None listed
Conditions
Brief summary
Examination of the throat is a routine part of the examination of an unwell child, but is usually saved until last as it is often challenging and upsetting to a younger unco-operative child. The traditional method of examination, described in paediatric textbooks, is for the child to sit on the caregiver’s lap, facing the doctor, with the caregiver restraining with one hand around the body and arms and the other around the head, possibly with the child’s legs gripped between the caregiver’s knees. Over the years the principal investigator has developed an alternative technique for in young children which he believes to be easier and less upsetting. This technique requires the examiner to sit opposite the caregiver, and positions the child supine with the head on the examiner’s knees and the child’s trunk and bottom supported by the caregiver’s lap. The caregiver holds the child’s hands. The head is controlled by the examiner’s knees and the throat is examined upside down. All children under the age of three years referred to the Paediatric Assessment Unit in Taranaki Base Hospital in whom a throat examination is clinically indicated will be eligible for the study. Informed consent will be obtained from the caregiver. The child will be randomly allocated to one of the two methods using random number generated allocation in sealed envelopes, stratified by age range (0<12 months, 12<24 months and 24<36 months). The only exclusion criteria will be lack of consent, or a clinical contra-indication to examining the throat (e.g. croup). The two methods will be explained to all staff participating and a laminated sheet describing each method will be available in the study box. The doctor examining the throat will use the allocated method. If it is not possible to complete an adequate throat examination by the allocated method then the other method may subsequently be used. The caregiver will rate the examination on a Likert scale for a) Upset to the child b) Ease of restraining the child The examiner will rate the method on a Likert scale for a) Ease of examination b) Adequacy of view The time taken to complete a throat examination will also be recorded.
Interventions
Comparison of two methods of examining the throat in young children (under 3 years). Traditional method of examination involves sitting on the caregiver's lap facing the examiner with head, legs and arms restrained by the caregiver, as described in a standard paediatric textbook (Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman, RE (Eds). Nelson’s Textbook of Paediatrics, 19th Ed (2001) Chapter 628). The new method involves the child lying supine with head on the examiner's knees and pe
Comparison of two methods of examining the throat in young children (under 3 years). Traditional method of examination involves sitting on the caregiver's lap facing the examiner with head, legs and arms restrained by the caregiver, as described in a standard paediatric textbook (Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman, RE (Eds). Nelson’s Textbook of Paediatrics, 19th Ed (2001) Chapter 628). The new method involves the child lying supine with head on the examiner's knees and pelvis on the caregiver's lap. This will occur as part of the normal examination routine and will take approximately 30-60 seconds in either case. It will be done only once, using one or the other of the described methods as allocated by randomisation.
Sponsors
Taranaki Base Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
1 Days to 3 Years
Healthy volunteers
No
Inclusion criteria
Children presenting with acute medical problems where examination of the throat is clinically indicated.
Exclusion criteria
Throat examination is contraindicated. Informed consent not obtained from carer. Seriously ill requiring urgent intervention. Previously recruited to study during current admission.
Outcome results
None listed