Look around the room to see if any accessories/ instruments like crutches/ wheelchairs/ glasses/ inhalers/ Sputum sample

Once the child is seated, ask if you could expose the upper body.

For lower body, you may need to ask permission from the examiner also

General examination

• Level of consciousness- Alert/ Oriented/ cooperative
• Decubitus (position in bed)
• Gait
• Built- Average/ small or large for age
• Nutrition- Average/ undernutrition
• Any obvious dysmorphism
• Respiration effort- rate, rhythm, pattern, depth, laboured or not

Face

1. Dysmorphism
2. Cyanosis/ Pallor
3. Respiratory distress- nasal cannula/ nasal flaring

Nose

1. Congestion
2. Hypertrophied turbinate
3. Bleeding
4. Polyps
5. Nasal septum – deviation

Sinuses

1. Tenderness Over maxilla
2. Heaviness on bending forwards

Throat

1. Post nasal drip
2. Pharyngitis signs
3. Tonsils

Hands

1. Fingers- Clubbing/ Koilonychia/ Pallor/ Cyanosis
2. Hands-Pallor in the crease/ Cannulation/ Scars

Neck

1. Trachea position- central/ deviated
2. Scars
3. Tracheostomy

Chest

1. Scars on the body- Chest/ neck/ abdomen
2. Work of breathing
3. Scars

Back

1. Scoliosis
2. Kyphosis
3. Winging of scapula
4. Venous prominence

Lower respiratory tract

Inspection of chest-

1. Shape
2. Movement
3. Apical impulse
4. Respiration
   • Rate
   • Rhythm
   • Type
   • Depth
   • Pattern
5. Accessory muscle of breathing
6. Audible wheeze/ stridor
7. Intercostal muscles indrawing
8. Skin
   • Pigmentation
   • Scars

Palpation

1. Temperature
2. Tenderness over chest
3. Position of trachea
4. Position of apex beat
5. Movement of chest bilaterally
6. Vocal fremitus

Percussion

1. Percuss both sides simultaneously.
2. The idea is to percuss at least 3 zones of bother the lungs.
3. Upper zone, middle zone and lower zone and compare

Auscultation

1. Breath sounds
2. Adventitious sounds
   • Ronchi
   • Crepitations
3. Pleural rub
4. Vocal resonance