While for children affected by ECC can be

  While pediatric patients may be small, they often can be as intimidating to us as we are to them. The factors that add to this anxiety are relative inexperience with children compared to adult patients, and the inability of younger patients to communicate or cooperate with the physical exam. While each physician may vary with style points and favorite tricks, here are a few tips for the pediatric physical exam to improve your interaction and comfort level. One of the first tasks as an emergency physician is to put the patient at ease. Talk to the child as well as the parents. For older children, introduce yourself to them first before the parents and sit down on the bed or chair as to not tower over them. Try to facilitate the relationship and open up communication by noticing something cool about them (i.e. light-up shoes, Dora T-shirt or fun toy).     While doing the actual physical exam, try to use the parent’s lap as much as possible as the child is most comfortable there. To distract and calm them, consider telling them a story throughout the exam or try to make the physical exam a game – play with the instruments. Finally, consider having something fun in your pocket such as stickers or a bubble-blowing pen to make the experience more enjoyable. In general, when evaluating any child, observation is the best initial diagnostic tool. The degree of alertness and interaction, responsiveness to parents and respiratory status are all valuable measures of illness that may either suggest or eliminate concerns of toxicity. After observation, it is important to begin the exam with auscultation of the heart and lungs as this is usually when the child is calm, quiet and most cooperative. Do not forget that a negative lung auscultation is not sufficient to rule out significant pulmonary disease; the appearance of the patient (tachypnea, respiratory distress) is much more predictive.     Finally, always save the worst for last. The last items to perform in the physical exam should always be those things that are most threatening to the child, including looking in the ears and mouth.     Oral Health is essential for health and wellbeing and early childhood is the time when most lifetime habits are established. It offers the greatest opportunity for prevention of disease that in turn can contribute to better health in adulthood. Early childhood caries (ECC) is a serious dental condition occurring during the preschool years of a child’s life when developing primary (baby) teeth are especially vulnerable. It can be devastating condition often requiring hospitalization and dental treatment in an operating theatre under general anesthesia. The pain, psychological trauma, health risks, and costs associated with restoration of carious teeth for children affected by ECC can be substantial, yet it is mostly preventable.     Establishment of a dental home during infancy provides an opportunity to make a meaningful impact on the oral and general health of a patient. Early dental assessment assists in the prevention of dental disease and helps to optimize oral health over a lifetime. Furthermore, implementing early dental visits is a practice builder not only by providing a new patient source, but through retention of patients by encouraging lifelong care.     Although it was previously recommended that the first dental visit should be scheduled for age three unless a pediatrician recommended an earlier assessment, dental disease can arise much earlier. Eight per cent of children aged two have at least one decayed or filled tooth and over 40 per cent of children are affected by caries by the age of five. Early childhood caries (ECC) is a disease that when severe can affect growth, cause pain and infection and have lasting detrimental effects on the quality of life of patients and parents. In these cases, a dental visit at age three is often too late for prevention and the interventions required to treat ECC are both expensive and invasive.