General Assessment

As mentioned before, there are a variety of ways of measuring temperature in a child older than 6 months. The heart rate of a child aged 1 to 5 years ranges from 80 to 140 beats per minute; the average rate is 100. The respiratory rate varies from 24 to 40 breaths per minute at 1 year of age and decreases to 20 to 24 by 5 years of age. Blood pressure assessment by auscultation is usually possible with children at least 3 to 4 years of age and should be performed on all children. Inform the child that the cuff will get tight for a few moments. The size of the cuff is important. The cuff must cover two thirds of the distance between the antecubital fossa and the shoulder. A cuff that is too small yields falsely high readings; conversely, a cuff that is too large yields falsely low readings. The techniques of palpatory and auscultatory blood pressure determination are the same as those used in adults. The National Heart, Lung, and Blood Institute has published standards of blood pressure measurements in boys and girls from 2 to 18 years of age. Figure 24-38 shows these percentile charts for boys and girls, taken in the right arm with the child seated.

Determine the height, weight, and body mass index for all children, and head circumference up to age 3.* Plot these values on the standard growth charts (see Figs. 24-24 and 24-25).

*Head circumference should be measured in older children if there is any reason to suspect abnormal head growth.

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