Paediatrics: Respiratory system

Respiratory system

·  Lips and buccal mucosa: what is the colour of the mucous membranes and lips? Is the tongue in good condition? What is its colour? Are there any plaques, white patches, or spots?

·Oropharynx: what is the colour and size of the tonsils? Is there an exudate? What is the shape of the palate, uvula, and posterior pharynx?

·Chest: what is the shape of the chest? Are there scars or deformity? What is the position of the trachea? What is the chest like on percussion? (hyperresonant or dull? Where?)

·Breathing: are there any signs of respiratory distress. Is there nasal flaring, intercostals, subcostal, and sternal recession, use of accessorymuscles, forced expiration, grunting, or tracheal tug? Is there an audible noise during inspiration or expiration?

·Auscultation of the lungs: listen for breath sounds in all regions of the chest. Evaluate inspiration and expiration. In the crying child you will still be able to listen during inspiration. Are there any fine crackles, rhonchi, or wheezes? Is there a pleural friction rub?

·Ears: the child will need to be positioned correctly for this part of the examination. It is often easier to have the child sitting on the mother’s lap; one of her arms should be held around the upper body, and with the other arm she should place her hand against the side of the child’s head so that it is held firm against her. Is there evidence of otitis externa? Is there a rash in the post-auricular area (a feature of dermatitis, measles, and rubella)? On otoscopy, check the state of the tympanic membrane. What is its colour and degree of lucency? Is it perforated, or is there a myringotomy tube present?

·  Nose: is there discharge? Can the child breathe through each nostril?