From the Guidelines
Vital signs in the pediatric age group should be assessed according to age-specific normal ranges, with normal blood pressure defined as less than the 90th percentile for children aged 1-13 years and less than 120/80 mmHg for children aged 13 years and older, as stated in the 2017 clinical practice guideline for screening and management of high blood pressure in children and adolescents 1.
Normal Ranges for Pediatric Vital Signs
The following are the normal ranges for pediatric vital signs:
- Newborns (0-28 days): heart rate 120-160 beats per minute, respiratory rate 30-60 breaths per minute, systolic blood pressure 60-90 mmHg, and temperature 36.5-37.5°C (97.7-99.5°F)
- Infants (1-12 months): heart rate 80-150 beats per minute, respiratory rate 25-50 breaths per minute, systolic blood pressure 70-100 mmHg
- Toddlers (1-3 years): heart rate 80-130 beats per minute, respiratory rate 20-30 breaths per minute, systolic blood pressure 80-110 mmHg
- School-age children (6-12 years): heart rate 70-110 beats per minute, respiratory rate 18-25 breaths per minute, systolic blood pressure 90-120 mmHg
- Adolescents (13-18 years): heart rate 60-100 beats per minute, respiratory rate 12-20 breaths per minute, systolic blood pressure 100-120 mmHg
Importance of Accurate Measurement
It is essential to measure pediatric vitals when the child is calm, as crying and agitation can artificially elevate heart rate, respiratory rate, and blood pressure 1. Temperature measurement methods vary by age, with rectal temperatures being most accurate for infants, while oral or tympanic measurements are appropriate for older children.
Guidelines for Pediatric Basic Life Support
The 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care provide a pediatric basic life support algorithm for healthcare providers, which includes verifying scene safety, checking for responsiveness, and activating the emergency response system 1. The guidelines also emphasize the importance of providing high-quality CPR with a compression rate of 30:2 for single rescuers and 15:2 for two rescuers.
From the Research
Vitals in Pediatric Age Group
- The measurement and interpretation of vital signs are crucial components of assessment in the emergency department, especially in pediatric patients 2.
- A study found that complete vital signs documentation was present in only 50.8% of pediatric encounters, with older age and patient acuity being associated with vital signs documentation 2.
- Abnormal vital signs were documented in 73.0% of encounters with complete vital signs, and were associated with younger age and hospitalization or transfer 2.
- Elevated heart rate and respiratory rate were found to be associated with hospitalization or transfer in pediatric patients 2.
Documentation of Vital Signs
- A study examined the documentation of pediatric vital signs by EMS providers over time and found that the trend of documenting critical vital signs improved over time for all four categories (blood pressure, heart rate, pulse oximetry, and respiratory rate) 3.
- However, blood pressure remained the most inconsistently obtained vital sign, especially in younger pediatric patients 3.
- Educational interventions were found to correlate with an increase in vital sign attainment, highlighting the importance of ongoing education and training for EMS providers 3.
Monitoring of Oxygenation
- Various techniques are available to evaluate oxygenation, including arterial blood gases, capillary blood gases, point-of-care testing, and pulse oximetry 4.
- Clinicians should understand the benefits and limitations of these techniques and base the decision to monitor oxygenation on therapeutic objectives 4.
- Oxygen supplementation has been a mainstay in the management of patients with acute cardiac disease, but hyperoxia can have adverse effects, including peripheral and coronary vasoconstriction, and direct cellular toxicity 5.