stethoscopeCartoonHow do you teach pediatric patients, especially toddlers, how to cooperate with your pulmonary exam? How do you get them to take adequately deep breaths in and out?

Trick of the Trade

Blow out a candle

With your stethoscope positioned on the patient’s back, ask the child to pretend like they are blowing out a birthday candle. Personally I have had variable success with this trick, because the child has to imagine a candle in front of them. Sometimes it works, but other times they just look at me like I’m crazy.

However, what if they had a virtual candle in front of them?

CandleflameIphoneAppTrick of the Trade (high tech)

Candleflame iPhone app

This free iPhone app displays a virtual candle burning for about 20 seconds. It is a slight hassle because a brief ad pops up at the beginning, which you have to manually select to skip over. It’s worth the minor hassle, because one can blow out the candle if you sufficiently blow hard enough at the virtual candle. The sensor is the iPhone speaker piece at the bottom of the unit.

Since then, I have used this as a means to grossly assess an asthmatic child’s peak flow ability if s/he can’t coordinate using a peak-flow meter. You can adjust and increase the distance from the child to the iPhone to encourage maximal expiratory effort.

(Turn audio on in this video to hear me blowing out the candle.)

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD