How to Measure Pulse in an Adolescent
To measure a resting pulse in an adolescent, palpate the radial artery for a full 60 seconds with the patient seated quietly for at least 5 minutes with their arm resting at heart level on a solid surface. 1
Patient Preparation
- Have the adolescent sit quietly for a minimum of 5 minutes before measurement to ensure a true resting state, as physical activity and emotional state can significantly affect heart rate even when the patient appears externally calm 1
- Position the patient seated (not supine) with their right arm resting at heart level on a solid surface 1
- Ensure the patient is truly relaxed, as measurements taken when patients are not genuinely calm are misleading even if they are not crying or visibly agitated 1
Measurement Technique
- Count the radial pulse for a full 60 seconds rather than shorter intervals multiplied by a factor 2
- Palpate the radial artery on the thumb side of the wrist using your index and middle fingers 2
- For resting heart rates, a 30-second counting interval may be acceptable and efficient, but avoid 15-second intervals as they are significantly less accurate 2
- Never use a 15-second counting interval for heart rates faster than 100 beats per minute, as this produces significantly less accurate results 2
Expected Normal Values
- Normal resting heart rates in adolescents vary by age: approximately 82 beats per minute in children under 11 years, 74 beats per minute in ages 11-15 years, and 67 beats per minute in those over 15 years 3
- Females typically have higher pulse rates than males, ranging from 1.6 to 4.7 beats per 30 seconds higher depending on age 4
- Seated pulse rates are consistently higher than supine rates by 1.3 to 2.9 beats per 30 seconds, so position matters 4, 5
- Heart rate normally decreases with age during childhood and adolescence due to lowering of cardiac sympathetic influence 3
Common Pitfalls to Avoid
- Do not measure pulse immediately after the patient sits down - the 5-minute rest period is essential for accurate resting measurements 1
- Do not assume a patient is relaxed based on external appearance alone, as white coat effect can elevate heart rate even in calm-appearing adolescents 1
- Avoid measuring during or immediately after physical activity, as activity significantly affects readings 6
- Do not use supine position measurements interchangeably with seated measurements, as they produce different values 4, 5