Paediatric Vital Signs
Normal ranges age by age, the anatomical differences that make a child compensate then crash, and the assessment, pain and weight-estimation tools used to read one.
Newborn (0–30 days)
Weight: 2.5–4 kgComplete Reference Table
| Age Group | HR (bpm) | RR (rpm) | SBP (mmHg) | SpO² (%) | Temp (°C) | BGL (mmol/L) |
|---|---|---|---|---|---|---|
| Newborn (0–30d) | 100–180 | 40–60 | 60–90 | >95 | 36.5–37.5 | 2.6–5.5 |
| Infant (1–12 mo) | 100–160 | 30–60 | 70–100 | >95 | 36.5–37.5 | 3.3–5.5 |
| Toddler (1–3 yr) | 90–150 | 24–40 | 80–110 | >95 | 36.5–37.5 | 3.3–5.5 |
| Preschool (3–5 yr) | 80–140 | 22–34 | 80–110 | >95 | 36.5–37.5 | 3.3–5.5 |
| School Age (6–12 yr) | 70–120 | 18–30 | 90–120 | >95 | 36.5–37.5 | 3.9–5.8 |
| Adolescent (13–18 yr) | 60–100 | 12–20 | 100–130 | >95 | 36.5–37.5 | 3.9–5.8 |
Tachycardia Note
A sustained HR >180 in an infant or >160 in a toddler warrants investigation. Always interpret in clinical context — pain, fever, and distress all cause physiological tachycardia.
- Larger occiput — neutral/sniffing position for airway
- Proportionally larger tongue — greater risk of obstruction
- High anterior larynx — more acute angle during intubation
- Narrowest point is the cricoid ring (subglottic) in young children
- Trachea shorter and softer — risk of inadvertent bronchial intubation
- Obligate nasal breathers in neonates — nasal obstruction causes significant distress
- Smaller tidal volume — compensates with rate rather than depth
- Compliant chest wall — subcostal/intercostal recession more visible
- Diaphragm-dependent breathing — abdominal distension impairs ventilation
- Fewer alveoli — less respiratory reserve than adults
- Desaturates rapidly — limited reserve means quick deterioration
- Cardiac output primarily rate-dependent (not stroke volume)
- Higher circulating blood volume per kg (~80 mL/kg in neonates)
- Bradycardia is an ominous sign — often pre-terminal
- Hypotension is a late sign of shock — compensatory mechanisms last longer
- CRT >2 seconds concerning; >3 seconds significant
- Brain proportionally larger — higher metabolic demand
- Fontanelle present until ~18 months — useful ICP indicator
- Myelination incomplete — nerve conduction slower in neonates
- More susceptible to hypoglycaemia — monitor BGL closely
Paediatric Assessment Triangle (PAT)
The PAT is a rapid 30–60 second visual assessment used to determine the severity of illness without touching the patient. Based on three components.
Appearance
Tone, interactivity, consolability, look/gaze, speech/cry. Use TICLS mnemonic.
Work of Breathing
Abnormal sounds (stridor, wheeze), abnormal positioning, retractions, nasal flaring.
Circulation to Skin
Pallor, mottling, cyanosis — indicate abnormal perfusion or oxygenation.
TICLS
Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry
AVPU Scale
A — Alert
Fully conscious, responds to environment, age-appropriate behaviour.
V — Voice
Responds to verbal stimuli. Eyes open or consistent response to commands.
P — Pain
Responds only to painful stimuli. Significant neurological compromise.
U — Unresponsive
No response to any stimulus. Treat as GCS 3 — critical.
Clinical Threshold
A paediatric patient responding only to pain (P) warrants urgent escalation. Equivalent to a GCS of approximately 8.
Paediatric Glasgow Coma Scale
| Component | Response | Score |
|---|---|---|
| Eyes | Spontaneous | 4 |
| To speech | 3 | |
| To pain | 2 | |
| None | 1 | |
| Verbal | Oriented / Coos, babbles (infant) | 5 |
| Confused / Irritable cries (infant) | 4 | |
| Words / Cries to pain (infant) | 3 | |
| Sounds / Moans (infant) | 2 | |
| None | 1 | |
| Motor | Obeys commands / Normal spontaneous (infant) | 6 |
| Localises pain | 5 | |
| Withdraws from pain | 4 | |
| Abnormal flexion (decorticate) | 3 | |
| Extension (decerebrate) | 2 | |
| None | 1 |
Moderate
9–12
Careful monitoring. Reassess frequently. Consider causes: hypoglycaemia, seizure, trauma.
