I wrote "How Primary Care ODs can Profit from Pediatric Practice" some time ago....but its basic premise is still true today and you may find this useful.

2. Foreword: Why Pediatrics? Getting Started in
When we announced our newest publication, Pediatric Optometry PediatricsNision Therapy
& Vision Therapy, a loyal reader of High Performance Optometry wrote 1. To decide whether expanding your pediatric/vision therapy
to express h i s concern. "Older patients a r e t h e largest a n d fastest- practice is right for you, do some basic research about your office a n d the
growing segment of the population," h e pointed out. "Why concentrate community you serve.
on pediatrics?"
a) Comb your patient charts to find out:
An excellent question for practitioners, more t h a n for publishing
companies! Here a r e the top 5 reasons you should consider expanding a What percentage of your current patients a r e children age
the pediatric portion of your practice: 1 2 a n d under? What percentage a r e age 13 to 18?
1. The demographics ARE right. So many "baby boomers" a How many of your adult patients have children who aren't
a r e having children of their own t h a t there's a "mini boom" occurring. seeing you? If this number is significant, you have built-in
They're having fewer children than past generations, but this typically growth potential.
means they have more disposable income for health care. b) Consult your local reference librarian or Chamber of Com
merce to learn the following:
2. Since 80% to 90% of all learning is mediated through the
visual system, many children need expert optometric care. For a How many children i n your a r e a a r e age 1 2 a n d under?
example, in a New York study of 1,634 children, 53% failed a t least one How many a r e age 13 to 18?
oculomotor, binocular, accommodative, or visual perception test. Other a Is the community growingor stable? How many new homes
studies show t h a t vision dysfunctions a r e even more common in the have been built there recently? How many companieshave
learning disabled, who comprise 11% of all schoolchildren. moved i n or out? Are there any new schools?
a W h a t is the income level of the parents i n your area? C a n
3. Adults are more likely to make appointments for chil-
dren than for themselves. When it comes to eye care, most parents they support specialized care for their children?
take care of their children's needs long before their own. Some reluctant If you subscribe to a commercial database, such as CompuServe,
patients even "test" a new doctor by bringing a child in first. you can instantly obtain much of this information for minimal cost. I
4. Working with children who a r e learning and growing can be recently conducted such a demographic search for one of my students
more psychologically rewarding t h a n relieving the symptoms of who was planning to buy a practice in a certain community. For $10 I
got a profile of the county's population by age, occupation, race,
elderly patients with progressive ocular disease.
household income, a n d other helpful data.
5. Children are the lifeblood of a practice. Win a child's
2. The clinical skills necessary for pediatric exams a r e not all
friendship now a n d you're likely to have a n enthusiastic "optometric
t h a t different from many of the techniques you currently use. However,
missionary" for decades.
you'll need to depend more heavily on objective assessment techniques.
This booklet will give you pointers about how to win those friend- The advantages include quick assessment of refractive error, oculomo-
ships a n d enhance your reputation for excellence i n "family practice." tor dysfunction, a n d eye health. Obtaining these clinical skills requires
If you have other ideas you'd like to offer for publication in our taking courses with workshops t h a t allow for hands-on learning a n d not
newsletter, please let u s h e a r from you! being timid i n applying these newly-learned skills i n practice.
Will Kuhlmann 3. To supplement hands-on courses, you should consider sub-
Publisher scribing to publications which specialize in pediatric optometry: Jour-
nal of Behavioral Optometry (Optometric Extension Program Founda-

3. tion, 714-250-8070),Journal of Optometric Vision Development (College persistent squinting i n one eye
ofOptometristsinVision Development, 619-425-6191),and the newslet- poor academic performance
ter I edit, Pediatric Optometry & Vision Therapy (Anadem Publishing, red eyes
Inc., 800-633-0055, 614-262-2539). The latter is a "Reader's Digestn
newsletter of clinical articles from a broad range of optometry, ophthal- reluctance to open the eye
mology, general medicine, and special education and rehabilitation wandering eye movements
journals. I n addition, it regularly includes tips for marketing and watery eyes
managing the pediatric portion of your practice.
