Normal Vital Signs in Children

Heart Rate Parameters by Age

The American Academy of Pediatrics recommends that heart rate parameters for neonates and young infants be assessed as follows: 91-166 bpm for the first week of life, 107-182 bpm for 7-30 days, and 121-179 bpm for 1-3 months 1, 2
The American Heart Association suggests that a heart rate <60 bpm with signs of poor perfusion requires immediate CPR and chest compressions, as cardiac arrest is imminent 1, 2, 3, 4
Abnormal heart rates, such as those below the lower normal limit (e.g., <107 bpm in infants 7-30 days) or above the upper normal limit (e.g., >182 bpm in infants 7-30 days), may indicate underlying pathology, including CNS abnormalities, hypothermia, or hyperthyroidism 1, 2

The American Academy of Pediatrics defines hypertension in children as systolic or diastolic blood pressure at or above the 95th percentile for age, height, and sex 5
The American Heart Association recommends that blood pressure be measured after 5 minutes of rest, with the patient seated and right arm supported at heart level 5
Hypotension with capillary refill >3 seconds indicates more severe shock than isolated tachycardia 1

The American Academy of Pediatrics advises against misinterpreting transient bradycardia during feeding, sleep, or defecation as pathological, as these represent normal vagal tone increases 1, 2
Altered mental status, poor peripheral perfusion, or weak pulses warrant immediate evaluation regardless of specific vital sign values 1
Persistent tachycardia or bradycardia requires investigation for underlying causes 1, 2

The American Heart Association recommends providing rescue breathing at 1 breath every 2-3 seconds (20-30 breaths per minute) if pulse is present but breathing is absent or inadequate 3, 4

For children <12 years, the American Academy of Pediatrics recommends using Pediatric Advanced Life Support definitions, which fit best with population-based lower centiles 6
For children >12 years, the American Academy of Pediatrics suggests that Parshuram's early warning score cut-offs agree better with the 5th percentile than other guidelines 6
The American Academy of Pediatrics advises that vital signs should be documented in kilograms for weight, with a full set including temperature, heart rate, and respiratory rate 7
A process should be in place for identifying abnormal vital signs according to the age of the patient and notifying the physician of abnormal values, as recommended by the American Academy of Pediatrics 7
The American Academy of Pediatrics recommends that blood pressure and pulse oximetry monitoring should be available for children of all ages based on illness and injury severity 7

The American Academy of Pediatrics recommends that all pediatric patients have a complete set of vital signs recorded, including temperature, heart rate, and respiratory rate, at every encounter, while blood pressure and pulse oximetry should be available based on illness severity 8, 9
A formal process must identify abnormal vital signs according to patient age and notify the physician of abnormal values, as recommended by the American Academy of Pediatrics 8, 9, 10
Weight must be documented in kilograms and recorded prominently with vital signs, except for children requiring emergent stabilization, as recommended by the American Academy of Pediatrics 8, 9

Vital signs must be documented at regular intervals with age-appropriate reference ranges readily available, as recommended by the American Academy of Pediatrics 10, 11
For children requiring resuscitation or emergency stabilization, a standard method for estimating weight in kilograms should be used, such as a length-based system, as recommended by the American College of Emergency Physicians 9