Patients with Wilms tumors should have their abdomens palpated only sparingly because rupture of the tumor capsule can result in dissemination of malignant cells. It is not the best form to ask a four-year-old for permission to perform an assessment, but this can be discussed after the assessment. Patients who are told they are being assessed for breathing tend to breathe with a different rate than normal; this also can be a later coaching moment. Asking the patient how the tummy feels when he or she has to throw up is fairly benign.