Respiratory examination in child

General examination:

Is child ill / well?

Comfortable at rest / breathless?

Any O2 mask, SaO2 probe or inhaler seen?

Noisy breathing? 

  Gruntng/ Stridor/ Stertor/ Ruttles?

Dysmorphic features / malformations?

Is child well nourished? 

Plot weight & height

Oral cavity- Tonsils, dental hygeine

Visualise palate, tongue

Coryzal? Nasal discharge? 

Ears- red / bulging TM? perforation?

Pallor / Cyanosis?

Clubbing of fingers?

Oedema of feet/ raised JVP/ sweaty?

Is there eczema?

Cervical lymph nodes?

Vitals:

Resp rate

 

Is O2 needed? record SaO2

 

Use of accessory muscles

– Nasal flaring

– Head bobbing

– Intercostal / subcostal recession

– Tracheal tug

– Pursed lips

 

Temperature- are peripheries cold?

 

Heart rate, pulse regular? volume?

Inspection of Thorax:

Ensure good exposure to inspect

– Shape of chest

– Pectus carinatum / excavatum?

– Scoliosis of spine?

– Any scars of thoracotomy?

– Scars of chest drain?

– Abnormal skin / discolouration?

– Symmetrical chest movement?

 

Palpation:

– Position of trachea

– Chest wall movements symmetrical?

  Upper zone, mid zone & bases

– Any subcutaneous emphysema?

 

Percussion of chest wall 

Upper zone, mid zone & bases

– Normal?

– Hyper-resonant?

– Dull?

Symmetrical findings?

Auscultation:

Listen for breath sounds anteriorly, posteriorly & axillary areas

Upper zone, mid zone & bases

– Is there prolonged expiration?

– Any ronchi/ wheeze?

– Any crackles- fine or coarse?

– Distribution of crackles- bilateral/ basal?

– Is there a pleural rub?

– Bronchial breath sounds?

– Can you elicit vocal fremitus?

– Any area of reduced / absent breath sounds?

– Silent chest in asthma?

 

Other systems:

– Cardiac- gallop rhythm? Murmur?

– Look for Hepatomegaly

– Is spleen absent?

– Evidence of neuromuscular weakness?