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8/6/2019 Pedia Clinics

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Katrina A. Pelinio


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INSPECTION : Shape and symmetry, size andposition of nipples, breasts, length of sternum,intercostal and substernal retraction,asymmetry, scapulas, clavicles.The shoulders should be examined, especiallyin the newborn, for clavicular fractures andforeshortened or absent clavicles. The width ofthe ribs and length of the sternum should benoted.


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L ook for supernumerary nipples, inverted

nipples, or widely spaced nipples with ashield-shaped chest

Practical notesN ormally, the chest is symmetrical and, in theinfant or young child, almost round.The transverse diameter increases with age.


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INSPECTION : symmetry of expansion withnormal breathing, dyspnea, prolongation ofexpiration, coughPALPATION : Confirm the degree ofexpansion in inspection by putting the palms ofyour hand on patients sides at the bases of thelungs; elicit vocal fremitusPERCUSSION :

flatness or dullness to,resonanceAUSCULTATION : breath sounds, rales,wheezing.


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Practical notes:The breathing of newborn infants is almostentirely diaphragmatic, so during inspirationthe soft front of the thorax is usually drawn

inward while the abdomen protrudes.If the baby is quiet, relaxed, and of good color,this paradoxical movement does notnecessarily signify insufficient ventilation .

N ormally, the breath sounds arebronchovesicular.


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B reath sounds in infants and children normallyare more intense and more bronchial, andexpiration is more prolonged, than in adults.Most of the young child's respiratorymovement is produced by abdominalmovement; there is very little intercostalmotion.

Flaring of the alae nasi and retraction of theintercostal muscles and sternum are commonsigns of pulmonary pathology.


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INSPECTION : symmetry of anterior chestwall, bulging of the precordium, PMI,engorgement of neck veinsPALPATION : confirm by touch, the location ofPMI; feel for a thrill over the precordiumPERCUSSION : start from the lateral ( along

the anterior axillary line) 2nd

intercostal spacegoing to medial, then follow with the rest of theinterspace up to the 5 th ICS


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AUSCULTATION : auscultate only over theclinical valvular areas :

apex (mitral area), then over the lower rightsternal border (tricuspid area), the second leftintercostal space at the sternal edge(pulmonary area), and the second rightintercostal space at the sternal edge (aorticarea)Heart sounds, including heart rate

MurmursArrythmias or abnormal rhythm of heart rate


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AGEHEART RATE(BEATS/MIN)

BLOODPRESSURE(MM HG)

RESPIRATORY RATE(BREATHS/MIN)

Premature 120170 [*] 5575/3545 [] 4070 []

03 mo 100150 [*] 6585/4555 3555

36 mo 90120 7090/5065 3045

612 mo 80120 80100/5565 2540

13 yr 70110 90105/5570 2030

36 yr 65110 95110/6075 2025

612 yr 6095 100120/6075 1422

12[*] yr 5585 110135/6585 1218


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http ://www.peds.arizona.edu/medstudents/Physicalexamination.aspN elson textbook of Pediatrics 18 th edition

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