Protect yourself at all times

When I was 8 and my sister was 10 months old, we were playing on the living room carpet when, suddenly and without provocation, the little creeper hit me in the mouth with a Kiwi shoe polish bottle.

I have no idea why we were playing with a shoe polish bottle, but of all the potential disasters that could have occurred, I guess a chipped central incisor was a relatively minor result. That was my first wake-up call to the destructive power lurking in the lightning-quick hands of infants and toddlers.

Unfortunately, many adults are unaware or have forgotten that their own faces can be enticing targets for babies eager to engage in tactile exploration of the environment. Scratched corneas, torn ear lobes, and mangled spectacles are the most common occurrences when relatives and strangers attempt an in-your-face style of getting acquainted. I recall meeting one grandmother who nearly lost her vision in one eye as the result of an infected infant fingernail scratch of her cornea.

We pediatricians should understand better than most people that infants can lash out without warning, but stuff happens. We might be distracted by a could-it-be-a-murmur sound coming through the stethoscope tubing. Or we may be suffering from some postlunch drowsiness and "Oops," there goes a new pair of glasses.

Given the frequency of our close encounters with infants and toddlers, one would expect that patient-inflicted injuries are quite common, but I’m not aware of any data on this kind of work-related hazard. I suspect that most of us fret more about the risk of contracting an infection from our patients than about being injured in the line of duty.

Looking back on a career that spans 4 decades, I can recall a few incidents in which I took a direct snot shot to the eye and developed conjunctivitis. I don’t remember being injured. Have I just been lucky or is there something about how I approach little patients that has protected me?

Like most of you, I have unconsciously learned some self-defense strategies along the way. For example, I got peed on quite a bit as resident, but now I always keep one eye on the penis and one hand on the flap of a diaper. I haven’t been hit in the last 30 years.

I examine patients under the age of 4 in their parents’ laps. I hold the child’s left elbow with my right hand, adjusting the grip depending on the child’s behavior. I ask the parent to hold the other elbow. When it’s time to get into the child’s face, I show the parents how to encircle the patient in a bear hug. Some parents don’t seem to realize that their role is critical to my safety, and so I must remain on alert for the first sign of a Houdini escape.

As infants become toddlers, innocent pokes of curiosity can become intentional jabs and swats. Hopefully, a low-key, gentle approach can keep these challenges to a minimum, but you know as well as I do that, when language fails them, children have few ways to respond but to strike out when they are afraid.

Have patients tried to bite me? Yes! Have they succeeded? Thankfully not.

Nowadays, my biggest safety concern when I enter an exam room is tripping as I navigate the minefield of toys scattered on the floor. I would like to hear from you about patient-inflicted injuries that you have experienced or heard about, and what strategies you may use to keep yourself intact while you examine these deceptively passive cuties.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

When I was 8 and my sister was 10 months old, we were playing on the living room carpet when, suddenly and without provocation, the little creeper hit me in the mouth with a Kiwi shoe polish bottle.

I have no idea why we were playing with a shoe polish bottle, but of all the potential disasters that could have occurred, I guess a chipped central incisor was a relatively minor result. That was my first wake-up call to the destructive power lurking in the lightning-quick hands of infants and toddlers.

Unfortunately, many adults are unaware or have forgotten that their own faces can be enticing targets for babies eager to engage in tactile exploration of the environment. Scratched corneas, torn ear lobes, and mangled spectacles are the most common occurrences when relatives and strangers attempt an in-your-face style of getting acquainted. I recall meeting one grandmother who nearly lost her vision in one eye as the result of an infected infant fingernail scratch of her cornea.

We pediatricians should understand better than most people that infants can lash out without warning, but stuff happens. We might be distracted by a could-it-be-a-murmur sound coming through the stethoscope tubing. Or we may be suffering from some postlunch drowsiness and "Oops," there goes a new pair of glasses.

Given the frequency of our close encounters with infants and toddlers, one would expect that patient-inflicted injuries are quite common, but I’m not aware of any data on this kind of work-related hazard. I suspect that most of us fret more about the risk of contracting an infection from our patients than about being injured in the line of duty.

