Pediatric Vital Signs (VS)

Temperature
1. 97.8 – 99.1°F
2. BEST taken with rectal temperature for children up to age 2
  1. Apply a small amount of lubricant to a covered probe, insert into rectum – wait for result
3. Up to age 5 – Axillary temperature
  1. Place covered probe under arm and hold child’s arm down – wait for result
4. Oral temperature after age 5
  1. Place probe in pocket under tongue, have pt close mouth
    1. Not accurate if pt has eaten or drank in the last 15 minutes
Pulse
1. Normals
  1. Preterm – 1 year:
    1. 120-160 bpm
  2. 3 year:
    1. 90-140 bpm
  3. 6 – 8 years:
    1. 80-120 bpm
  4. 10+ year:
    1. 60-100 bpm
2. Listen with stethoscope to apical pulse for a full minute – just below the left nipple line.
3. Locate brachial pulse on inside of elbow, count for a full minute
  1. Best practice is 1 minute due to possible irregularity, but CAN do 30 seconds and multiply by 2
4. For children 10 and older, can also check a radial pulse just like an adult
Respirations
1. Normals
  1. Preterm – 1 year:
    1. 30-60 bpm
  2. 3 year:
    1. 25-40 bpm
  3. 6 year:
    1. 22-34 bpm
  4. 8 year:
    1. 16-24 bpm
  5. 10 year:
    1. 16-20 bpm
  6. 12 year:
    1. 14-20 bpm
  7. 14+ years:
    1. 12-20 bpm
2. Children may be belly breathers, watch chest or abdomen rise and fall to count respirations for 30 seconds and multiply by two
  1. Can count while waiting for temperature to result
  2. Older children may change their breathing pattern if you tell them you’re counting – count for 30 seconds after checking pulse
Blood Pressure
1. Normal Systolic Blood Pressure
  1. Preterm:
    1. 50-70 mmHg
  2. Newborn – 3 mo.:
    1. 60-70 mmHg
  3. 1 year:
    1. 70-80 mmHg
  4. 3 year:
    1. 76-90 mmHg
  5. 6 year:
    1. 80-100 mmHg
  6. 8 year:
    1. 80-110 mmHg
  7. 10+ year:
    1. 90-120 mmHg
2. May have to hold child’s hand to prevent movement of arm during blood pressure
3. Same technique as for adults – make sure you have the right size cuff!
SpO2
1. Normal 95 – 100%
2. Same technique as for adults
Pain
1. Use FLACC (Face, Legs, Activity, Cry, Consolability) for younger children and infants
2. Use Wong-Baker FACES scale with children who can point to the face that looks like how they feel
3. Use numerical pain scale with older children who can comprehend it

Assessment

Temperature, Pulse, Respirations, SpO2
1. Same causes as adults (see Adult Vital Signs lesson)
Blood Pressure
1. In children under 10:
  1. High
    1. Hormonal disorders
    2. Kidney disorders
    3. Heart defects
  2. Low
    1. Hypovolemia
    2. Hypothyroidism
    3. Tachycardia
2. In children over 10:
  1. Same causes as adults

Therapeutic Management

Tips and Tricks
1. Make it fun
2. Make a game out of it
3. Be honest, but compare it to something they understand
  1. “It’s like getting a big hug on your arm” for blood pressure
  2. “It’s just like putting on a bandaid” for pulse ox (the sticky ones)
4. Involve mom and dad! They can help hold the child or keep them calm
5. Do not say “it won’t hurt” if it WILL – you need the child to trust you!

Patient Education

Parents may need education on purpose and frequency of vital signs
Report what the results are, do not diagnose, but explain objectively what it means

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Transcript

Hey guys, in this lesson we just want to review a little bit about pediatric vital signs – the highlights and important points!

For each of these in your outline there’s information about normal values and techniques on how to get these specific vital signs. Now, the normal temperature in kids is the same as adults, but it’s important to know that the most accurate temp you’ll get in a child is a rectal temp – especially in kids up to age 2. Up to age 5 we usually use an axillary temp, and then after that we can switch to oral as long as the child can tolerate it. On this thermometer I want to show you a cool thing that some thermometers have, which is this little stopwatch button here. It will beep at 15 or 30 seconds and you can actually use that to count respirations while you take their temperature!

Pulse rates in kids – that’s how many times their heart beats in one minute – vary by age and we’ve listed those in your outline, but by age 10 or so, their normal values start to mimic adult values more closely. For littles, the most accurate pulse technique is to listen to the apical pulse, which is usually just below the left nipple line. You listen for a full minute with your stethoscope to get the beats per minute. If you don’t have a pediatric stethoscope, you can use the bell of an adult stethoscope since it’s smaller. In kids we also use the brachial pulse, which is found just inside the elbow. Again, as kids get older they are more and more like adults and you can move to a radial pulse if you can feel lit.

With respirations, again the normal values will vary by age, so check out the outline. One important thing to know here is that kids may be belly breathers, so you may actually be watching the abdomen rise instead of the chest. You also want to look for retractions and make sure you aren’t seeing the muscles go IN during inspiration, because that indicates labored breathing. Either way you’re going to count their respirations for 30 seconds and multiply by 2. Now, especially in older kids and adults, if you tell them you’re counting their breaths, they WILL breathe differently – so you can count while you’re taking their temp like we talked about earlier or while you’re taking their pulse, so they don’t know what you’re doing.

The technique for taking a pediatric blood pressure is the same as an adult, so make sure you check out that lesson – the big thing to note is that you HAVE to have the right size cuff. Same rules apply, check the range lines and make sure it’s the right size! Now, we all know kids can get squirmy, so sometimes you have to hold their hand or hold their arm still – you can even tell them “this cuff is just going to give your arm a big hug!” to make it a little less scary. Check out your outline for normals and the adult vital signs lesson for techniques.

Kids LOVE the pulse ox! It’s a shiny red light! Sometimes in peds we have the little sticky ones, so you can tell them it’s like putting on a bandaid. Either way, you may just need to hold their hand still to make sure you get a good waveform.

Lastly is pain – the scale that you use for pain is entirely dependent on the child. Nonverbal younger kids – you’ll use the FLACC scale, which is in the cheatsheet attached to this lesson. If they’re verbal, but may not yet be able to comprehend the numeric scale, you can use the Wong-Baker FACES scale and have them tell you which face looks like how it makes them feel. You can also just kind of look at their face and tell, but the scale itself is designed for the child to choose. And, of course, with older kids who can conceptualize it – you can use a standard 0-10 scale.

Just wanna give you a couple of tips and tricks for taking pediatric vital signs. Being in a doctor’s office or hospital can be really scary, so we want to make it fun and make a game out of it if we can – same thing with peds assessments. You can tickle their tummy while you listen to their heart, lungs and belly. We always want to be honest with them, but we can related it to something they understand – like giving their arm a hug or putting on a bandaid – that can help take some of the fear out of it. We can involve the parents – this is SO important, you can see the mom is holding baby here and that’s so helpful. Not only can they help to hold the child still, but again it makes the child feel safe and comforted. Don’t force a child into a certain position, just make sure they feel safe – that helps build trust. We NEVER want to tell a child “this won’t hurt” if it will – they will immediately lose trust and be terrified of you. So be honest with what you’re doing!

Hope that was helpful – again check out the outline attached to this lesson and the cheatsheets as well, and check out the adult vital signs lesson for more details on techniques. Now, go out and be your best selves today. And, as always, happy nursing!!

Pediatric Vital Signs (VS)

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Outline

Overview

Nursing Points

General

Assessment

Therapeutic Management

Patient Education

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