Table of Contents
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
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)
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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Try some questions
What are the commonest causes of bronchiolitis, Croup and Whooping cough?
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What is primary ciliary dyskinesia?
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What is the cause of cystic fibrosis?
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What are the non-respiratory features of cystic fibrosis?
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