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A Guide to Pediatric Vital Signs By Age


Pediatric Vitals Girl with Hat

Emergency medical technicians (EMT) often find pediatric patients to be more of a challenge than adult patients. Normal pediatric vital signs change as the child grows which makes remembering them difficult for even the best first responders. Unlike adults, pediatric vital signs don’t give a clear picture in sick kids and it’s often more important to look at the overall condition of the child. Below you will find a pediatric vital signs chart, a list of differences in pediatric anatomy, along with suggestions for taking pediatric vitals.

 

Children: Challenging Patients for EMS

Pediatric patients are often a challenge for EMTs and paramedics. The important thing to know is that you aren’t the only first responder who feels challenged with pediatric patients.

 

The truth is that if you saw more sick and injured children you would quickly get more comfortable with them. However, children are generally only 10% of emergency calls and they may be less depending on where you work. 

 

Here are some reasons pediatric patients are more difficult for first responders:

Injured children can be more emotional for first responders to deal with.

Anatomy and physiology is different in kids. 

EMTs often can’t relate to a child like they can to an adult.

Normal pediatric vitals vary with age.

More family dynamics involved due to parents in high stress situations.

Need different size equipment for children.

Each age group has its own set of normal behaviors to be familiar with.

Infants & children can seem fragile to EMTs who aren’t used to handling kids.

Less room for error with children – especially when administering medications.

Less pediatric calls & less skills practice with children.

 

Newborn Vital Signs Medical

 

Taking Pediatric Vital Signs

Vital signs that EMS should be taking on all pediatric patients include heart rate, blood pressure, temperature, and respiration rate. With pediatric vital signs we keep track of both sleeping heart rates and awake heart rates in the hospital setting because they can be very different. However, EMTs do not commonly assess sleeping pediatric patients when responding to medical emergencies. 

 

Normal pediatric vital signs for blood pressure, pulse and respirations change as the child grows from newborn to infant to child. For this reason, first responders often use a pediatric vital signs chart as a reference sheet.

 

Along with vital signs it’s important to look at the overall appearance of the child when dealing with pediatric patients. First responders use the Pediatric Assessment Triangle to rapidly assess whether the child appears to be “sick or not sick” before taking vitals.

 

Getting a general impression can be just as important as having a set of vitals in pediatric patients. In fact, skin signs can be obvious and important indicators of circulatory status issues in children.

 

  Pediatric Vital Signs Chart

The pediatric vital signs chart categorizes vitals based on age. It is important for EMTs to have a basic understanding of appropriate vitals for newborns, infants and children. However, I don’t recommend memorizing the entire pediatric vital signs chart, unless you have an exceptional memory.

 

EMTs who don’t memorize normal pediatric vitals should always have access to a card, app, or device with some version of a pediatric vital signs chart.

 

AgeBreaths Per MinuteAwake Heart RateDiastolic BPSystolic BPTemperature
Birth (12H) 30-58 100-20516-45 39-76 98.6
1-12 Months 30-58100-180 37-56 72-104 98.6
1-2 Years 22-37 98-140 42-63 86-106 98.6
3-5 Years 20-28 80-120 46-72 89-112 98.6
6-9 Years 18-25 75-118 57-76 97-115 98.6
10-11 Years 18-25 75-118 61-80 102-120 98.6
12-15 Years 12-20 60-100 64-83 110-131 98.6

–Pediatric Vital Signs Chart–

All of the vitals from the pediatric vital signs chart are written out at the end of this article. This is for anyone who prefers to see normal pediatric vital signs listed outside of the chart format.

 

Learning Normal Pediatric Vital Signs

 

Did you look at the Pediatric Vital Signs Chart above and say to yourself:

You want me to remember all that?

 

It would be great if we could easily memorize all the normal pediatric vital signs, but for most of us it’s just not worth the effort. If you have a great memory or a photographic memory than it won’t be much of a challenge.

 

For the rest of us, I recommend you at least have a general idea of what a newborn, infant, and child’s normal vital signs should be. Next, use a tool so you have normal pediatric vital signs available to you at all times while on duty.

 

However, EMTs who frequently work with pediatric patients or specialize in this population should have normal pediatric vital signs memorized.

 

There are a lot of tools available to help EMS remember normal pediatric vital signs while on duty. The first option is to use the pediatric vital signs chart above and carry it while at work. You can also take a picture or screen shot of the pediatric vital signs chart and have that available in your phone’s photos.

