For anxious or young children, you may want to leave this part of the examination toward the end, because it may require parental restraint. The young, cooperative child may be more comfortable sitting in the parent's lap, as shown below.
The following figure demonstrates some tricks to getting children to open their mouths. The child who can say "ahhh" will usually offer a sufficient (albeit brief) view of the posterior pharynx so that a tongue blade is unnecessary. Healthy children are more likely to cooperate with this examination than sick children, especially if the sick child sees the tongue blade or has had previous experience with throat cultures.
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