No Kidding:

Put a bunch of ECPs in a room and ask them whether or not they enjoy seeing children in their practice and you are bound to get a mixed bag of responses, ranging from those that focus only on children to those that for whatever reason do not like to see children in their practice.

However, some say ECPs that do not treat the younger set are missing out on some golden opportunities. For instance, Dr. Aaron Franzel, assistant clinical professor and chief of pediatric/binocular vision services at the University of Missouri-St. Louis College of Optometry – who sees children 16 and under at the University's vision clinic – says seeing children can help build a practice by drawing in entire families through helping a child. “There's a very significant bond and relationships that you can establish that you don't really see much in general practices anymore,” Dr. Franzel explains. “You're sharing an experience with people and they're connected to you. I feel that's one of the reasons why you get in to the entire profession.” And Dr. Karen Griffith, who sees children from ages 6 months on up at Westside Optometry in Petaluma, CA, says if an ECP is not seeing their adult patients' children, then probably no one is, so they will end up doing more for that child by seeing them than not seeing them. “They could definitely pick up a problem that goes undetected or that would otherwise go undetected – they're going to help that child out in the long run,” she adds.

Still not convinced that seeing children is right for your practice? To help, a few ECPs with years of experience treating children tackle the top five concerns an ECP may have when it comes to treating a child in their practice and tips on how to overcome them.

#1 – Getting Children Through the Door in the First Place

Before an ECP can treat children, they have to get them through the front door of their practice. And that can be a concern due to the confusion or misconception as far as when children can have their first eye exam, Dr. Franzel says.

“There will be educated parents who know they have risk factors for certain conditions, but they're convinced or have been told that we can't really measure visual skills until (children) know their letters and are confident,” he explains. “I'm not exactly sure where that comes from, but it's a difficult thing to overcome because we hear it all the time.”

To help overcome this obstacle, Dr. Bruce Meyer of Newport Vision Center in Jersey City, NJ, and Riverdell Family Vision in Oradell, NJ, makes sure to talk to parents and posts the recommendations of the American Optometric Association (AOA) in his offices.

“Many parents are getting a different perspective if they broach it to their pediatricians that if the kid passes or seems reasonable on a (pediatric vision) screening that they can just wait to have their child's eyes examined,” Dr. Meyer continues. “Those of us in the trenches know that screenings, while they're wonderful, are not perfect and we see plenty of kids come in with lazy eyes and other issues that would have been nice to have been picked up earlier on. So it's a challenge, but that's the way we address it.”

#2 – Making Kids Comfortable and Happy in the Office

Once you educate parents on the age their child can have an eye exam, the children will start flooding in, leaving ECPs with the concern of how to make kids comfortable in their office and give them something to do while they wait for their appointment.

Dr. Samuel Oliphant of Advanced Family Eyecare in Oklahoma City, OK, has found the answer to be in “the cave” – a designed child play area complete with toys and television in his waiting room. “It is actually like a cave, so they can go inside there, play and make noise that doesn't seem to filter out into the waiting area,” he explains. “We do see adults and they don't want the noise of the kids.”

Dr. Franzel also has a play area in the pediatric clinic he manages, including a kids' table with activities. Additionally, he says many times he is able to get valuable information just by observing the kids at play at one of the tables. “It really gives us a pretty good idea as to what they like to do, what they avoid, some of their visual habits, how does their head tilt or turn,” he explains. “All of these things can be cues for us to look at specific things that may or may not have been picked up by the parent.”

#3 – No Exam Room Battles

When it comes time to bring a child back to an exam room, how can ECPs continue to keep a child at ease while still extracting the information they need?

“The practitioner needs to have a clear-cut understanding of what information they need to extract and the goal is to be able to do it as efficiently as possible with the kid feeling as comfortable as we can,” Dr. Meyer says.

Dr. Franzel says bringing yourself down to the child's level – such as maybe performing a cover test from your knees rather than a chair so you're eye-to-eye with the child – can help make the child feel you are on their level.

And he says ECPs need to trust their objective test, cover test and first impression if a child is not responding in the manner they need them to. “Most practitioners have done this on adults hundreds of thousands of times, so you have to trust your observational skills,” he explains. “(Kids) are not going to tell you what they see all that accurately – you need to use objective means to measure these things and you need to rely on those.”

#4 – Dealing with Tweens & Teens

Working with kids is one thing – working with tweens and teens is quite another. What can ECPs do to meet the ever-changing needs of the angst-ridden set?

Dr. Oliphant says first off to not have parents in the exam room because tweens and teens “can play their parent like a violin.” “It seems to help when we have the children just one-on-one – they seem to be much more respectful,” he adds. “We prefer to do it that way because then the parent doesn't answer for the child, which happens often.”

Dr. Franzel advises ECPs not try to be “cool” and talk like a teen as that will only cause more issues. “You can't turn yourself into a teenager, you can't fake it – that is something they will definitely detect,” he explains.

He says ECPs acting as an authority figure and giving them information on their condition is the way to go. He even goes so far as to give his tween and teen patients his card, instructing them to call him directly if they have any questions or concerns after the exam. “With adolescents you sometimes just have to be that outside authority and many times – not all the time – but many times they do respond to it just as long as you're not their parents,” he adds.

#5 – Making It a Team Effort

Now that you're ready to see kids in your office, one last concern to tackle – how can you ensure your staff is just as ready?

Dr. Oliphant says he tackles this issue by hiring kid-friendly assistants with great personalities, because you can't train personality. “You just have to have assistants that are kid people – they like kids, like playing with them, like teasing them,” he says. “We always kid around with our kids.”

Additionally Dr. Oliphant and his staff dress to make young patients feel at ease. “I don't wear white coats because it seems to make (children) think they're going to get a shot or something like that,” he explains. “All of the assistants do have scrubs, but they're bright colors or they have patterns on them.”

Dr. Meyer says he and his staff work to try to engage any children that come in to their practice. “Both the staff and I try to engage them, talk to them, and get them (to tell us) what they like, what they like to do, what they like to watch – just to try to make them more comfortable,” he adds.