2. Keep track of which of your adult patients have young
4. Once your academic and clinical skills are in place, send children. On your new patient questionnaire, ask for the names of all
notices to your established patients, announcing that you are now other immediate family members, their date of birth, a n d their year in
offering specialized services for children. school. Question parents occasionally (or have your staff question them)
about whether their children are exhibiting any of the signs above. This
5. Include information about children's vision and vision ther- is a practice-builder, but even more importantly, you'll be likely to catch
apy in your practice newsletter, informational pamphlets, and presen- problems while they're still treatable.
tations to community groups. The AOA h a s "news backgrounders"
available on these and 10 other topics. They present facts and statistics 3. Once a patient's children have reached school age, ask about
in jargon-free language, so the information is ideal for sharing with the their grades and whether they're having any difficulties with reading or
public. Contact the AOA Order Department, 243 N. Lindbergh Blvd., studying. Stress t h a t 80% of learning is dependent on vision.
St. Louis, MO 63141,314-991-4100.
4. Here's a n especially persuasive fact. (You may remember this
from the AOA News a while ago.) A study a t the Optometric Center of
The Best Marketing Technique: Maryland concluded that vision problems almost certainly contribute to
juvenile delinquency. Over 98% of the 132 delinquents studied had
Education learning-related vision problems (inability to perform vision tracking
required for reading and writing, inability to copy from a chalkboard,
1. Thorough, understandable patient education is the #1 way to inability to discriminate left-right, lack of eye alignment, a poor near-
set yourself apart from retailers. In written handouts a n d face-to-face, point of convergence, and a decreasing ability to reachlgrasp).
tell parents:
5. The medical history form for your young patients can do
That you can examine a child who is too young to answer double duty a s a n educational tool. Include the following items, with
questions. explanations about why you're asking:
That children should have their first eye exam a t age 6
months to 1year. Child's birth weight. (Explain t h a t low birth weight i s a
risk factor in retinopathy, visual-motor problems, visual
That infants with a family history of a serious visual development, and moderate to high refractive errors.)
disorder should be examined even earlier.
Whether there was any difficulty in labor, or whether
That parents should watch children for the following con- there was delivery by forceps. (Explain that both are risk
ditions: factors i n extraocular muscle damage.)
abnormal appearance of the eyes Parent's assessment of the child's reading performance.
avoidance of readin~schoolwork (Explain that poor performance can be related to refractive
excessive sensitivity to light or binocular problems.)
lack of fixation or following Parent's assessment of the child's skill in copying text.
(Explain that letter reversals beyond age 7% can be related

4. to perceptual problems.) 7. Don't approach children right away, even if you've examined
6. Train your staff about the importance of ongoing pediatric them before. Even infants need time to look around the examining room
vision care, so they can remind parents, too. Your assistants should be and get used to your voice. If the parents are present, chat with them
able to explain the recommended age for first exams, the difference for a minute. Childrenhave changeable emotions and won't react to you
between your exam and a school vision screening, and the rationale for the same way a t each visit.
the tests you perform.
8. During the exam, fix 90% of your attention on the child. I
7. When a new patient calls to make an appointment, your front position myself so that I'm eye-level with the patient, not towering over
desk assistant should inquire whether any children in the family need him or her. I smile frequently. I'm sincere in the warmth and caring
appointments, too. I t seems obvious, but you'd be amazed how many attitude I project, because children can instantly spot a phony!
practices neglect this.