 

Tools for Pediatric Vital Signs Chart

 

Another option is to look up pediatric vital signs whenever you have a young patient and hope the internet is working well at your location. EMT’s can also use a phone app with normal pediatric vitals and have it available on your phone at work.

I found a pretty good Pediatric Vital Signs Calculator here. It works well if you have internet service and doesn’t require downloading an app.

 

If you don’t want to depend on technology, you can go old school and use an EMT field guide, a pocket guide, or even a pedi-wheel. These often will have other information for EMTs in them along with normal pediatric vitals. Paramedics can use Broselow’s Pediatric Tape for help with vitals, medications, airway sizes, and more.

 

I recommend having a hard copy of pediatric vitals available along with a digital resource because you won’t always have your phone service available. Also, difficult pediatric patients can often be subdued by giving them your phone to watch cartoons on. So you may not be holding it while treating your patient. 

 

EMTs taking pediatric vital signs will usually assess respirations first, then pulse and then blood pressure and temperature. Pediatric vital signs should be assessed every 5 minutes in unstable patients and every 15 minutes in stable children.

 

However, the EMT should be continually monitoring the child’s respiratory effort, level of consciousness, interactiveness, skin color and skin condition. Pediatric vitals will need to be taken more frequently if there is any change in the patient’s condition.

 

 Tips for Taking Pediatric Vital Signs

When taking vital signs in children there are a few things you want to focus on that may be different from adult patients.

 

→ With kids you want to be accurate when counting respirations. It’s better to take respirations for 30 seconds and double that number, rather than taking them for 15 seconds.

 

→ Children under 3 and especially infants tend to breathe using their stomachs. EMTs often watch the rise and fall of the abdomen in these patients, instead of the chest rise and fall when counting respirations. 

 

It’s good practice to take a pediatric pulse for a full minute and document the quality and regularity.

 

In infants you will take the heart rate using the brachial pulse and you probably won’t move to the radial pulse until the child is around age 6.

 

→ Normal body temperature basically remains constant throughout the lifespan. Keep in mind a complication of fevers in children is febrile seizures. 

 

Children Are Not Just Small Adults

You won’t learn about pediatrics in EMS without hearing the saying children aren’t just small adults, or some version of it. This refers to quite a few things and one of them is the anatomy and physiology of the child.

 

Here, I will quickly go over some differences that pediatric patients will present for EMTs and paramedics. It’s important to know the physical differences between a pediatric and adult patient so you can adjust your patient care.

 

Many of these differences are especially important for paramedics during intubation.

 

 

Pediatric Patient with US Medical Personnel

 

Differences in Pediatric Anatomy & Physiology for EMS

• The pediatric head is proportionately larger than an adult’s head.

 

• Pediatric patients have a larger rounder occiput bone in the skull.

 

• When supine, an infants large head can cause flexion of the neck. This can cause the trachea or tongue to obstruct the airway. EMTs can place a towel under the shoulders to prevent obstruction.

 

• The pediatric tongue is proportionally larger inside the mouth than an adult’s tongue. It can easily obstruct the airway. EMTs may need to place an OPA to keep the airway patent.

 

• Pediatric lungs are much smaller and have a small lung capacity. There is increased risk for barotrauma with resuscitation. Avoid prolonged time without ventilating.

 

• The glottic opening is higher and positioned more anteriorly in a shortened pediatric neck. As the child grows the neck becomes longer and the vocal cords and epiglottis move into adult positioning.

 

• Children have a floppy U-shaped epiglottis. Often paramedics can’t visualize the airway with a curved blade due to the child’s epiglottis.

 

• A pediatric airway is small in diameter and shorter in length than an adult. The trachea is narrowest at the cricoid ring and is in the shape of an hourglass.

 

• Diameter of the trachea in infants is about the same as a drinking straw.

 

The pediatric patient’s airway can become easily obstructed. Relatively little swelling, improper positioning, secretions and a small amount of cricoid pressure can easily occlude the airway.

 

• The shorter trachea in children increases the chances of right mainstem intubation.

 

• Pediatric patients have an oxygen demand twice that of an adult.

 

• Breath sounds are more easily heard in pediatrics because of thinner chest walls. This makes poor air movement or absence of breath sounds more difficult to detect.

 

• In pediatric patients the diaphragm is the primary mode of breathing. The diaphragm muscles dictate the amount of oxygen inspired. Adult inspiration uses intercostals & the diaphragm.

 

• Gastric distention can interfere with movement of the diaphragm and lead to hypoventilation in children.

