Obtain Meaningful Vital Signs

Normal ranges for heart rate, respiratory rate, and blood pressure vary significantly with age and must be interpreted in the context of a child's activity at the time

(Table 111-1). Anxiety, pain, fever, and crying will increase all values, and these states should be documented if present. Optimal vital signs are obtained without eliciting an adverse reaction to the examiner (e.g., respiratory rate taken by observing abdominal movements, and heart rate auscultated through clothing). If fever is a concern, temperature should be obtained rectally in infants, toddlers, and uncooperative children, because the oral, axillary, and tympanic routes are less reliable. Temperature measured by the oral route is likely to be feasible and accurate in children by 4 to 5 years of age. Blood pressure should be measured on previously well children who are 5 years of age and older (school age), children with chronic disease associated with hypertension (e.g., renal disease), and all children who are critically ill. Weight is a pediatric vital sign because of dosing considerations and the importance of growth as an indicator of chronic disease in children. Appropriate scales and growth charts should be available in emergency departments. For resuscitation purposes, bedside estimates of weight are frequently inaccurate, and length-based resuscitation resources (e.g., Broselow tapes) are recommended.

TABLE 111-1 Pediatric Vital Signs (Awake and Resting)

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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