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If increased effort is needed to fill the lungs, supraclavicular and infraclavicular retraction may be seen. In infants, sternal retraction occurs with only a slight increase in respiratory effort, the result of the pliability of their chests. Compare intercostal bulging.
The otoscopic exam is performed by gently pulling the auricle upward and backward. In children, the auricle should be pulled downward and backward. This process will move the acoustic meatus in line with the canal. Hold the otoscope like a pen/pencil and use the little finger area as a fulcrum.