Physical Exam at the Heart Institute at UPMC Children’s Hospital of Pittsburgh

A physical exam can help your child's doctor detect and diagnose possible heart disease or see how well your child is coping with existing heart problems.

At the Heart Institute at UPMC Children's Hospital of Pittsburgh, doctors might check your child from head to toe.

Head, Face, and Neck Exam


The doctor will check the soft spot on the top of your infant's head, known as the anterior fontanelle. A normal soft spot is flat, soft, and level with the rest of the scalp.

The doctor will feel your infant's soft spot throughout the first year of life to check for dehydration problems.

Nose and Lips

The doctor will inspect the nostrils as your child breathes. Many heart defects present at birth (congenital) can stress the lungs and cause breathing issues.

Your child's doctor can assess the degree of breathing difficulty by watching for your child's nostrils to flare as he or she breathes. When the lungs are working hard, the nostrils may open up wide as a way to take in extra air.

Lip color is an important indicator of heart disease. The inside of the lips should be a pink color.

A blue or purple lips color can mean your child has:

  • Some degree of unoxygenated blood flowing through the arteries.
  • Inadequate blood flow from heart failure.
  • Anemia.
  • Blood loss.


The jugular veins and the carotid arteries are located on either side of the neck.

The jugular veins bring blood from the head back to the heart in order to receive a new supply of oxygen. The carotid arteries take oxygen-rich (red) blood back to the brain.

Veins and arteries that are easily visible in the neck while a child is resting may be a sign of heart failure.

Chest (Heart and Lung) Exam

Your child's doctor will observe and feel your child's chest. Heart defects present at birth can cause breathing problems.

One of the signs that doctors can observe is retractions. Each time your child breathes, the doctor will watch for a pulling inward of the skin between or below the ribs, or above or below the breastbone.

Your child's doctor will also use a stethoscope to listen to the front and back of your child's chest.

The doctor will count your child’s heart rate and listen for odd sounds in the heart, such as:

  • Murmurs
  • Clicks
  • Irregular heartbeats

The doctor will count your child's breathing rate and listen to both lungs for sounds proving good airflow through them. Breathing sounds that are not as clear or strong in one lung compared to the other will need further testing.

If your child was born with a heart defect or has an acquired heart disease, fluid may build up in the lungs.

If there is fluid in the lungs, your child's doctor will hear:

  • Crackles
  • Congestion
  • Other moist or "wet" sounds

Abdomen (Liver) Exam

Many congenital or acquired heart problems can cause issues with the body's water balance, leading to fluid retention and swelling of your child's liver.

Your child's doctor will feel the right side of the abdomen to check for swelling of the liver.

Checking the Pulse in the Arms and Legs

Your child's doctor will feel your child's arms and legs to find pulses.

In each arm, doctors can check pulses:

  • On the inside of the wrist
  • In the bend of the elbow
  • On the inner surface of the upper arm

In the legs, your doctor can find pulses:

  • On each side of the groin
  • Behind the knee
  • On the top surface of the foot
  • Behind the inner ankle

Absent or very strong pulses may be a sign of heart problems.

Skin and Nails Exam

Skin temperature

Skin temperature is helpful in evaluating heart disease.

When the heart isn't pumping properly, it can't pump enough blood to meet the body's demands. The body will narrow the blood vessels to nonessential areas — such as the limbs —to preserve blood flow and protect the brain.

The skin becomes cool in areas where blood vessels have narrowed. This coolness most often starts in the fingers and toes and then moves up the arm or leg as the problem worsens. The skin color may be pale.


Your child's nail beds also reveal vital information about the heart. Normal nails are a pink color.

Blue or purple nail beds may mean insufficient amounts of oxygen in the bloodstream or inadequate blood circulation.

Pale nail beds may be a sign of anemia (low numbers of red blood cells in the bloodstream).

Children born with cyanotic heart disease — that allows unoxygenated blood to flow to the body — may have a widening of the nail beds, called clubbing.

Growth, Development, and Activity Level

To make sure your child is within the expected growth and development ranges for his or her age, the doctor will:

  • Measure your child’s height and weight.
  • Assess your child's development with walking and talking.

The doctor will also want to know about your child's activity level.

He or she will ask you if your child:

  • Is active and busy.
  • Tires easily.
  • Has shortness of breath or other symptoms during activities, such as walking or playing.

The symptoms of heart disease may resemble other health conditions or problems. Always consult your child's doctor for more information.

Make an Appointment for a Physical Exam

To schedule a physical exam for your child, contact the Heart Institute at UPMC Children's Hospital at 412-692-5540.