A successful pediatric physical exam is all about taking advantage of opportunities when they present themselves. Picture this: you enter the room and the child is draped over his/her parent’s shoulder, fast asleep. Consider taking a moment to whisper a brief introduction to the parent and mime that you are going to listen to their child’s lungs. In general, if a child is quiet when you are ready to start the exam, start by listening to the lungs and heart first. If the very sight of you upsets the child, try asking the parent to hold the child over their shoulder facing back to listen to the lungs. For the abdominal exam, unless the chief complaint requires a careful thorough abdominal (and GU in that case) exam, you can reach around to palpate as the parent holds the child in this position. You can also ask the parent to palpate (for tenderness) once the child calms down because you have walked across the room. Save the ENT exam for last. Start with the ear exam and if the child cries with his/her mouth wide open, take advantage to do a quick throat exam between ears! More pediatric exam tips can be found on AliEM here