Auscultation

Auscultation of the chest in a child can be difficult; time and patience can be needed to keep the child relatively quiet. The subsequent interpretation of breath sounds and additional noises can also pose problems, and a careful listening is needed to note differences rather than absolute signs. This particularly applies to signs such as bronchial breathing; often this is a comparative finding in a small child, where most of the breathing would appear bronchial to the adult physician.

Specific sign may include:

• crepitations in bronchiolitis or rarely heart failure
  
  
• coarse intermittent noises secondary to debris from infections
  
  
• wheezing, and, often more helpful, prolonged expiratory time in asthma
  
  
• the silent chest is an emergency in an ill child
  
  
• stridor may be heard in upper airway obstruction:
  • subtle stridor on a noisy ward can be heard by holding the stethoscope near the mouth
  • however, beware the child who wants to render the examiner deaf