emergency Medicine – accessed from

Help children acclimate themselves to the environment

This article mentions several helpful techniques to help scared children get used you, and the often scary, unfamiliar environment of the Emergency Department.

  • Desensitization Allow children to touch, or “play with” items used during the examination. This can include the stethoscope, tongue depressors and the otoscope.
  • Matching Mirror the child’s posture and tone and pace. Watch for signs that they are relaxing – like uncrossing arms for example and match this.
  • Focusing attention Once the child is engaged use developmentally appropriate techniques to help get them to pay attention to you. In the preschool aged child this could be something as simple as counting. In older children discussing areas of interest are more appropriate.
Courtesy of Annals of Emergency Medicine – accessed from

In a neat twist they call the final stage “Bluetooth pairing”

It’s a likely hokey I’ll say – but I think the authors were trying to engage with the modern audience through the use of this colloquial term. Plus, you engage/pair with the child and then leave their life “unpair” like a Bluetooth device, so it makes sense.

You should ideally proceed to the physical examination once you’re sure the child is engaged with you and not fearful. In all honesty this takes years of practice. But, I like this article and its videos because it will help give you some strategies to try out, and a framework to consider before you enter the room. Don’t just “wing it.” Don’t assume that “all children love you.” Remember, the ED is a scary place and the child is often ill or injured. A thoughtful approach, lost of practice and observing experts and reading material like this one can help you accelerate your engagement with the frightened child. Good luck!


Krauss and Krauss. Managing the Frightened Child. Annals of Emergency Medicine, 2018.