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Pediatric Considerations:

Kids & Vital Signs

Vital Signs in the Ambulatory Setting:An Evidence-Based Approach

Cecelia L. CrawfordRN, MSN

Children in the Clinic• Children are NOT small adults• Anxiety & fear can affect vital signs

Allow parents & family members to stay with child

Allow child to stay in parent’s arm or lap

• May need special equipment & techniques to take vital signs Temperature Pulse Respirations Blood Pressure

VS – It’s All About The Numbers!

Terminal Digit PreferenceHCW may show a preference for certain numbers in

Pulse, Respirations, & auscultated BP readings* Zeros, even numbers, odd numbers Research study on BP revealed 99% of auscultated

SBP/DBP readings ended in zero, demonstrating lack of adherence to AHA recommendations*

HCW should be aware of this possible tendency

(*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)

Ear (Tympanic) TemperatureCan be affected by heat & cold:

Heating & cooling measuresHeat & ice packs, heating blanketsChild wrapped in blanket for a long time

Extreme outside and inside temperaturesVery hot or very cold roomsVery hot or very cold days

Bathing or swimming May need to wait 20 minutes for accurate temp

Ear (Tympanic) Temperature

•Can also be affected by: Impacted ear wax & ear

infections Whether an ear tug is used

•Should NOT be used if child had ear surgery

Ear (Tympanic) Temperature Insert covered thermometer probe into ear canal & use ear tug

to position properly: Children 1 year & older: Gently pull top of ear back, up, & out Children less than 1 year: Gently pull top of ear straight back Point tip towards nose

• Less than 2 yrs: point tip between eyebrows & sideburns

http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

Ear (Tympanic) Temperature•What Patients Think About Ear Temperatures

Parents like them! Fast, easy, clean, and safe

Children react better! Faster measurement Stay in parent’s lap or arms

No holding or restraining No positioning

Pulse - Brachial• Used for infants and small

children• Place fingertips of first 2

or middle 3 fingers over the brachial pulse area Inside of the elbow

• Lightly press your fingertips on the pulse area

Normal Pulse Rates

Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

Babies to age 1: 100–160

Children ages 1 to 10: 60–140

Children age 10 & older: 60–100

Respiratory Rate

• Count for 60 sec• If panting, use stethoscope to count• Agitation can result in inaccurate RR

Normal Respiratory Rates

Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

AGE BREATHS/MIN

Newborn to 6 weeks 30 - 60

Infant (6 weeks to 6 months) 25 - 40

Toddler ( 1 to 3 years) 20 - 30

Young Children ( 3 to 6 years) 20 - 25

Older Children (10 to 14 years) 15 - 20

Blood Pressure•Automated BP machines cannot be used in children with:

Seizures, shaking, or shivers Weak pulses Agitation Any situation where the arm cannot be kept still

Blood Pressure• Allow child to remain in

parent’s arm or lap• Use the right-sized cuff• Switch automated BP

machine to the pediatric setting Adult setting is too high for

children!

Normal BP Measurements

Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

AGE Normal BP

Newborn to 6 weeks * Systolic 50 - 70

Infant (6 weeks to 6 months) * Systolic 70 - 95

Toddler ( 1 to 3 years) * Systolic 80 - 100

Young Children ( 3 to 6 years) Systolic 80 - 110

Older Children (10 to 14 years) Systolic 90 - 120

(* BP is often not taken on children less than 3 years of age)

Children in the Clinic• YOU can make the difference:

Welcoming presence Decrease the child’s anxiety & fears Reassure the parents & family Accurate vital signs