Introduction
Physical Examination
General
Cyanosis
Labored respirations
Tachypnea
Chest wall retractions
Nasal Flaring
Coughing/Sneezing
Grunting
Stridor
Differential Diagnosis
Specific Diseases
References
Other Lectures
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Chest wall retractions are much more specific for respiratory tract disease than is tachypnea, although they are seen in airway obstruction, as well as parenchymal lung disease. Both of these cause an increased airway resistance, which in turn causes a greater than normal negative inspiratory pressure to be generated. This increased negative pressure causes the soft parts of the infant's chest, which is compliant and poorly ossified, to retract inward.
Most commonly retractions are seen in the intercostal spaces. They appear early in the course of the disease. While they do worsen as the disease progresses, it may be difficult to distinguish "mild" from "moderate" or "moderate" from "severe" retractions, especially between observers. However as the disease worsens, retractions also begin to occur in additional locations, such as the subdiaphragmatic and supraclavicular spaces. If severe disease is present, the entire sternum may retract on inspiration.
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