The technique involves using a
pediatric stethoscope as indicated.
If the tool is too big, you won't be
able to isolate the breath sounds.
You'll ask the patient to open their mouth
and you're going to listen
directly on their skin.
You don't want to be listening
over a gown or clothing
because this can cause
sounds similar to rhonchi.
You want to make sure the patient
is sitting up, if they're able,
and this is going to allow them
to fully expand their lungs.
In each position, you're going to listen
for 1 complete respiratory cycle.
That includes a full inhalation
and a full expiration.
Don't forget about the apices of the lungs,
and these are found above the clavicles.
You also want to listen all around
the rib cage under the axilla,
so that you get every lung field.
You're going to compare
the sounds bilaterally
and you're going to be listening for any
adventitious or abnormal breath sounds.
You're also going to be checking, during
this exam, does your patient cough?
When you listen to a child,
you're going to be comparing the
equality of the breath sounds
and you're always comparing the right with
the left in the same level of the lung.
You're going to be listening
for diminished sounds,
and this can show up in the setting
of a pneumothorax or a consolidation.
And you're going to be checking
for air exchange bilaterally.
The normal breath sounds.
We have bronchial, bronchovesicular,
and the vesicular.
The bronchial sounds are a tubular and
hollow sound heard over the trachea
and sometimes, the mediastinum.
The expiratory phase and bronchial
sounds is slightly longer
than the inspiratory phase.
The next, as you move down the chest,
is the bronchovesicular sounds.
These sounds are heard over
the main bronchus region.
These are the normal sounds
in the mid-chest area
and these are heard also on
the back between the scapula.
In this phase, the inspiration and
expiration are of similar duration.
Last, you'll listen for vesicular sounds, and
these are found over the lesser bronchi,
the bronchioles, and the
actual lobes of the lung.
The inspiratory phase is longer
than the expiratory phase.
And these are low frequency, non-musical,
and they're barely audible at rest.
Next, you're going to listen for wheezing,
and similar to turbulent wind and
airflow whistling through a chimney,
the airway can also cause a whistle.
And this is a high-pitched
sound that's flow-dependent,
and it can be present on
inspiration, on expiration, or both.
Next, you'll listen for crackles and these
are high-pitched, short-duration sounds.
They can indicate that the patient
is trying to move secretions.
You're also going to listen for rales,
and these are discontinuous rattling,
bubbling, or clicking sounds,
heard usually during inspiration.
Next, you'll check for rhonchi, and
these are low-pitched wheezes.
They're continuous and they
often sound like snoring.
They can be present on
inspiration and expiration,
and sometimes, these clear with a cough.
Last, you're going to check for stridor,
and this is a high-pitched wheezing sound
caused by a disruption of
airflow in the upper airway.
There may be a foreign body
obstruction, mucus, or edema
that blocks the airflow
through the upper airway.
And this can usually be heard
on the other side of the room
without needing your stethoscope.
Next, you're going to listen for a cough.
Is it present or absent?
You can also ask the parents about this
if the patient isn't currently
coughing in the clinic.
You want to ask, "Is this a wet
cough, or is it a dry cough?"
Certain conditions are associated with each.
Is it paroxysmal?
Does the patient get coughing spasms?
And we worry about this in
the setting of pertussis.
Is the cough worse at night?
This is typically the condition, and
it's usually from the post-nasal drip.
As the patient lays flat, the
cough will worse at night.
This is really frustrating for
patients and for their parents.
They're always asking, "What can I do to
help my child stop coughing at night?"
And we encourage symptomatic
care as propping pillows,
honey in warm water or tea,
or taking sips of water.
Is the cough barking or
does it sound croupy?
These patients may have croup, which
is a tightening of the upper airway.