Looking back on a career that spans 4 decades, I can recall a few incidents in which I took a direct snot shot to the eye and developed conjunctivitis. I don’t remember being injured. Have I just been lucky or is there something about how I approach little patients that has protected me?

Like most of you, I have unconsciously learned some self-defense strategies along the way. For example, I got peed on quite a bit as resident, but now I always keep one eye on the penis and one hand on the flap of a diaper. I haven’t been hit in the last 30 years.

I examine patients under the age of 4 in their parents’ laps. I hold the child’s left elbow with my right hand, adjusting the grip depending on the child’s behavior. I ask the parent to hold the other elbow. When it’s time to get into the child’s face, I show the parents how to encircle the patient in a bear hug. Some parents don’t seem to realize that their role is critical to my safety, and so I must remain on alert for the first sign of a Houdini escape.

As infants become toddlers, innocent pokes of curiosity can become intentional jabs and swats. Hopefully, a low-key, gentle approach can keep these challenges to a minimum, but you know as well as I do that, when language fails them, children have few ways to respond but to strike out when they are afraid.

Have patients tried to bite me? Yes! Have they succeeded? Thankfully not.

Nowadays, my biggest safety concern when I enter an exam room is tripping as I navigate the minefield of toys scattered on the floor. I would like to hear from you about patient-inflicted injuries that you have experienced or heard about, and what strategies you may use to keep yourself intact while you examine these deceptively passive cuties.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

When I was 8 and my sister was 10 months old, we were playing on the living room carpet when, suddenly and without provocation, the little creeper hit me in the mouth with a Kiwi shoe polish bottle.

I have no idea why we were playing with a shoe polish bottle, but of all the potential disasters that could have occurred, I guess a chipped central incisor was a relatively minor result. That was my first wake-up call to the destructive power lurking in the lightning-quick hands of infants and toddlers.

Unfortunately, many adults are unaware or have forgotten that their own faces can be enticing targets for babies eager to engage in tactile exploration of the environment. Scratched corneas, torn ear lobes, and mangled spectacles are the most common occurrences when relatives and strangers attempt an in-your-face style of getting acquainted. I recall meeting one grandmother who nearly lost her vision in one eye as the result of an infected infant fingernail scratch of her cornea.

We pediatricians should understand better than most people that infants can lash out without warning, but stuff happens. We might be distracted by a could-it-be-a-murmur sound coming through the stethoscope tubing. Or we may be suffering from some postlunch drowsiness and "Oops," there goes a new pair of glasses.

Given the frequency of our close encounters with infants and toddlers, one would expect that patient-inflicted injuries are quite common, but I’m not aware of any data on this kind of work-related hazard. I suspect that most of us fret more about the risk of contracting an infection from our patients than about being injured in the line of duty.

Looking back on a career that spans 4 decades, I can recall a few incidents in which I took a direct snot shot to the eye and developed conjunctivitis. I don’t remember being injured. Have I just been lucky or is there something about how I approach little patients that has protected me?

Like most of you, I have unconsciously learned some self-defense strategies along the way. For example, I got peed on quite a bit as resident, but now I always keep one eye on the penis and one hand on the flap of a diaper. I haven’t been hit in the last 30 years.

I examine patients under the age of 4 in their parents’ laps. I hold the child’s left elbow with my right hand, adjusting the grip depending on the child’s behavior. I ask the parent to hold the other elbow. When it’s time to get into the child’s face, I show the parents how to encircle the patient in a bear hug. Some parents don’t seem to realize that their role is critical to my safety, and so I must remain on alert for the first sign of a Houdini escape.

As infants become toddlers, innocent pokes of curiosity can become intentional jabs and swats. Hopefully, a low-key, gentle approach can keep these challenges to a minimum, but you know as well as I do that, when language fails them, children have few ways to respond but to strike out when they are afraid.

Have patients tried to bite me? Yes! Have they succeeded? Thankfully not.

Nowadays, my biggest safety concern when I enter an exam room is tripping as I navigate the minefield of toys scattered on the floor. I would like to hear from you about patient-inflicted injuries that you have experienced or heard about, and what strategies you may use to keep yourself intact while you examine these deceptively passive cuties.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.