Paediatric Vital Signs
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Paediatric vital signs (normal reference ranges for observations) are a crucial part of assessing any unwell child.  Importantly, paediatric vital signs vary by the child’s age. Generally, the normal heart rate and respiratory rate decline as a child grows, whilst the normal blood pressure increases.

Unlike adult vital signs, the exact reference ranges for paediatrics are not universally agreed upon and there is some variation between sources. The table below is an approximation based on several sources, most closely approximated to those recommended by The Royal Children’s Hospital, Melbourne.

Age
Heart rate (bpm)
Respiratory rate (/min)
Systolic blood pressure (mmHg)
< 3 months
110-170
25-60
60-105
3-6 months
105-165
25-55
65-115
6-12 months
85-150
20-40
70-120
1-2 years
85-150
20-40
70-120
2-5 years
85-150
20-40
70-120
5-12 years
70-135
16-34
80-130
Over 12 years
60-100*
14-25

95-140

*Note – some sources report HR up to 120 as within the normal range for individuals under 17

The pattern of observations is also important – not just the raw numbers. For example, a child with a respiratory rate and / or heart rate that is steadily rising (even though the numbers themselves may remain with the ranges above) would be a cause for concern.

Other important factors in the assessment of the unwell child include:

  • An assessment of the child’s work of breathing. This is especially important in children under 5. If ANY of the following signs are present this indicated an increased work of breathing
    • Nasal flaring
    • Tracheal tug (skin is “sucked in” around the trachea on inhalation)
    • Subcostal recession (skin “sucked in” below the rib cage on inhalation)
    • Intercostal recession (skin “sucked in” between ribs)
    • Suprasternal recession (skin “sucked in” above clavicle)
  • Assessment of central capillary refill time

Both of these require that clothing be removed from the child’s torso.

Intercostal recession in a neonate
An example of intercostal recession – in this example seen in a neonate. This file is taken from wikimedia commons and is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

This Post Has 2 Comments

  1. William Pavey 5th November 2019 Reply

    Hi, I think some of these ranges are way off. The neonate respiratory rate is generally taken as 40 to 60 for example. 30-39 wouldn’t be normal. Some others are wrong too. May need amending

  2. Dr Tom Leach 5th November 2019 Reply

    Hi William, thanks for pointing this out – this certainly needed updating!

    I agree that the previously noted ranges were not particularly accurate, although they were in line with some (older) sources (such as those at GP notebook, and several Deaneries guidelines in the UK e.g. Bradford/Yorkshire and Southampton from what I can find with a quick search today).

    In the last decade or so with the move to using early warning score charts (EWS aka MEWS, PEWS etc) to spot sick patients in hospital, there has been more research and a broader consensus about paediatric reference ranges.

    As such, I have re-done the whole table and added some references in a bid to make it more accurate.

    It is worth noting there is still some variation between quoted ranges.

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