I. The importance. A range of positive and negative parent and child behavior happens in examination rooms. Children are uncertain and stressed; parents may feel under pressure in the spotlight. Under these circumstances, some children will impulsively climb furniture, whine and yell at mother, or display other problematic behaviors that elicit anger, frustration, or excessive concern in the parent.

II. The child’s perspective. This is a special moment for children. They may be upset or anxious for a variety of understandable reasons. Maybe they got up earlier than usual, breakfast was rushed or even omitted in the hurry, maybe the bus was late, maybe finding a parking space was difficult, maybe the wait in the waiting room was long. These previsit issues are coupled with recollections of what happened to him the last time he was in this room— maybe immunizations, maybe a finger stick or venipuncture, or maybe a forced and painful ear examination. Doubtless, the examination room offers many interesting possibilities for exploration—a door with a knob, drawers with handles, a wastebasket, a sharps disposal unit, a sink with running water and a paper towel dispenser, boxes of latex gloves that make interesting balloons, and much more. Although children do not want to get into trouble as their mother is preoccupied talking with the doctor, some children will engage in a behavior for their own amusement or need at the same time, with the plan in some cases to get the mother’s attention.

III. The parent’s perspective. This is also a difficult moment for the parent, especially if she has other important or acute stresses at home or work. Many thoughts and emotions may fly through her head as she tries to concentrate on what you are saying about fluoride and the temperature of her hot water heater. Maybe she felt embarrassed last visit because her child was very uncooperative. When he now misbehaves while you are in the examination room, she is unsure what to do. At some level she is aware that her threats (“Stop that or else…”) do not seem to work very well. Spanking seems sometimes to work, but she does not think you would approve. A bribe is another possibility (“Behave and I’ll take you to … on the way home.”). Anything she does, however, will call the behavior to your attention and she is hoping that you are either too preoccupied to notice or too hurried to talk to her about it.

IV. The clinician’s perspective. When your patient misbehaves you have to decide whether or not to intervene and, if so, you do not want to offend the child’s parent nor do you want the child to hurt himself and you want to decrease the noise level in the office and return focus to your history taking, physical examination, and anticipatory guidance.