Inside Ophthalmology

Examining children

Examining a small child can be hard enough; it’s even more difficult when it’s your own. Clare Quigley reports

You need to cancelled and postponed last have him year. We have since found sitting on out that it is rescheduled to your lap, his take place in the summer, back against virtually. Our WhatsApp group your chest. One arm around him, was aptly renamed by one incorporating his arms, and one of the registrars; “A Desk at hand on his forehead, keeping Home in June.” Another his head back. And clamp his feet COVID casualty. between your knees.” Studying now is both easier

Standard instructions to give and harder than when I was to a parent when examining younger. It is more interesting, a small child, ones that I had as I can read up on any new given many times before. But developments in clinical it felt more severe, delivering problems that I see regularly. the instructions to my husband. Even for rare diseases or Michael was squirming on his problems, studying them, lap, bouncing with curiosity reading about them, makes it about the odd hat on his mother’s more likely that I’ll know what head, wriggling and squealing. to do when I do see a patient

He was amused until I presenting with them one day. focused the indirect’s beam on I have motivation, as I know it his fundus, when he got upset. will make me a better clinician. His Dad held him more firmly, But the harder aspect is etching and I worked quickly, checking one eye and then the other. “Nerves normal, fundi normal.” I sighed in relief. The idea of examining Michael came up after talking with a paediatrician family Illustration by Eoin Coveney out time to get study done. The day-to-day job is busy, and the evenings and weekends feel like time to relax and spend with family. My solution is to do a little most days, especially at work in the morning before the friend. I had spoken to her about clinics start, after a coffee to get our visit with the public health Next thing, we were awaiting a visit to me going. Question banks are nurse, when Michael’s head circumference had come out as hospital to have him checked over, easy to dip in and out of. Playing an ophthalmology podcast is above normal on routine checks. pondering differential diagnoses handy when driving, or out Next thing, we were awaiting grocery shopping. Somehow, I a visit to hospital to have will ramp up my reading as the him checked over, pondering exam gets closer... differential diagnoses. Hydrocephalus seemed very unlikely, given By the time we made it to the hospital appointment with he was well otherwise, but I wanted to minimise the chance that Michael, we had started to get anxious again. The paediatrician he would need any neuro-imaging to rule out a problem. Normal examined him, and then turned to me. The measuring tape was nerves, despite the large head, was reassuring. Hopefully the out, this time for my head. He looked up the adult female head paediatrician would agree with me. circumference centiles – it turned out that my head measures

At the moment I am making an effort to study more, as exams pretty big too. I had an inkling about this, from hats often not loom again. Our training includes exams that mark the progression fitting me well. Then the paediatrician took out some old centile from senior house officer to registrar, giving membership status, charts, that are out of production, specific for children in Ireland and final exit exams, granting fellow status. Coming up for us now and Britain. On these more localised charts, Michael’s head are the European Board of Ophthalmology exams, mandatory to was trending along a more acceptable centile. It turns out that complete before we can sit our national exit exam. Compared to inhabitants of these islands tend to have larger heads, and it can other exams we do, there is one distinct positive aspect: the exam be inherited in an autosomal dominant pattern. The new WHO normally takes place in Paris. There were registrars working in charts, including a global population, can place healthy Irish different cities around Ireland who were all planning to sit the babies off the scales in head circumference. exam, and we formed a WhatsApp group, excited about the Next time I was looking after a child in distress was in the upcoming trip. emergency department, after a mild chemical injury. I found

The group was named “Paris in Maytime”, evoking mental myself sympathising more with both parent and child at their images of suitably French scenes – walking to a boulangerie shared discomfort of the examination, and sharing in their joy for breakfast croissants, reading over exam notes while sitting when I could discharge them. outside a café enjoying the early summer light, and an evening celebration after finishing the exam, meeting up in Clare Quigley is a resident at the Royal Victoria Eye and Ear a bar, enjoying some wine... That was until the exam was Hospital, Dublin, Ireland