ICU and You · Aphorism Series · Number 37
“Be wary of the toddler who readily and happily lets you examine them.”
An aphorism is a compressed argument, not a rule. It earns its shape by leaving things out, which is exactly what makes it memorable and what makes it arguable. Every one in this series is contestable, and chosen because it is.
Each is a mantra, a paradigm, a truism or occasionally a plain myth — something repeated in our units often enough that nobody examines it any more. The piece sets out the case for it, the case against it, and the case for something in between, and then asks which you hold.
There is no right answer waiting at the bottom. The point is to find out what you actually believe and why, because the beliefs that run your practice at three in the morning are mostly ones you have never said out loud.
A well two-year-old meeting a stranger in a strange room should object. Wariness of unfamiliar adults appears in the second half of the first year and is at its height through the second; it is not a defect of character but a developmental achievement, and it is the reason paediatric examination is a negotiation rather than a procedure. The child who submits without complaint has skipped a step that healthy children do not skip.
Resisting you is expensive. It takes muscle, breath, an intact conscious state, and enough spare capacity to care what is happening. A child who is working hard to breathe has none to lend to fighting you. Nor does the child who is hypoglycaemic, shocked, postictal, encephalopathic, poisoned, or lying still because movement hurts. So compliance is not the absence of a finding. It is the presence of one, and we tend to record it as “examined easily, cooperative” and move on.
There is one more reason a small child does not protest at being handled by an adult stranger, and it has nothing to do with physiology. A child who has learned that objecting does not help, and who watches the room rather than the person touching them, is telling you something else entirely.
The difficulty, and the reason this is an aphorism rather than a rule, is that placid children exist. So do children who have been examined a hundred times for a chronic condition, children whose parents have prepared them well, children absorbed in a screen, and children whose response to unfamiliar people is simply not the expected one. The aphorism gives you a question. It does not give you an answer.
Have you ever been quietly relieved that a child was easy to examine — and been wrong?
Send it back to me either way, with your Yes, No or Maybe. Themes, and the best of your responses, go into a coming newsletter.
The button opens a reply straight to me with the headings already in it. If your device blocks it, write to icuandyou@icloud.com instead.