The Pediatric Pulmonary Physical Examination
Christopher Harris, MD, FAAP
Anthropometrics
•Important features of the physical examination pertinent to the respiratory tract begin with a careful assessment of the patient’s anthropometrics. Children with chronic respiratory distress do not grow well, whether because of calories being expended with increased respiratory effort or because of chronic hypoxia.
•Weight and height must be measured accurately, particularly in children with concerns about failure to thrive.
•Accurate height measurement is also required for correct interpretation of spirometry data.
Vital Signs
•Respiratory rate varies widely, especially in the first several years of life. It is helpful to have charts of normal ranges available to determine if values are outside of the expected range.
•Pulse oximetry (see Chapter 9, Oximetry and Capnography) has become readily available in many practices and is now practically a fifth vital sign.
—Pulse oximetry is most useful in ensuring that levels of oxygenation are adequate, especially during times of stress to the pulmonary system.
—Staff must be well trained in the intricacies of probe application and interpretation of pulse waveforms.
Upper Airway
Ear, Nose, and Throat
•Chronic otitis may be a sign of immunodeficiency or primary ciliary dyskinesia.
•Nasal examination is key for determining whether the patient has allergic rhinitis.
—Pale, edematous mucosa is the usual finding in allergic disease.
—Nasal polyps should be noted because they are a key finding in the “aspirin allergy, nasal polyps, and asthma” triad, as well as in children with cystic fibrosis.
•Oral examination is vital for evaluating causes of respiratory difficulty, particularly in infants. Inspection and palpation for cleft palate (including submucous clefts) must be performed because the risk for aspiration in these infants is high.
—Macroglossia and tonsillar hypertrophy place patients at risk for the development of obstructive sleep apnea.
—
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
