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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

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 year1-2 years2-5 years5-12 years>12 years
Resp rate30-4025-3525-3020-2515-20
Heart rate110-160100-15095-14080-12060-100
Normal paediatric observations

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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