How should the nurse perform an examination of a 2-year-old child with a suspected ear infection?

A) Pull the ear up and back before inserting the speculum.
B) Omit the otoscopic examination if the child has a fever.
C) Ask the mother to leave the room while examining the child.
D) Perform the otoscopic examination at the end of the assessment.

In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever. For the infant or young child, the timing of the otoscopic examination is best toward the end of the complete examination because many young children protest vigorously during this procedure and it is difficult to re-establish cooperation afterward. When performing an ear examination on a 2-year-old child, with or without a suspected ear infection, the pinna should be pulled down (not up) and back. In addition to its place in the complete examination, eardrum assessment is mandatory for any infant or child requiring care for an illness or fever, so should not be omitted. Rather than asking the parent to leave the room, the nurse should enlist the parent's help in holding the child to protect the eardrum from injury.