NG-409 · NUR 235

🩺 Vital signs, pain & assessment by age

A child is not a small adult. They compensate brilliantly and then crash suddenly, and blood pressure is the last thing to fall. The ranges matter, but the pattern matters more.

📈 The ranges

Two directions and one exception.

Learn the pattern, not the table As age goes up: heart rate and breathing come down, blood pressure goes up. ▼ HEART RATE falls Newborn110–160 Infant100–150 Toddler90–140 School age70–120 Teen60–100 ▼ RESPIRATIONS fall Newborn30–60 Infant25–40 Toddler20–30 School age18–25 Teen12–20 ▲ Systolic BP climbs: ~65 at birth to ~120 by 18
You can reason out any missing row from the direction of travel. A normal blood pressure never rules out shock in a child — it falls last.
AgeHeart rateRespirationsSystolic BP
Newborn110–16030–60~65–85
Infant100–15025–40~70–100
Toddler90–14020–30~80–110
School age70–12018–25~85–120
Adolescent60–10012–20~95–140

⭐ The one idea

A child compensates by raising the heart rate, and keeps compensating until they cannot. Blood pressure falls last. A normal blood pressure never rules out shock.

🚨 A child going off

In order, earliest first.

🚨 Early signs, in the order they appear

  • 1 · Tachycardia — the very first compensation
  • 2 · Tachypnea, then nasal flaring, grunting, retractions
  • 3 · Irritability, then lethargy — a change in behavior is a vital sign
  • 4 · Poor feeding in an infant — often the parent's first complaint
  • 5 · Falling blood pressure — late, and ominous

If the stem gives you a quiet, floppy child after a period of crying, that is not settling. That is decompensation.

💧 Urine output by age

  • Infant — 1–3 mL/kg/hr
  • Child — 0.5 mL/kg/hr
  • Adolescent / adult — 40–80 mL/hr

👀 Findings that are normal, and findings that are not

  • Circumoral cyanosis can be benign; central cyanosis of the lips and tongue is always abnormal
  • A protuberant abdomen is normal; a firm distended one is not
  • Petechiae after delivery are normal; generalized petechiae are not
  • Innocent murmurs are common in school age as the heart outgrows the chest

😭 Pain, by what they can do

Pick the scale by whether the child can self-report — not by how much pain you think there is.

0–3 yearsFLACC Behavioral. Five items scored 0–2, max 10. You observe it.
3 years and upWong-Baker FACES The child points. They pick the face, you do not pick it for them.
Around 5–8 and upNumeric 0–10 Only if cognitively able to grasp the scale.

FLACC vs FACES is decided by whether the child can self-report. That is the whole distinction, and it is the trap.

🧭 The order you do things in

✅ Least invasive first, always

  • Auscultate the apical pulse a full minute — and do it before you disturb the infant
  • Respirations and heart rate before anything that makes them cry
  • Invasive and frightening things last
  • Specimen collection moves least invasive to most invasive. A urine culture needs a sterile cath specimen; a 24-hour collection discards the first void.
  • Do procedures in a treatment room, never in the child's bed — the bed has to stay a safe place
Peds