Rapid Review I: What You Assess Changes With the Age
A horizontal range strip in six age columns: a heart rate lane and a respiratory rate lane both tapering downward left to right, with a blood pressure line ascending against them.
Pediatric vital sign ranges, awake and at rest
| Age | Heart rate, beats per minute | Respiratory rate, breaths per minute | Systolic blood pressure, mm Hg |
|---|---|---|---|
| Newborn, birth to 1 month | 100 to 180 | 30 to 60 | 60 to 90 |
| Infant, 1 to 12 months | 100 to 180 | 30 to 53 | 72 to 104 |
| Toddler, 1 to 2 years | 98 to 140 | 22 to 37 | 86 to 106 |
| Preschool, 3 to 5 years | 80 to 120 | 20 to 28 | 89 to 112 |
| School-age, 6 to 11 years | 75 to 118 | 18 to 25 | 97 to 115 |
| Adolescent, 12 to 15 years | 60 to 100 | 12 to 20 | 110 to 131 |
Heart rate and respiratory rate fall as the child grows. Blood pressure climbs. Count a pediatric respiratory rate for a full minute, because infants breathe irregularly, and take an apical pulse for a full minute in any child under about five years.
Hook: tachycardia is the earliest compensation a child makes and hypotension is a very late one. A normal blood pressure never reassures you in a sick child. Bradycardia in a child is a pre-arrest sign, usually from hypoxia, and it is treated by fixing the oxygenation. crit
Growth is a vital sign. Birth weight roughly doubles by about six months and triples by about twelve months. The posterior fontanel closes by two to three months and the anterior fontanel between twelve and eighteen months. Head circumference is measured at every well visit through age two. Hook: the child with cystic fibrosis fails to gain weight because fat is not absorbed, so pancreatic enzymes go with every meal and every snack, the diet is high calorie and high protein with fat-soluble vitamin supplementation, airway clearance comes before meals rather than after, and weight is the outcome you evaluate.
Dehydration watch. Infants dehydrate faster: a higher proportion of body water, more surface area for their mass, and no ability to ask for a drink. Look for a sunken anterior fontanel, absent tears, dry mucous membranes, capillary refill longer than two seconds, tachycardia, and fewer wet diapers. Hook: daily weight on the same scale is the most reliable indicator of fluid status in a child.
Pain by age. A behavioral tool for the preverbal child, a faces scale for the preschooler who can point, a numeric scale for the school-age child who understands what a number stands for. Hook: match the tool to the cognitive stage, not to the diagnosis.
Hips in infancy. Asymmetric thigh and gluteal folds, limited hip abduction, unequal knee height when the hips and knees are flexed, and a clunk on the newborn hip maneuvers. A harness is worn as prescribed. Hook: teach the caregiver never to adjust the straps and to check the skin under them daily.
Spines in adolescence. The forward bend test shows a rib hump, uneven shoulders, and an uneven waistline. A brace is worn most of the day and night until skeletal maturity. Hook: adherence is an identity problem before it is an orthopedic one.
Anticipatory guidance. Infants sleep supine on a firm surface with nothing else in the bed and ride rear-facing. Toddlers need locked cabinets and touch supervision near any water. Preschoolers need pedestrian rules. School-age children need helmets. Adolescents need conversations about driving, substances, firearms, and mood.
Margin notea normal blood pressure in a floppy child is not good news.
Takeawayat every age the normal number, the pain tool, and the danger the caregiver needs warned about are all different. → BOOK 07 · P4