Chest

Inspect the shape of the chest.

Determine the respiratory rate. The respiratory rate of a 6-year-old child is 16 to 20 breaths per minute.

Palpate the chest for tactile fremitus, as described in Chapter 13, The Chest. Tactile fremitus has low sensitivity and specificity in childhood.

Auscultation needs to be done systematically, but it can be difficult, and patience is required. If you tell a child to ''take a deep breath,'' the child frequently holds the breath; instead, tell the child to imitate you taking deep breaths. Alternatively, you can ask the child to ''blow out the birthday candles.'' Are the breath sounds normal? Are there any adventitious sounds? Breath sounds in children sound louder than those in adults as a result of the chest configuration.

Percuss the chest, using the same technique as in adults. Because the chest wall is thinner in children than in adults, the percussion notes are more resonant in children. Percuss gently, because overly vigorous percussion may produce vibrations over a large area and obscure an area of dullness.

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