Palpation

The chest expansion of a child can be observed in the same way as in an adult. However, note that in children the actual expansion of the chest is less during inspiration; the younger the child the more diaphragmatic the breathing. This is a consequence of the angle of the ribs to the spine; in young children the ribs are nearly horizontal, and the bucket handle effect of expansion in inspiration cannot occur.

The two important things to do on palpation are:

• check that the trachea is central
• ensure that the apex beat is in the correct place as lateral displacement may indicate lung collapse or fibrosis