Pediatric Vital Signs and Safety
Normal ranges, pain scales and safe medication dosing
Approximate normal vital signs (awake, at rest)
| Age | Heart rate | Respirations | Hypotension if systolic BP below |
|---|---|---|---|
| Newborn (0–28 days) | 100–160 | 30–60 | 60 |
| Infant (1–12 months) | 100–160 | 30–50 | 70 |
| Toddler (1–2 yr) | 90–150 | 24–40 | 70 + (2 × age in years) |
| Preschool (3–5 yr) | 80–140 | 22–34 | 70 + (2 × age in years) |
| School age (6–12 yr) | 70–120 | 18–30 | 70 + (2 × age) up to 10 yr; then 90 |
| Adolescent (13–18 yr) | 60–100 | 12–20 | 90 |
Ranges vary between references; know your facility's chart. Count infant respirations and apical pulse for a full minute. Children compensate well, then crash: hypotension is a late sign of shock; tachycardia and delayed capillary refill come first.
Pain assessment
| FLACC | Pre-verbal or non-verbal (2 months–7 yr): Face, Legs, Activity, Cry, Consolability |
| Wong-Baker FACES | ~3 years and older |
| Numeric 0–10 | ~8 years and older (who understand numbers) |
| Neonates | NIPS, PIPP, or similar |
Non-drug comfort: breastfeeding or sucrose for infants during procedures, skin-to-skin, distraction, topical anesthetic before needles.
Safe dosing
- Doses are weight-based (mg/kg): weigh in kilograms and record kg only.
- Calculate the safe dose range and compare it with the order before giving.
- Never exceed the adult maximum dose.
- Oral liquids: use an oral syringe or the device supplied, never a kitchen spoon. Check the concentration.
Example: 22 lb child → 10 kg. Acetaminophen 15 mg/kg = 150 mg. Liquid 160 mg/5 mL → 150 ÷ 160 × 5 = 4.7 mL.
Development: the nursing angle
| Infant | Trust; stranger anxiety from ~6–8 months: keep parent present |
| Toddler | Autonomy; separation anxiety; simple choices; rituals |
| Preschool | Magical thinking (may see illness as punishment); use dolls to explain |
| School age | Industry; explain with simple science; involve in care |
| Adolescent | Identity; privacy; interview alone for part of the visit; body image |
Priority
Most pediatric cardiac arrests start as respiratory failure or shock. Watch for: increasing work of breathing, grunting, nasal flaring, retractions, head bobbing, decreasing level of consciousness, and a falling heart rate in a hypoxic child (pre-arrest).