II. Approach: Formulas and General Rules

  1. Systolic Blood Pressure in children over 1 year old
    1. Median SBP = 90 mmHg + (2 x Age in years)
    2. Minimum SBP = 70 mmHg + (2 x Age in years)
  2. Heart Rate and Fever
    1. Expect Heart Rate to increase 7-10 bpm for each degree fahrenheit
  3. Rough Approximations
    1. Pulse or Heart Rate (HR)
      1. Infant Pulse: 160
      2. Preschool Pulse: 120
      3. Adolescent Pulse: 100
    2. Systolic Blood Pressure (SBP)
      1. Infant SBP: 80
      2. Preschool SBP: 90
      3. Adolescent SBP: 100
    3. Respiratory Rate (RR)
      1. Infant RR: 40
      2. Preschool RR: 30
      3. Adolescent RR: 20

III. Indications: Rapid cardiopulmonary assessment (e.g. Pediatric Assessment Triangle)

  1. Systolic Blood Pressure is observed to drop 10 mm Hg
  2. Respiratory Rate >60
  3. Heart Rate outside ranges shown below
  4. Increased work of breathing
    1. Retractions
    2. Nasal Flaring
    3. Grunting
  5. Cyanosis or decreased Oxygen Saturation
  6. Altered LOC (irritability, lethargy)
  7. Seizures
  8. Fever with Petechiae
  9. Trauma
  10. Burns >10% of body surface area

IV. Evaluation: Age associated Vitals

  1. Premature Infant
    1. Heart Rate: 120-170 bpm
    2. Blood Pressure: 55-75 / 35-45 mmHg
    3. Respiratory Rate: 40-70 breaths/min
  2. Term Newborn (3 kg)
    1. Temperature: 36.5 to 38.0 C (97.7 to 100.4 F)
    2. Mean arterial pressure (MAP): (Gestational age at birth) + (age in weeks)
      1. Example: An newborn at 38 weeks presents at 1 week of life, MAP = 39
    3. Blood Pressure:
      1. Birth: 75-95/37-55 mmHg
      2. Age 12 hours: 50-70 / 25-45 mmHg
      3. Age 96 hours: 60-90 / 20-60 mmHg
      4. Age 7 days: 74 +/- 22 mmHg (Systolic BP)
      5. Age 42 days: 96 +/- 20 mmHg (Systolic BP)
    4. Heart Rate: 100-150
    5. Respiratory Rate: 40-60
  3. Infant (0-3 months old)
    1. Heart Rate: 100-150 bpm
    2. Blood Pressure: 65-85 / 45-55 mmHg
    3. Respiratory Rate: 35-55 breaths/min
  4. Infant (3-6 months old)
    1. Heart Rate: 90-120 bpm
    2. Blood Pressure: 70-90 / 50-65 mmHg
    3. Respiratory Rate: 30-45 breaths/min
  5. Infant (6-12 months old)
    1. Heart Rate: 80-120 bpm
    2. Blood Pressure: 80-100 / 55-65 mmHg
    3. Respiratory Rate: 25-40 breaths/min
  6. Toddler (1-3 years old)
    1. Heart Rate: 70-110 bpm
    2. Blood Pressure: 90-105 / 55-70 mmHg
    3. Respiratory Rate: 20-30 breaths/min
  7. Preschool (3-6 years old)
    1. Heart Rate: 65-110 bpm
    2. Blood Pressure: 95-110 / 60-75 mmHg
    3. Respiratory Rate: 20-25 breaths/min
  8. School Age (6-12 years old)
    1. Heart Rate: 60-95 bpm
    2. Blood Pressure: 100-120 / 60-75 mmHg
    3. Respiratory Rate: 14-22 breaths/min
  9. Teen (>12 years old)
    1. Heart Rate: 55-85 bpm
    2. Blood Pressure: 110-135 / 65-85 mmHg
    3. Respiratory Rate: 12-18 breaths/min

V. References

  1. Claudius, Behar, Salway and Kearl in Herbert (2018) EM:Rap 18(5): 1-3

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