Lesson 29: Respiratory Assessment of a Child

 

An important first step in assessing the chest of an infant or toddler is to help the small patient feel comfortable.

Some nurses carry an extra stethoscope for use by the child. It may be helpful to start with playing a game, using either a favorite doll or stuffed animal, or by involving the parent. The nurse can listen to the animal or parent's chest first, and then apply the stethoscope to the child's chest.

***A small child may feel more secure and cooperate more if he or she sits on a parent's lap during the examination.
In doing the assessment, keep in mind that respiratory rates in children are different than those of adults. 
A normal respiratory rate for an infant averages approximately 40 breaths per minute, for a preschool child 30 breaths per minute, and for a school age child 20 breaths per minute. Abdominal breathing is common and normal in infants.

Assess the child for signs of labored breathing, such as retractions, and look for color changes in the lips, and nail beds. If retractions are noted, look for the location of the retractions.

If the child has retractions, look for compensatory respiratory mechanisms, such as nasal flaring during inspiration, grunting during expiration, or the use of accessory muscles in the neck and shoulders. 

When auscultating breath sound in young children, use the bell of the stethoscope. The bell is a more sensitive indicator of sounds and detects softer, lower-pitched sounds than the stethoscope diaphragm.

NCLEX tip: Breath sounds of toddlers are generally more intense and bronchial sounding than adults, with expiration more pronounced than inspiration.