9. I direct the majority ofmy questions directly to the child; when
8. Your personal computer can be used to prepare sophisticated the parent's confirmation is needed, I turn to him or her after the child
educational materials. Some of the options include distributing free answers. This makes children aware that they're the important ones in
software programs to patients, schools, and rehabilitation centers; the examination.
putting informational files on a computer "bulletin board"; and prepar-
ing your own brochures using desktop publishing. For more informa- 10. Make conversation, just a s you would with a n adult. Sample
tion, see the book I co-edited, Computer Applications in Optometry conversation starters: "What's your favorite TV program? Do you have
(Butterworths, 1989). pets? Dolls? Toys? How many children are in your family? Are you the
oldest? Have you been on any trips? Did you see the Easter Bunny? Do
you have your Valentines ready? What are you going to be on
Putting Children at Ease Halloween? When's your birthday? Are you going to have a party?
What is that you brought with you?"
1. Get children into the examining room as quickly as possible.
The longer children wait, the more restless they become. 11. Try to use a soft, non-threatening tone of voice. (If you're not
sure how you sound, it's a good idea to tape yourself.) Listen for
2. Speak to children directly, a t their eye level. For example, a t questions-about having to wear glasses, having a n operation, going
the first appointment, introduce yourself to the child as well as to the blind-which may be disguised a s casual remarks.
parent. This communicates respect for the child's feelings.
12. Tell and show the child what you plan to do. For example: "I'm
3. Take time to find out what name the child goes by. For going to cover one of your eyes with this paddle, then 1'11 cover the other
example, Michael might prefer Mike or Mikey. one."
4. If you permit parents in the examining room, have them ask 13. Be truthful: if the eyedrops are going to sting a little, say so.
their child whether he or she wants their company. 1'11usually say somethinglike, "These drops may be cold or stinga little."
After I put the drops in, 1'11 ask the child to count to "5" while squeezing
5. Consider inviting the whole family into the examining room. my finger. When the child concentrates on counting and squeezing,
This helps young children feel even more secure, and observing siblings , they soon forget the stinging!
may give you clues to a child's visual problems. Allow family members
to view the stereo fly or other " 3 D tests. 14. More tips about eyedrops:
6. If the parents will be present, ask them not to make any a. Cathy Tibbetts, O.D. of Farmington, NM puts the drop on the
comments during the exam unless you direct a question their way. (Do end of a fluorescein strip (or another type of filter paper) and dabs the
this out ofthe child's earshot.) Of course, you'll want to assure them that paper on the inside of the lid a few times. "Kids don't mind if you tell
you'll answer any questions they have, a t the end. them you are just going to touch their lid with a little piece of paper," Dr.

5. Tibbetts says. "It doesn't even sting." For faster corneal penetration, 4. A good diversionary tactic is to have the child count, recite
ask the child to close their eyes for a few moments. ABC's, or name colors of objects in the room.
b. If you know in advance t h a t drops will be required and t h a t
the child may be fussy, ask parents to administer artificial tears for a 5. Young children are usually entranced by the wooden toy
week or two a t home. That way you won't have to contend with a called "Jacob's Ladder," which clackety-clacks down itself. Keep one in
squirming youngster, and the childwon't learn to loathe visits to your every examining room to distract fussy preschoolers.
office. 6. Human contact i s reassuring-a p a t on the back, a hand-
15. Provide frequent positive reinforcement: "That's very good." shake, a hug.
But during testing, your goal i s to have the child respond well to the 7. Is there something the child could hold for you? Holding
exam, not necessarily provide the "right" answer. Even if a response things makes people more comfortable with them and lessens the "Fear
isn't correct from a visual standpoint, you can say, "Thank you, t h a t of the Unknown." For example, 1'11 let children shine the ophthal-
gives me a lot of information." moscope into my eye and view the red reflex.
