Differences in Vital Signs

Normal values for heart rate and respiratory rate vary based on their age. Normal values for blood pressure vary based on gender and age for all pediatric patients, and also height percentile for patients greater than 1 year of age. Normal values for blood pressure in pediatric patients can be found in various national guidelines and other pedi-atric diagnostic references. Heart rates are highest in neonates and infants, ranging from 95 to 180 beats per minute (bpm) and decrease with age, reaching adult rates (60-100 bpm) around 10 years of age.8 Respiratory rates are also higher in neonates and infants (24-38 breaths/min), decreasing with age to adult rates around 15 years of age (12-20 breaths/min).9 Another vital sign commonly monitored in children by their caregivers is body temperature, especially when they seem "warm to the touch." The American Academy of Pediatrics (AAP) recommends rectal temperature measurement in children 4 years of age or younger, using a digital thermometer. For children 4 years of age or older, axillary or oral temperature measurement is appropriate as the child is more able to cooperate when asked. Axillary thermometers can be used in children as young as 3 months, but may be less accurate.10 Tympanic (otic) temperature readings are also safe for all ages; however, these temperatures may be less accurate and can be affected by cerumen accumulation. Generally, rectal temperature is greater than oral temperature by 0.6°C (1°F), and oral temperature is 0.6°C (1°F) higher than axillary temperatures. Also known as the fifth vital sign, pain assessment is more challenging to assess in neonate, infants, and young children due to inability to communicate symptoms. Indicators of possible pain include physiologic changes such as increased heart rate, respiratory rate, and blood pressure, decreased oxygen saturation, as well as behavior changes such as prolonged, higher pitch crying and facial expressions. Laboratory values also vary depending on age. Normal ranges are often noted by the laboratory facility on reported results.

Table 3-1 Pediatric Age Groups, Age Terminology, and Weight Classification

Age Group

Age

Neoima

a warts) cf lire on la w

hftrl

¡9 days lew than 1J months

CNld

1-Qyean

Www

15-17 ¡fltffi

Age Terminology

Oefm Hon

Age from dtla ot mothers f iritdayif UHirwisnuai (wiod to riiTee' brih

Full term

Describe rfarili Sorn at 3fl'W<?c geitalicn or lew

Piemarurf

Deiihbes intf^nrs. born fce'cre J 7-v/ee*. $

SnvJIfsi

fcirihiKiglhl bi*Jv* (he ¡Oih p"(cntilc jmflni) rxoftiKS if um( GA

Li!Q5 'or GA

Neonaiei wSi bill* we^Tt above theWlh pe<iaen(ile among net™:«-tf 1he lime

Chfofiotogical ch powv«ii sqe

Age from bith tg pmewn:. meswieil in dsyi. wnwlii, month*, or yew

idff«!«! Ci Kfjuiied 4ge

Mjy bt L«d » dtKiite ttii tge oT» preniture cMd up 3 ycwidiage

Corrected ags - Chronokjgiijl age mon^hi - WO - GA al b-i th in weelu) - a weeks)

For enameie. if a former ga tiia ¡i now lomomru okJchronoieg tally. his «a« ted

jqe ii Bppnj* n^ly ? mtmrnf

10 months - [(4D-ij weeks.: + w«kil » 7.2S monttis.

Wfi-yhi CliiilfItalian

DeftnttJon

LBW infant

Premalurs Infant birth weight between 1,500 and ¿iOG a

VL9W Infim

Prifiilyne ir^im wi^h i)ir(h weight l.WQ g to leii thjn l.MQtf

EnticmF LBW

Pramjlurt rifjmt wih brfri weight Ich than I.OOQ g

(W fpiJUtioni ; LSW. lew iJi! I h Jt* VLBW. vtfi birth Wdfighl

(W fpiJUtioni ; LSW. lew iJi! I h Jt* VLBW. vtfi birth Wdfighl

Compiled fnsro Oaiiin Pet. 5

Age (Months)

Woqh>

FIGURE 3-1 Example of CDC growth chart of boys, birth to 36 months: Head circumference-forage and weight-for-length percentile, 2000. (From Ref. 6.)

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