Evaluating the

Child’s Respiratory
System
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 SYMPTOMS
1.Cough
2. Wheeze
3. Recurrent respiratory infections
4. Noisy breathing: snoring/ stridor/
grunting/ rattly breathing
5. Fever
6. Fast breathing/ chest indrawing
7. Bluish discolouration
8. Altered sensorium/ seizure/ inability
to drink (indicates severity as per ARI
Control program)

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 Cough
 Dry or productive
 Diurnal variation--Time of day
 Postural variation
 Aggravating & relieving factors
 Associated with stridor/ wheeze/ whoop
 Associated with feeding/ choking = GER
 Expectoration– Amount/ colour/ smell/
character ( mucoid/ rusty/ frothy/ mucopurulent/ blood
stained?)
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 Recurrent respiratory infection
 Acute = < 3 weeks duration
 Chronic / long standing => 3 months duration
 Recurrent = symptom free interval of at least 2
weeks duration

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 Associated symptoms

URTI LRTI
 Fever  Wheeze

 Rhinorrhea  Chest pain

 Earache  Shortness of breath

 Headache

 Sore throat  Non pulmonary causes

 Lymphadenopathy of dyspnea should always
be considered

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 Causes of recurrent LRTI
 Asthma
 Congenital heart disease
 Foreign body aspiration
 GERD
 Bronchiectasis
 HIV & other immunodeficiency
 Anatomical malformation- tracheo-esophageal fistula
 Swallowing dysfunction like in cerebral palsy
 Tuberculosis
 Cystic fibrosis
 Past history
 Past h/o measles, FB
aspiration, primary
complex
 Previous hospitalisation
 Treatment & compliance
 Environmental factors
 Exposure to smoking
 Pets
 School absenteeism
 Growth & development
 Allergic symptoms
 G I symptoms
 Family history- Asthma/
Tuberculosis/ similar
illness
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 Approach to Physical
Examination

Focused general
examination
Chest examination

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 What is different in children?
 Respiratory rate is faster in infants and children
 Percussion is generally more difficult and usually
unnecessary

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Focused general examination
Observe the patient generally Ill or well
Position
Colour

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Examine the hands

Pulse 11
 Observe the Respiratory Rate
Quiet child
Tachypnea is when respiratory rate
>60/ min in a neonate
>50 / min in an infant
>40 min in a older child

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Look at Face & Neck

Mumps parotitis

Tracheal deviation
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Upper Respiratory Tract
Examination

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Chest Examination

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 Anteriorly:
 Inspection
 Palpation
 Percussion

 Posteriorly:
 Inspection
 Palpation
 Percussion
 Auscultation

 Anteriorly
 Auscultation 16
Inspection Of Chest- Anterior

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 Inspection
 Nasal flaring What are accessory muscles
 Use of accessory muscles of respiration?
 Retractions  Sternocleidomastoid
 Trapezius
 Chest wall shape &
 Abdominal muscles
deformity
 Alae nasi

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Palpation Of Chest

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Percussion Of Chest

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 Rules of percussion
 Middle finger of left hand is placed firmly on the part to be
percussed. No other fingers should touch the chest wall.
 Back of the middle finger is then struck with middle finger
of right hand
 Stroke should be delivered from wrist and finger joints, not
from elbow
 Percussing finger should be bent so that its terminal
phalanx is at right angles to pleximeter finger
 As soon as blow is delivered striking finger must be
released
 Blow should be no longer than necessary
 Give two blows for each percussion
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Auscultation - Anterior
 Vesicular = softer, lower
pitched, I > E, no pause.
Due to filtering effect of lung
parenchyma
 Bronchial= tubular quality,
guttural, gap between
inspiration and expiration
Due to consolidated lung

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Insp, Palp, Percuss, Auscultation-
Posterior

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 Added sounds
 Crackles/ crepitations  Wheeze or rhonchi
Short crackling non musical Musical sounds associated
sounds often described with airway narrowing
as bubbling or clicking Expiratory polyphonic
noise wheeze = Asthma
May be fine or coarse Fixed monophonic wheeze
= Foreign body

Pleural rub =harsh grating sound synchronous with

respiration, accentuated by increased pressure of chest
piece , disappears on holding breath, associated with local
pain/ tenderness
 Salient features of common
respiratory diseases
Movement Mediastinum Percussion Breath Vocal
sounds Resonance

Consolidation Diminished Centre Dull Tubular Increased

Collapse Diminished Pulled to same Dull Absent Absent

side
Pleural Diminished Pushed to Stony dull Absent Absent
Effusion opposite side
Hydro- Diminished Opposite side Stony Absent Absent
pneumo dullness & Succussion
thorax shifting splash
dullness
 Thank the patient
&
ensure they are appropriately
covered before leaving

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