16. Ask a n assistant to gently hold a young child's head in place 8. "Before I touch a young patient," says Dr. Max Heeb, "I ask if
during ophthalmoscopy. Tell the child, "I'm gettingready to look inside he can tell me what courage is. The usual answer is something like,
your eye . . . Your eye looks really good." 'Courage is not being scared.' That's not my answer. Even if the child
says nothing, I volunteer t h a t I used to think t h a t brave people were
17. When examining a squirmy young patient, touch the child on
the shoulder or hand a s you talk, to get their attention. never afraid, but that I've learned t h a t it's normal and all right to be
scared, and t h a t people who are not scared are sometimes just plain
18. If appropriate, report to the parents in the presence of the nuts. Courage i s doing what you need to do even though you're scared.
child. This i s another way to show respect for children. I t also helps It's amazing how children will settle down and cooperate after you
insure t h a t children will get accurate information about their vision and impart this information."
the importance ofvision care. Never talk about young patients a s if they
weren't there. 9. Dr. Bruce Hoekstra relaxes fearful children with "magic." "I
tell them that if they let me feel their stomachs, I can guess what they've
19. Take advantage of children's honesty. Their actions and had for breakfast. I always guess cereal, because it's correct about 8 0
facial expressions will generally tell you exactly what they're thinking! percent of the time. IfI'm wrong, the children are only too happy to blurt
out the right answer; ifI'm right, their eyesgrow wide a t my mysterious
power. Either way, it makes a potentially difficult examination easy
Working with Fearful and it's never failed to relax cranky, nervous patients."
or Boisterous Children Another "magic" trick: P u t two pieces of Scotch Tape on a balloon
so t h a t they form a n "X" You'll be able to push a needle right into the
1. Never force a child to go through a n exam crying if it can be balloon without popping it.
postponed until another day. Don't let children learn to associate fear
with your office. , 10. If you're fairly introverted, it's helpful to have a live-wire
assistant who talks easily with children. "Children don't like quiet-
2. I find t h a t having parents in the examining room is very ness," pedodontist Dr. Marvin Berman says. "Kids often don't relate to
helpful. There are times I'll ask them to leave, but that's infrequent. reserved people. Kids like craziness, people who repeat things over and
over. They love rhyming, they love singing, they love faces, they love
3. In most instances, if a child is acting up I try to '?till them with action. Ifyou do things too quietly, they don't learn. You need somebody
kindness." Only occasionally will I use sterner methods. in your ofice who's capable ofkeeping up with the shortness of a child's
attention span."

6. 2. Ask the parent to remain present during the exam.
Working with They can help you communicate with the child, and if the child becomes
Mentally Handicapped Children upset, they can usually discern the problem. (If the child remains upset,
ask the parent whether they'd like to reschedule the appointment.)
High refractive error, amblyopia, strabismus, poor perceptual
skills, and ocular disease are the norm, not the exception, in mentally 3. Modify your exam technique. In particular, avoid sudden
handicapped children. Early detection and treatment can be vital in movements, and shine the ophthalmoscope into your own palm, directly
helping them get the most from other rehabilitation programs. Some of in front of the patient, to demonstrate it before you shine i t in their eye.
my articles listed in the bibliography provide a n introduction to the Explaining procedures using an eye model will help patients under-
mental retardation syndromes most commonly associated with ocular stand you're going to do something for them.
defects: the fragile X syndrome, cerebral palsy, and Down's syndrome.
4. Remember to smile. A smile is understood and appreciated
Developing expertise in working with handicapped children by all-even the most severely handicapped.
demonstrates just how unique your practice is. Many parents with
handicapped children will bring other family members to you if you can
work well with their exceptional child. Don't hesitate to seek out other Building Rapport with Parents
professionals working in this area and offer your assistance.
1. Use the child's examination a s an opportunity to educate the
To assess visual acuity, choose from the tumblingE test, Landholt parents, ifthey're in the room. For instance, if a child can't see four dots
C or Brokenwheel test, Lighthouse cards, the Catford Visual Acuity on the Worth Four Dot test (a measure of second degree fusion), I'll place
Apparatus, the OKN response, visually evoked response, and preferen- the anaglyph glasses on Mom. When she sees the four dots, she knows
tial looking. Oculomotor assessment should include the cover/uncover her child is not responding appropriately, and has a greater under-
test, Hirschberg, physiological H test, near point of convergence, standing of how her child's visual system is working. Or I may use the
saccades, rotations and pursuits (visual tracking). Random Dot Stereo E test. A strabismic child won't be able to see the
"E," but Mom or Dad will. (When parents can't, this often prompts them
Assessment of refractive error should include the Placido disk or to schedule an exam for themselves!)
