The examination of the chest is best performed while the infant is either sleeping or being held by a parent.

Often the tracheal breath sounds, or even nasal and pharyngeal sounds, are transmitted down to the chest. Do not misinterpret these sounds as crackles, and do not interpret the accompanying tactile sensation of ''rattling'' as abnormal fremitus.

Is the child in respiratory distress? The most important signs of distress are tachypnea, the use of accessory muscles, head bobbing, and flaring of the nasal alae. Intercostal retractions are also commonly present. Does the child have stridor, a high-pitched noise on inspiration? Stridor is indicative of tracheal narrowing, as in croup.

Auscultate the lung fields. Percuss if you hear any focal abnormalities in the lungs.

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