Severe
3–8
Significant neurological impairment. Airway protection priority. Consider early escalation.
FLACC Scale — Infants & Pre-verbal Children
Used for infants, toddlers, and children who cannot self-report pain. Each category scored 0–2, total 0–10.
| Category | 0 | 1 | 2 |
|---|---|---|---|
| Face | No expression | Occasional grimace, frown | Frequent frown, clenched jaw |
| Legs | Normal / relaxed | Uneasy, restless | Kicking, drawn up |
| Activity | Lying quietly | Squirming, tense | Arched, rigid, jerking |
| Cry | No cry | Moans or whimpers | Crying steadily, screams |
| Consolability | Content, relaxed | Reassured by touch/talk | Difficult to console |
Relaxed or mild
0–3
Moderate pain
4–6
Severe pain
7–10
Wong-Baker FACES — Ages 3 and Over
Self-report pain scale. Show the child the faces and ask them to point to the face that best shows how much pain they have right now.
0
No hurt
2
Hurts little bit
4
Hurts little more
6
Hurts even more
8
Hurts whole lot
10
Hurts worst
Usage Note
Present all six faces before asking the child to choose. Do not suggest a number — let them point. Valid from age 3 with appropriate developmental ability.
Numerical Rating Scale — Ages 8 and Over
Ask the child to rate their pain from 0 (no pain) to 10 (worst pain imaginable). Most children aged 8 and over can use NRS reliably.
Mild
1–3
Aware of pain. Not disrupting activity. Monitor and reassess.
Moderate
4–6
Interfering with activity. Analgesia indicated. Reassess after intervention.
Severe
7–10
Overwhelming. Prioritise analgesia per local clinical guidelines.
| Age | Motor | Language / Social | Assessment Relevance |
|---|---|---|---|
| 2 months | Lifts head prone, tracks objects | Social smile, cooing | Lack of social smile is a red flag |
| 6 months | Sits with support, rolls over | Babbles, laughs | Stranger anxiety begins |
| 12 months | Walks with support, pincer grasp | First words, waves bye-bye | No words by 12 months — flag for developmental review |
| 18 months | Walks independently, climbs | 10–20 words, follows 2-step commands | Fontanelle normally closed |
| 2–3 years | Runs, jumps, kicks a ball | Phrases, parallel play | FLACC becoming less reliable; use FACES |
| 4–5 years | Hops, draws shapes | Full sentences, cooperative play | Can engage in interview-style history |
| 6+ years | Mature gross motor | Reads, complex reasoning | NRS increasingly reliable from age 8 |
Broselow Formula (Ages 1–12 yr)
Weight (kg) = (Age + 4) × 3 ÷ 2
1 year~ 7.5 kg
2 years~ 9 kg
3 years~ 10.5 kg
4 years~ 12 kg
6 years~ 15 kg
8 years~ 18 kg
10 years~ 21 kg
12 years~ 24 kg
Simplified Formula
Weight (kg) = (Age × 3) + 7
Newborn2.5–4.0 kg
6 months~ 7 kg
12 months~ 10 kg
5 years~ 22 kg
10 years~ 37 kg
Teen (>13 yr)Adult dosing
Dosing Note
Always use the lowest appropriate dose. Weigh the patient if possible. Formulas are estimates — if actual weight is known, use it. Paediatric formulas are not valid for obese children.
Respiratory
- RR >60 in any age group
- Apnoea >20 seconds or with cyanosis
- Stridor at rest
- Absent or significantly reduced breath sounds
- SpO² <92% on oxygen
Cardiovascular
- Bradycardia (especially in infant)
- HR >220 in infant, >180 in child
- CRT >3 seconds in warm environment
- Mottled, pale, or grey skin colour
- Absent central or peripheral pulses
Neurological
- GCS <9 or AVPU = P or U
- Bulging fontanelle (in infant)
- Purpuric non-blanching rash
- Neck stiffness with fever
- Posturing (decorticate / decerebrate)
General
- BGL <2.6 mmol/L (any age)
- Temp >38°C in neonate <3 months
- Hypotonia / floppiness
- Inconsolable or high-pitched cry
- Failure to recognise parents (infant)
Key Principle
Paediatric patients compensate effectively — then deteriorate rapidly. A child who looks "okay" can decompensate quickly. When in doubt, treat and transport early. Trust your clinical gestalt alongside vital signs.
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