keratoscope, standard distance retinoscopy, and cycloplegic or dynamic
retinoscopy. Binocularity may be determined with such procedures a s 2. Take parents' observations seriously. If you can't verify a
the Titmus, Frisby, or Randot E stereotest. Accommodative function parent's report, offer a n explanation as to why this might be. For
may be assessed quickly with the monocular estimation method (MEM). example, if a mother reports that she sees her child's eye turn out, but
during your examination you don't find strabismus, explain that eye
Because mentally handicapped children are prone to ocular pa- turns can be intermittent. Suggest scheduling a visual efficiency
thology, a biomicroscopic exam should be performed with either a evaluation for further assessment. Never tell parents that they were
standard slit lamp or hand-held model. Pupillary actions should be wrong; instead, let them know that you're simply unable to verify their
noted as present or absent, and direct or indirect ophthalmoscopy observations at this time.
should be completed. You should also attempt to assess visual fields and
intraocular pressures. 3. In discussing a child's visual status, keep in mind that parents
often feel embarrassed about not detecting or reporting a problem
Examinations of mentally handicapped children will go most sooner. Unless we're careful, our comments may be interpreted a s
smoothly if you: criticism or a charge of neglect.
1. Schedule extra time. You may want to talk casually with Of course, it's wise to correct misconceptions: "You may have
the child and parent in your office before proceeding to the exam room. heard that children will grow out of a squint, but this isn't so." Still, the
Also, give the child time to get accustomed to the exam room before you
begin.

7. emphasis should be on what can be done to help the child now. Give all 5. Here are sample answers to common questions from parents:
the information and reassurance you can. Praise the parents for
bringing the child to you when they did. Will watching TVhurt my kids'eyes? No, but it may dull their
minds! Children should sit on the family couch, not right in front of the
Guilt can be particularly pronounced in parents of strabismic TV.
children. They may withdraw from the child, unconsciously encourag-
ing him or her to discard glasses in an attempt to regain acceptance, or Is it all right ifmykids lie down while reading, or read in low
become too authoritarian or solicitous regarding the wearing of glasses. light? Appropriate posture and lighting is always desirable. However,
lying down while reading or usingdim illumination won't h u r t the eyes.
4. Although far from comprehensive, the following may help you
respond to parents' concerns about symptoms: I f my child sees 20120, why does she need glasses to correct
the farsightedness? Although the child can see clearly a t a distance,
Diplopia in children is rare, but the complaint of seeing double is the eye must constantly refocus to see near objects. This can result in
common. It's very important to differentiate between blur and diplopia reading difficulties or eyestrain.
-at times it's difficult for patients to tell the two apart. One excellent
method is to patch and eye and see if diplopia is still noted. Monocular Will my child become dependent onglasses? You don't become
diplopia is very rare and is usually due to a pathological etiology which dependent on glasses-youjust get used to seeingclearly and appreciate
can be ruled out by a good eye health exam. the benefits of wearing them!
Pain isn't always a reliable indicator of the seriousness of the Won't other children tease my child if he wears glasses?
disorder. A child with a lacerated globe may barely complain, while a When a child may be teased because of the glasses or other therapies I
child with a simple corneal abrasion may raise quite a ruckus. may prescribe (binasal occlusion, for example), I usually give t h e child
several of my professional cards. I tell the child, "If any of your
Photophobia and redlwateringleyes often occur in children classmates start to pick on you because of your glasses, you just tell
without obvious cause. I n most cases of itchy eyes, we should be able them, 'I see great with my glasses, and if YOU have a problem with it,
to determine the etiology (allergies are the most common). just call my doctor and he'll explain everything to you!"' This helps the
child cope with the "class bully" who picks on other kids.
Dark-adaptationcomplaints should be considered a "red light."
This symptom is rare in children, so look for pathology.
Color-vision defects are also rare. Again, look for pathology.