 

• Children often use accessory muscles which contributes to respiratory fatigue.

 

• The pediatric brain requires increased: cerebral oxygen, blood flow and glucose.

 

• Children compensate for poor perfusion by constricting the vessels of the skin.

 

• Signs of vasoconstriction include pallor (early sign), weak distal pulses in extremities, delayed cap refill, along with cool hands and feet.

 

• Children can have a near normal blood pressure while experiencing shock.

 

Pediatric patients compensate by increasing heart rate and respiratory rate. This is different from adults who also increase the cardiovascular stroke volume or respiratory tidal volume to compensate.

 

• Pediatric patients can compensate for shock longer but when they crash it will be faster and more dramatic than an adult patient.

 

• Children can become hypoglycemic during or after resuscitation.

 

• The pediatric patient’s heart is higher in the chest than an adults.

 

• The child’s large occipital region increases the momentum of their head during a fall.

 

• Pediatric brain tissue and cerebral vasculature are fragile and prone to bleeding from shearing forces.

 

• Spinal cord injuries are less common in children.

 

• Abdominal muscles aren’t well-developed and provide less protection to organs from trauma.

 

• The liver, spleen, and kidney are more anterior and proportionally larger in kids. This makes children more at risk for bleeding and organ injury.

 

Normal Pediatric Vital Signs

This information can all be found on the Pediatric Vital Signs Chart above. Listed below are normal pediatric vital signs for anyone who prefers the information outside of the pediatric chart format.

 

Normal Pediatric Vital Signs by Age

 

Newborn Vitals (12 Hours) 

Pulse Rate: 100 – 205 beats per min  

Respiratory Rate: 30 – 58 breaths per min

Diastolic Blood Pressure: 16 – 45 breaths per min

Systolic Blood Pressure: 39 – 76 mm Hg

Body Temperature: 98.6 degrees F

Infant Vital Signs (1-12 months)

Pulse Rate: 100 to 180 beats per min  

Respiratory Rate: 30 – 58 breaths per min

Diastolic Blood Pressure: 37 – 56 mm Hg

Systolic Blood Pressure: 72 – 104 mm Hg

Body Temperature: 98.6 degrees F

Toddler Vital Signs (1-2 year)

Pulse Rate: 98 – 140 beats per min

Respiratory Rate: 22 – 37 breaths per min  

Diastolic Blood Pressure: 42 – 63 mm Hg

Systolic Blood Pressure: 86 to 106 mm Hg

Body Temperature: 98.6 degrees F

Preschool Age Vital Signs (3-5 yrs)

Pulse Rate: 80 to 120 beats per min  

Respiratory Rate: 20 – 28 breaths per min

Diastolic Blood Pressure: 46 – 72 mm Hg

Systolic Blood Pressure: 89 – 112 mm Hg

Body Temperature: 98.6 degrees F

School Age Vital Signs (6-9 yrs)

Pulse Rate: 75 – 118 beats per min  

Respiratory Rate: 18 – 25 breaths per min

Diastolic Blood Pressure: 57 – 76 mm Hg

Systolic Blood Pressure: 97 – 115 mm Hg

Body Temperature: 98.6 degrees F

Pre-Teen Vital Signs (10-11 yrs)

Pulse Rate: 75 – 118 beats per min  

Respiratory Rate: 18 – 25 breaths per min

Diastolic Blood Pressure: 61 – 80 mm Hg

Systolic Blood Pressure: 102 – 120 mm Hg

Body Temperature: 98.6 degrees F

Adolescent Vital Signs (12-15 yrs)

Pulse Rate:  60 – 100 beats per min

Respiratory Rate: 12 – 20 breaths per min

Diastolic Blood Pressure: 64 – 83 mm Hg 

Systolic Blood Pressure: 110 – 131 mm Hg

Body Temperature: 98.6 degrees F

 

If you are interested in the topic of pediatrics in EMS, I recommend checking out a podcast called The Medic Assessment. Episode 12 of the podcast Is titled Pediatric Medicine in EMS and it has a lot of interesting insights about modern pediatric treatments. This episode proposes fundamentally changing EMS education about pediatric patients and takes an honest look at how children affect EMS on duty. 

 

Want to more articles about assessing patients? Check out:

How to Perform the Primary Survey

Taking a SAMPLE History & OPQRST Pain Assessment 

 

Looking for EMS gear? Check out: 

2018 Boot Buying Guide and 10 Best EMS Boots

Top 10 Pants for EMTs and Paramedics

 

 

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