What to know about pediatric vital signs

Most of the time high blood pressure doesn't cause symptoms. In rare cases, severe high blood pressure can cause headaches, blurry vision, dizziness, nosebleeds, a fluttering or racing heartbeat, and nausea. If your child has high blood pressure and gets any of these symptoms, get medical care right away.

A child is considered to have an elevated blood pressure if their blood pressure falls above the 90th percentile, and hypertension if they are above the 95th percentile. Over the age of 13, normal blood pressure ranges are the same for teenagers as they are for adults: Normal blood pressure: Less than 120/80 mm Hg.

Vital signs are measurements that reveal important information about how well the heart, lungs, and other important organs are functioning. They include measurements such as heart rate and blood pressure.

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The ideal pediatric vital sign numbers are different to those of adults. For example, babies and children tend to breathe more rapidly and have a quicker heart rate. Many factors can cause a child’s vital signs to deviate from the norm. Heavy exercise can elevate body temperature, heart rate, and breathing rate, for example, whereas tired or cold children may have lower body temperatures and slower heart rates. These vital sign numbers can also vary widely from child to child. Keep reading to learn more about pediatric vital signs.

Heart rate

Heart rate is a measure of how many times the heart beats in a minute. There are a few ways to test heart rate. For example, a person can place a finger on a child’s pulse and count the total number of beats per minute (bpm). Alternatively, they can count the number of beats in 10 seconds and multiply this number by six. Heart rate tends to decrease as a child gets older. Adolescents have similar resting heart rates to healthy adults. Normal heart rates usually fall into the following ranges:

Age	Awake	Sleeping
Under 28 days old	100–205 bpm	90–160 bpm
1–12 months old	100–190 bpm	90–160 bpm
1–2 years old	98–140 bpm	80–120 bpm
3–5 years old	80–120 bpm	65–100 bpm
6–11 years old	75–118 bpm	58–90 bpm
12–15 years old	60–100 bpm	50–90 bpm

Blood pressure is a measure of how hard the heart is working. It measures the amount of pressure put on the veins and arteries by the blood that the heart is pumping. Blood pressure levels tend to increase with height and weight, so larger children will have slightly higher blood pressures. Girls often have a slightly higher blood pressure than similarly sized boys. Pediatric blood pressure also increases with age. Very high blood pressure could signal a heart health issue. Less frequently, low blood pressure may also indicate a problem. Low blood pressure can also be a sign of unusual bleeding or infection. Systolic blood pressure refers to the top number of a blood pressure measurement, and this is always higher. Diastolic blood pressure is the bottom number. Systolic blood pressure is the reading “on the beat.” This is when the heart muscle contracts in order to pump blood. Diastolic blood pressure is the reading between beats. This is when the heart muscle relaxes. For most children, normal blood pressure measurements in millimeters of mercury are as follows:

Age	Systolic	Diastolic
Newborn (under 1,000 grams [g])	39–59	16–36
Newborn (over 1,000 g)	60–76	31–45
0–1 month old	67–84	35–53
1–12 months old	72–104	37–56
1–2 years old	86–106	42–63
3–5 years old	89–112	46–72
6–9 years old	97–115	57–76
10–11 years old	102–120	61–80
12–15 years old	110–131	64–83

Breathing rate

The rate at which a child breathes indicates how hard their body is working to inhale oxygen. Very rapid breathing may mean that a child is having trouble getting enough oxygen. Very slow breathing might indicate a neurological problem, such as a head injury. Doctors measure breathing rate in breaths per minute. To measure a breath, look for signs that a child has exhaled, such as air coming out of the nose. Count the total number of breaths per minute by monitoring their breathing for a minute or by counting the number of breaths in 10 seconds and multiplying the number by six. Typical breathing rates are as follows:

Age	Breaths per minute
1–12 months old	30–60
1–3 years old	24–40
3–6 years old	22–34
6–12 years old	18–30
12–18 years old	12–16

Symptoms of distress

Temporary changes in a child’s vital signs can be normal. Children’s blood pressures, breathing rates, and body temperatures often go up when they are anxious or very active. These vital signs tend to go down when a child relaxes or sleeps. Likewise, a minor deviation from the norm — such as a heart rate that is 5 bpm above normal — probably does not signal a problem if there are no other symptoms. It is helpful for parents and caregivers to know what is normal for their child, so that they can keep track of vital signs and recognize when there may be a problem. Typically, blood pressure is the last vital sign to change in a very sick child. So, normal blood pressure coupled with abnormal breathing or heart rate can still be a warning sign for a potential emergency. Some warning signs of distress in a child include:

a fever, which most healthcare providers define as a temperature over 100.4ºF (38ºC)
grunting or making other noises when trying to breathe
bleeding
significant changes in multiple vital signs, such as an increase in heart rate and a drop in blood pressure
breathing that stops for longer than 20 seconds
chest breathing, especially in newborns and babies
very fast breathing
skin that is white, pale, or blue, especially under the nail beds or on the lips
nostril flaring, especially in young babies

Seek immediate care for a baby or child who experiences a sudden change in their vital signs. If there are other symptoms, such as a high fever or difficulty breathing, go to the emergency room or dial 911.

Summary

Knowing the ideal pediatric vital sign numbers can help parents and caregivers assess a child’s health. Unusual vital signs may provide early evidence that an apparently minor health problem is serious. Try not to panic when noticing that one of a child’s vital signs are abnormal. In most cases, there is only a problem if there are also other symptoms of illness. Only a healthcare professional can determine whether or not abnormal vital signs point to a serious medical problem. If they recommend treatment, do not delay, since prompt treatment can save lives and prevent minor issues from becoming more serious.

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