Dispensing to Youngsters
Ask if other family members have color vision problems. 1. I usually recommend polycarbonate lenses, frames with hinge
temples, and head bands (croakies) for children. The polycarb lenses
Complaints of visual phenomena, such a s micropsia (percep- offer better protection for a n active child, the hinge temples allow the
tion of objects a s smaller than they actually are) or macropsia (the frame to stand up to "punishment" for longer periods of time without
opposite) may require additional testing, like a n Amsler grid. breaking, and the croakies keep the glasses on the child's face!
Excessive blinking is sometimes due to stress induced by the 2. Instead offacing children across a table, sitright next to them.
home or school environment. This allows for easier and more accurate fitting.
A parent's report of protrusion of the globe usually signals true 3. To take PD's, I usually have my staff use a pupilometer or use
orbital pathology. Lay people rarely pay attention to such a symptom a penlight technique (do a Hirschberg, measure the distance between
unless it's pronounced. light reflexes for near PD, and add 2-3 mm for distance PD).

8. 4. Encourage parents to let children choose their own frames. If Market Your Practice
children don't like their glasses, they may deliberately lose them, break
them, or throw them away. This is true even for children as young as with Special Services
3 or 4. 1. Children don't get much mail, so it means a lot to them.
Involve your staff in hand-writing (or hand-printing) a thank-you note
Another practical reason to minimize parental involvement: it
after a young patient's first visit. It's a nice touch to use cartoon-
saves time. Optician Fred Spangler says, "In the 15 minutes to one hour
illustrated notepaper, but your regular practice letterhead is fine too.
that I spend per patient, I usually have to show the child and parents
together some 100 frames. When I'm dealing only with the young 2. If your practice sees many young families, you might want to
patient, that figure drops down to more like 20 or 25." offer a "nanny service." Hire a retired adult or high school student to
babysit several hours a week, or arrange a "drop-in" service with a
5. When fitting infants and children with birth defects, it's
nearby childcare center. The cost will probably be minimal compared
usually best for you or your assistant to select frames yourself. The best
to the patient satisfaction and new referrals you'll have.
are those with a built-up nasal area and comfortable cable temples.
3. Consider setting up field trips to your office for young chil-
6. Many children are aware of the fashion aspect of eyeglasses.
dren. For demonstration purposes I use a real human skull, pickled
These days, the most popular frame colorsfor boys are brown, deep blue,
cow's eyes, X-rays of the human skull, and a bunch of Seymour Safely
and black marble in plastic, and yellow gold and y n m e t a l in metallic.
puppets, stickers, and a movie. I've found that preparing for a talk to
Girls prefer navies and greens. Both like bright, solidreds, and logos are
first graders requires just as much planning and forethought as prepar-
particularly popular.
ing a presentation to my optometric colleagues! You have to be ready for
7. If conflicts arise between children and parents, leave the room the unexpected and be able to respond appropriately.
for a time. That way, the child may find it easier to gracefully yield to
the parent's wishes (or vice versa!).
Using Computers
8. When dispensing to a very young child, ask the parent to bring
along the child's favorite toy. Then ask the parent to stand back about in Pediatric Practice
6 to 10 feet, hold the toy, and call to the child. Immediately place the Your personal computer can be a powerful diagnostic and thera-
corrective lenses on the child's face-the response is gratifying! peutic tool in pediatric practice. Computers perform their testing and
9. Instruct both children and parents in proper care of eye- training activities consistently and without bias; they never get bored,
glasses. Explain the importance oftaking the frame on and offwith two tired, or ill.
hands, folding the temples properly, and placing the spectacles into a In addition, most children will look forward to coming into your
case. Also, describe proper cleaning procedures for glass or plastic office and "playing with the computer." One of my patients even brought
lenses. his grandmother so he could show off his newly acquired skills.
10. Consider displaying, in your reception area, Polaroid photo- The following companies sell programs that are specifically de-
graphs of children wearing their new glasses. Let children pin them signed for optometric diagnosis and therapy:
onto the bulletin board themselves-kids love to feel part of the crowd!
