Why You Should Consider Adding Pediatrics to Your Practice

Devoting part of your practice to a pediatric clientele allows you to have fun while continuing to develop your practice.

Pediatrics is only part of my practice, but it is my favorite part.

Some think that if you are a pediatric optometrist, all of your patients are children. However, unlike pediatric dentistry and primary care, having a partial pediatric practice can work well while taking care of the rest of your clientele.

There are great benefits to adding pediatrics to your schedule: the kids can be fun, they don’t complain about their other doctors, they don’t talk politics, and they don’t think my fees are too high.

I have been practicing for 35 years. Unlike a pediatrician’s office, where patients “age”, our pediatric patients become adult patients. Many of them have children of their own and as a result our practice continues to grow.

Parents of pediatric patients are very loyal; they often seek out other parents for recommendations. Although many of our pediatric patients are privately paid or have vision plans that we don’t accept, parents want what they perceive to be best for their children. I have found that parents, more than any other patient, will trust your recommendations.

Magnification and equipment for pediatrics

To expand your practice in the world of pediatrics, I suggest you slightly redecorate one of your exam rooms. We have framed artwork created by my own children over the years, and we still use the room for brief adult checks and contact lens aftercare. You don’t have to dedicate the room strictly to pediatrics. In addition, adult patients who are seen in this room often ask to have their own child assessed.

Examination room equipment can be simple. We have manual phoropter (easier for retinoscopy), Heine slit lamp head for direct handle, BIOs, retinoscopy racks and color and depth perception tests, and acuity charts forced-choice for non-verbal patients.

Additionally, we have a simple screening test to look for saccadic deficits when indicated. Finger puppets are great rigging tools for version tracking and coverage testing. I draw a “smiley face” on a cotton swab for fixation, which makes children smile.

To minimize chair time, I tend to let the kids roam where they want while I open the board and review the story with their parents. Sitting on a parent’s lap is fine too. For younger children, I ask them to sit “applesauce criss-cross” so their feet don’t dangle and they squirm less.

Talk to the child at his level. It’s okay to be a little clumsy to get them to relax and use baby talk. And I’ve found that telling the child what you’re doing eases the tension.

My script goes something like this:

“I’m an ophthalmologist, so I’ll make sure your eyes see well and work together. When you come to my office, you will never get a prick or a finger prick. You can keep your clothes on and you don’t have to go to the toilet in a cup because I think it’s disgusting.

The goal is to put them at ease.

Performing the exam

Some doctors insist on using cycloplegia on every child, but I don’t. If my autorefraction and retinoscopy results are consistent and consistent with visual acuities, I generally do not use cycloplegic drops.

For dilation, I prefer to use hydroxyamphetamine hydrobromide, tropicamide (Paremyd, Akorn) because it doesn’t sting and it works great on young eyes.

To instill the drops, I tell the child, “I’m going to lay this chair flat, like you’re lying down, and then you can close your eyes. I have a few drops that will be cold, and these are the kids drops.

While they are still lying down, I allow enough time for the drop to penetrate through the eyelids. If they rub their eyes, that’s even better. After they open their eyes, I give them some handkerchiefs; I get them up and then I keep handing them tissues until they start laughing. Then I give them another dozen, and sometimes I empty the whole box. They laugh, the parents too, and they have already forgotten the drops.

For external examination, I use a portable slit lamp head that fits over my direct handle. For the internal examination, I use a binocular indirect ophthalmoscope (BIO) with red-free light and a finger puppet for fixation.

Exams should be quick. Kids only give you borrowed time before they get tired of you. I tend to work quickly and then trace. Parents will also appreciate a quick review.

After the exam

When glasses are indicated, I review the wearing schedule with the parent and my equipment recommendations.

For new wearers, I ask parents to bring their child in for a free “acuity check” in 6-8 weeks to ensure they are adjusting to their glasses and using them correctly. I let them know if I’m measuring a different prescription, and if the glasses were purchased from us, I’ll make new lenses for free if there’s a difference. The visit is quick and much appreciated, and helps prevent prescriptions from working.


Consider expanding into the world and delight of pediatric patients. You can even set your own age limits. Our practice begins at age 3, and I refer younger patients to an optometric colleague who sees infants and toddlers, as well as refer to another optometric colleague for vision therapy when indicated. Other doctors in your area will be receptive to referring their children to you. We also have a steady stream of pediatric referrals from ophthalmologists.

Growing a pediatric practice is a great next step for continued success.

Bradley Middaugh, OD, graduated from Wake Forest University and earned his Ph.D. from the University of Alabama at Birmingham. He has been in private practice since 1988 and founded the Fort Myers Eye Center in 1993. In 2020, he joined the Center for Sight team to provide his patients direct access to some of the best cataracts, LASIK, glaucoma, cornea , retina and eye plastic specialists in Southwest Florida. He can be contacted at: [email protected]

Luz W. German