Version June 2024
| Physical examination feature | Possible significance |
| General appearance (state of awareness, cyanosis)* | Most children with radiographically confirmed pneumonia appear ill |
| Vital signs | |
| Temperature | Fever may be the only sign of pneumonia in highly febrile young children; however, it is variably present and nonspecific |
| Respiratory rate | Tachypnea¶ less predictive of radiographically confirmed pneumonia than hypoxemia or increased work of breathing Tachypnea correlates with hypoxemia Absence of tachypnea helps to exclude pneumonia |
| Degree of respiratory distress | Respiratory distress is more specific than fever or cough for lower respiratory infection |
| Tachypnea | Described in section on "Vital signs" |
| Hypoxemia | Predictive of pneumonia |
| Increased work of breathing: | |
| Retractions | More common in children with pneumonia than without; absence does not exclude pneumonia |
| Nasal flaring | More common in children with pneumonia than without; absence does not exclude pneumonia |
| Grunting | Sign of severe disease and impending respiratory failure |
| Accessory muscle use | Sign of severe disease |
| Head bobbing | Sign of severe disease |
| Lung examination | |
| Cough | Nonspecific finding of pneumonia |
| Auscultation | Findings suggestive of pneumonia include: crackles (rales, crepitations), decreased breath sounds, bronchial breath sounds, egophony, bronchophony, and whispered pectoriloquy Wheezing more common in viral and atypical pneumonias |
| Tactile fremitus | Suggestive of parenchymal consolidation |
| Dullness to percussion | Suggestive of parenchymal consolidation or pleural effusion |
| Mental status | Altered mental status may be a sign of hypoxia |
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