Pediatric Vital Sign Ranges by Age
Neonates (0 to 28 days): Heart rate 120 to 160, respiratory rate 30 to 60, systolic BP 60 to 80. Infants (1 to 12 months): Heart rate 100 to 160, respiratory rate 25 to 50, systolic BP 70 to 95. Toddlers (1 to 3 years): Heart rate 90 to 150, respiratory rate 20 to 30, systolic BP 80 to 100. Preschool (4 to 5 years): Heart rate 80 to 140, respiratory rate 20 to 25, systolic BP 80 to 110. School age (6 to 12 years): Heart rate 70 to 120, respiratory rate 15 to 20, systolic BP 85 to 120. Adolescents (13 to 18 years): Heart rate 60 to 100, respiratory rate 12 to 20, systolic BP 90 to 130. Remember that in pediatric patients, tachycardia is often the earliest and most reliable sign of distress or shock, occurring well before blood pressure changes. Hypotension is a late and ominous finding in children.
Minimum Acceptable Systolic Blood Pressure
For quick field estimation of the minimum acceptable systolic blood pressure in children, use the following formulas. For infants (1 to 12 months), the lower limit is approximately 70 mmHg. For children 1 to 10 years of age, use the formula: 70 + (2 x age in years). For example, a 4-year-old should have a minimum systolic BP of 70 + (2 x 4) = 78 mmHg. For children over 10 years, the minimum is approximately 90 mmHg. Any systolic BP below these thresholds indicates decompensated shock requiring immediate intervention including fluid resuscitation and rapid transport.
Broselow Tape Usage
The Broselow tape (also known as the Broselow-Luten tape) is a color-coded, length-based measurement tool used to estimate a pediatric patient's weight and determine appropriate medication doses, equipment sizes, and fluid volumes. To use the tape, place it alongside the child with the red end at the top of the head and read the color zone at the child's heel. Each color zone corresponds to a weight range and lists pre-calculated medication doses, IV fluid rates, endotracheal tube sizes, defibrillation energies, and other critical values. The tape is designed for children up to approximately 36 kg (about 80 pounds) or 145 cm in length. For children larger than the tape's range, use standard adult dosing. The Broselow tape reduces the risk of dosing errors during high-stress pediatric resuscitations by eliminating the need for real-time weight estimation and calculation.
Weight-Based Dosing Principles
Pediatric medication dosing is almost always weight-based, expressed as mg/kg or mcg/kg. When the child's actual weight is unknown, estimate using the Broselow tape or the formula: weight in kg = (2 x age in years) + 8 for children 1 to 10 years old. Key weight-based doses to know include: epinephrine for anaphylaxis 0.01 mg/kg IM (EpiPen Jr 0.15 mg for 15 to 30 kg, adult EpiPen 0.3 mg for over 30 kg), epinephrine for cardiac arrest 0.01 mg/kg IV/IO of 1:10,000 concentration, atropine 0.02 mg/kg IV/IO (minimum dose 0.1 mg to prevent paradoxical bradycardia), amiodarone 5 mg/kg IV/IO for cardiac arrest, and normal saline 20 mL/kg bolus for fluid resuscitation. Defibrillation energy is 2 joules/kg for the first shock and 4 joules/kg for subsequent shocks. Always double-check calculations and have a second provider verify doses when possible.
Key Anatomical Differences in Pediatric Patients
Understanding pediatric anatomical differences is critical for proper airway management and assessment. The pediatric airway is narrower and more anterior than in adults. The tongue is proportionally larger relative to the oral cavity, making it the most common cause of airway obstruction in children. The larynx is more superior and anterior (at C3 to C4 in infants compared to C5 to C6 in adults). The epiglottis is longer, floppier, and U-shaped. In children under 8 years, the narrowest part of the airway is at the cricoid ring (subglottic), not at the vocal cords as in adults. This is why uncuffed endotracheal tubes were traditionally used in young children, though current guidelines allow cuffed tubes with appropriate monitoring.
Head and Body Proportions
Infants and young children have proportionally larger heads and shorter necks compared to adults. The occiput is more prominent, which can cause neck flexion and airway obstruction when the child is placed supine on a flat surface. A thin pad or towel placed under the shoulders (not the head) helps maintain a neutral "sniffing position" for optimal airway alignment. Children have a higher body surface area to mass ratio, making them more susceptible to heat loss and hypothermia. The abdominal organs are less protected by the rib cage, which is more pliable, so significant internal injury can occur without rib fractures. The fontanelles (anterior closes at 12 to 18 months) can be assessed for signs of increased intracranial pressure (bulging) or dehydration (sunken).
Respiratory Considerations
Infants are obligate nose breathers until approximately 4 to 6 months of age, so nasal congestion or obstruction can cause significant respiratory distress. Children have higher metabolic rates and oxygen consumption per kilogram than adults, causing them to desaturate more rapidly during apnea or hypoventilation. The chest wall is more compliant in children, and retractions are a more prominent sign of respiratory distress. When providing BVM ventilation to pediatric patients, use an appropriately sized mask that covers the mouth and nose without compressing the eyes, and avoid excessive tidal volumes and pressures to prevent gastric distension and barotrauma. Use the E-C clamp technique for proper mask seal, and ventilate only until visible chest rise is observed.
Pediatric Assessment Triangle (PAT)
The Pediatric Assessment Triangle is a rapid, across-the-room assessment that takes 30 to 60 seconds and provides an initial impression of the child's condition without touching the patient. It evaluates three components. Appearance assesses muscle tone, interactiveness, consolability, look/gaze, and speech/cry (remembered by the mnemonic TICLS). Work of Breathing assesses for abnormal airway sounds, abnormal positioning (tripod, sniffing), retractions, and nasal flaring. Circulation to Skin assesses for pallor, mottling, cyanosis, and skin color. Abnormalities in one or more components help categorize the child's condition as respiratory distress, respiratory failure, shock, or CNS/metabolic disorder, guiding the urgency and type of intervention needed.