Computer-Eyes
5887 Hamilton Road
Columbus, GA 31909

9. Frontier Technologies, Inc. 5. Be sure to introduce staff members to children. It's friendliest
2444 Solomons Iguana Road if you use their first names. If your assistants wear name badges, the
Annapolis, MD 21401 letters should be big enough for young readers to decipher.
R.C. Instruments, Inc. 6. To make waiting time fly by, put some of these in your
99 W. Jackson St. reception room:
P.O. Box 109
Cicero, IN 46034 A bathroom scale. Kids will weigh themselves over and
over!
VTC Enterprises
3408 Arcadia Court Pictures your patients have colored. (Be sure to hang them
Bloomington, IN 47401 a t child's-eye level.)
A water cooler with paper cups. Kids love to watch the
Other programs are available from commercial software compa- water "glug" out.
nies, and some are even available free or for a nominal fee ("public
domain software"). For detailed information, see the book I co-edited, An inexpensive computer.
Computer Applications in Optometry (Butterworths, 1989). A backless birdhouse or bird feeder, attached to a window
so kids can see inside it.
Families of children with visual, physical, cognitive, hearing1
communicative or learning disabilities, and the professionals who work Stained glass suncatchers and rainbow-making prisms in
with them, are eligible to join The Committee on Personal Computers a sunny window.
and the Handicapped (COPH). This not-for-profit group provides free Cassette tapes and headphones. Some storybooks have
loans of computer equipment, operates a computer bulletin board, and companion tapes.
offers other services to the handicapped. Contact COPH a t The Illinois
Children's School, 1950 West Roosevelt Road, Chicago, IL 60608,312- Abigchalkboard and colored chalk. Better yet (because it's
421-3373 (voice) or 312-286-0608 (modem). cleaner), a white dry-erase board with water-based mark-
ing pens.
7. If you know a young patient will be accompanied by restless,
Office Design and Atmosphere disruptive siblings, ask your front desk assistant to schedule the family
for the last appointment of the day, or the last before lunch. That way,
1. Consider doing away with your white lab coat, which might fewer of your other patients will be disturbed.
remind children of a painful visit to a hospital, physician, or dentist. If
you do wear a lab coat, you might carry a little stuffed animal in your 8. As you're saying goodbye:
pocket and let i t peek out.
a. Let the child pick a gift from a loaded "treasure chest." (Let
2. Don't make examining rooms any darker than necessary, siblings have a gift, too, to thank them for waiting patiently.)
especially when examining a very young child.
b. An examining glove makes a great balloon. Inflate i t slightly,
3. Mirroring a wall seems to make time spent in that room go then tie off the 4 fingers two-by-two. (This makes "hair.") Leave the
faster. A mirror can be a good distraction for fussy kids, too. thumb inflated a s a "nose." Give the child a felt marker and invite him
or her to draw a face on the balloon.
4. Display frames a t a higher level, to prevent youngsters from
snatching them off racks. c. Dr. Charles Perakis of Pine Point, Maine gives children sand
dollars, chestnuts, seashells, minerals, or animal pictures. "They come
to appreciate the beauty of the natural world," Dr. Perakis says, "in a
society that bombards them with commercialism."

10. Conclusion McVoy M. How to Build Your Medical Practice by Marketing to Children and
Their Mothers. Boulder, CO: Expressions, 1989.
This booklet has given you dozens of suggestions for developing Muth E. Selling to tomorrow's customer today. Optical Prism 7(5):36, 1989.
a n d publicizing your expertise in pediatric optometry. Most are inex- OD makes kids feel like ' i shots." Professional Enhancement Strategies
bg
5(3):8, 1989.
pensive a n d e a s y to implement immediately, a n d all will contribute to OD uses special technique on kids. Professional Enhancement Strategies
increased referrals a n d a n increase i n t h e number of patients r e t u r n i n g 5(6):8, 1989.
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