Around the child – oxygen, inhalers, creon, other tubing, wheelchair, monitors, sputum pot, peak flow

General Overview of child

-       Nutritional status

-       Growth

-       Respiratory effort – RR, WOB, stridor, audible wheeze,

-       Colour

-       Dysmorphism – T21, Pierre Robin

-       Ex-Prem appearance

Hands

Fingers – Clubbing, peripheral cyanosis

Hands – cannulation scars, tremor

Pulse

Face

-       Pallor

-       jaundiced sclera

-       central cyanosis

-       central hypoplasia

ENT – Perform at END of examination if needed

-       Ears – shape and size / dimorphic

-       Nose – Polyps, deformity, deviated septum

-       Throat – cleft palate/ tonsillar hypertrophy

-       Consider cervical lymph node examination

Neck – trachea – central/deviated /tracheostomy/ tracheostomy scar

CHEST

-Inspection

-       Respiratory Rate

-       Chest wall symmetry / shape and movement

-       Scars – front and back

-       Central Lines – Picc Line site, Ports (look under bra strap in teenage girls), Hickman lines

-       Work of breathing

-       Harrisons Sulci / Pectus Excavatum / Pectus Carinatum

-       Spine – Kyphosis and Scoliosis

Palpation

-       Apex

-       Chest Wall expansion – not in infants

-       Huff at this point (if CF likely)

Percussion

warn child first

percuss over same zones as auscultated

-dullness/ hyper-resonance

Auscultation

Listen to 6 zones including axillae

o   Wheeze/decreased air entry/ crepitations / bronchial breathing

o   Vesicular breath sounds / Prolonged expiratory phase

o   Vocal Resonance – ‘99’ (only in older children)

Repeat process on back with child sat up

-check for back scars at this point is not done already

To complete my examination I would like to:

-ENT

-Plot height and weight on growth chart

-Peak flow if indicated

-Oxygen saturations / BP

-Abdominal examination if indicated (liver/spleen)

-Cardiac Examination if indicated

Authors: Abigail Whitehouse and Cecilia Ng