We can all relate to that dreadful moment when we inform parents that their child has a murmur. Improving the physician s skill in assessing this physical finding is a must for all practitioners, since recognizing if it is an innocent murmur after all, can decrease those anxiety levels quickly and effectively, improve parental confidence in the physician, and be cost-effective. The most important and essential aspect of cardiac auscultation of the child remains familiarity with what is normal. The patient should be supine in such a manner that the examiner can stand to the right of the patient. The examiner palpates pulses in both arms an in at least one leg followed by the chest and suprasternal notch.
Auscultation is begun in the second right intercostal space at the sternal border.
When listening to a child s heart, one expects to hear the first and second heart sounds, including splitting of the second heart sound. The physician should assume that the finding of innocent murmurs will occur in a normal examination. It must be evaluated just as any other observation, and its normality established. These skill come from experience, as expected. The table below describes 10 characteristics that can be described regarding each heart murmur.