Paediatric respiratory examination

Do a full adult respiratory examination with the following additional components.

General

• Dysmorphic features
• Work of breathing
• Colour (pallor, cyanosis, mottling) 
• Alertness and interest in surroundings
• Nutritional status

Listen to breathing

• Wheezing (bronchiolitis, asthma, viral-induced wheeze)
• Stridor, harsh voice (croup, foreign body)
• Grunting (bronchiolitis, pneumonia, asthma)
• Secretions 
• Cough

Cough characteristics by cause

Croup = Barking

URTI = Dry

Whooping cough = Coughing fits with inspiratory whoop

Bronchiectasis = Fruity cough

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Nails

• Clubbing (CF, bronchiectasis)

Respiratory rate

• Count for 1 minute – usually best with chest exposed (tachypnoea = respiratory distress; bradypnoea = final stages of respiratory failure)
• Prolonged expiration (bronchoconstriction in bronchiolitis or asthma)

	<1 year	1-2 years	2-5 years	5-12 years	>12 years
Resp rate	30-40	25-35	25-30	20-25	15-20
Heart rate	110-160	100-150	95-140	80-120	60-100

Chest deformities

• Barrel chest (asthma)
• Harrison’s sulcus (permanent groove in chest wall at insertion of diaphragm in chronic asthma)
• Pectus carinatum 
• Pectus excavatum 

Work of breathing

• Nasal flaring
• Tracheal tug
• Recession
  • Supraclavicular
  • Intercostal (in-drawing between ribs – an earlier feature in younger children because the chest wall is less firm)
  • Subcostal
• Use of accessory muscles and head bobbing caused by sternocleidomastoid contractions (quite severe respiratory distress)

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💡 Conditions

Chest auscultation

• If child is crying, try to listen during inspirations 
• Noises transmit all over chest as they are small
  • Crepitations crackles (secretions, bronchiolitis, infection)
  • Bronchial breathing (pneumonia)
  • Wheeze (asthma, viral-induced wheeze)

To complete

• Observations
• Growth charts
• Ear, nose and throat exam

Causes of stridor (ABCDEF)

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