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?