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Normal Values in Children

During evaluation, conduct the primary assessment, secondary assessment, and diagnostic tests. If at any time a condition is determined to be life-threatening, intervene immediately.

Primary Assessment

Assessment

Assessment Techniques

Abnormal Findings

Interventions

A – Airway

Observe for movement of the chest or abdomen; Listen to the chest for breath sounds

Obstructed but maintainable

Keep airway open by head tilt/chin lift

Obstructed and cannot be opened with simple interventions

Keep airway open using advanced interventions

B – Breathing

Rate

<10 or >60 = Abnormal (apnea, bradypnea, tachypnea)

Immediate respiratory intervention required

Effort

Nasal flaring, head bobbing, seesaw respirations, retractions

Immediate respiratory intervention required

Chest or abdominal expansion

Asymmetrical or no chest movement

Immediate respiratory intervention required

Breath sounds

Stridor, grunting, wheezing, rales, rhonchi

Immediate respiratory intervention required

Oxygen saturation (O2 sat)

<94% on room air

<90% at any time

Supplemental oxygen

Advanced airway

C – Circulation

Heart rate

Bradycardia

Bradycardia Algorithm

Tachycardia

Tachycardia Algorithm

Absent

Cardiac Arrest Algorithm

Peripheral pulses (radial, posterior tibial, dorsalis pedis)

Diminished or absent

Close monitoring

Central pulses (femoral, brachial, carotid, and axillary)

Diminished or absent

Management of Pediatric Shock

Capillary refill

>2 seconds

Management of Pediatric Shock

Skin color/temperature

Pale mucous membranes

Management of Pediatric Shock

Central cyanosis

Immediate respiratory intervention required

Peripheral cyanosis

Management of Pediatric Shock

Blood pressure

Outside normal range for age

Management of Pediatric Shock

D – Disability

AVPU Scale

Alert – Awake, active, responsive to parents (normal)

Uoice – Responds only to voice

Pain – Responds only to pain

Unresponsive – Not responsive

Monitor and consult neurologist

Glasgow Coma Scale

Pediatric Glasgow Coma Scale

 

Pupils

Unequal or non-reactive

 

E – Exposure

General evaluation

Signs of bleeding, burns, trauma, petechiae, and purpura

Management of Pediatric Shock

Table 3: Primary Assessment Model

Use the Primary Assessment to evaluate the child using vital signs and an ABCDE model:

A – Airway

Head tilt-chin lift and jaw thrust may be used to open the airway quickly and without the use of an advanced airway. The jaw thrust maneuver is preferred when a cervical spine injury is suspected or cannot be ruled out.

Advanced interventions for maintaining a patent airway may include:

  • Laryngeal mask airway (LMA)
  • Endotracheal (ET) intubation
  • Continuous positive airway pressure (CPAP)
  • Foreign body removal if one can be visualized
  • Cricothyrotomy in which a surgical opening is made into the trachea.

B – Breathing

The child’s respiratory rate is an important assessment that should be made early in the primary assessment process. The clinician must be aware of normal respiratory ranges by age:

Age Category

Age Range

Normal Respiratory Rate

Infant

0-12 months

30-60 per minute

Toddler

1-3 years

24-40 per minute

Preschooler

4-5 years

22-34 per minute

School age

6-12 years

18-30 per minute

Adolescent

13-18 years

12-16 per minute

Table 4: Normal Respiratory Rates

A respiratory rate that is consistently below 10 or above 60 breaths per minute indicates a problem that needs immediate attention. Periodic breathing is not unusual in infants; therefore, you may have to spend more time observing the infant’s breathing to determine true bradypnea or tachypnea. Nasal flaring and retractions indicate increased work of breathing. Head bobbling or seesaw respirations are potential signs of impending deterioration. Likewise, slow and/or irregular breathing suggest imminent respiratory arrest.

C – Circulation

The child’s heart rate is another important assessment that should be made in the primary assessment. The normal heart rates by age are:

Age Category

Age Range

Normal Heart Rate

Newborn

0-3 months

80-205 per minute

Infant/young child

4 months to 2 years

75-190 per minute

Child/school age

2-10 years

60-140 per minute

Older child/ adolescent

Over 10 years

50-100 per minute

Table 5: Normal Heart Rates

The child’s blood pressure should be another part of the primary assessment. Normal blood pressures by age range are:

Age Category

Age Range

Systolic Blood Pressure

Diastolic Blood Pressure

Abnormally Low

Systolic Pressure

1 Day

60-76

30-45

<60

Neonate

4 Days

67-84

35-53

<60

Infant

To 1 month

73-94

36-56

<70

Infant

1-3 months

78-103

44-65

<70

Infant

4-6 months

82-105

46-68

<70

Infant

7-12 months

67-104

20-60

<70 + (age in years x 2)

Preschool

2-6 years

70-106

25-65

<70 + (age in years x 2)

School Age

7-14 years

79-115

38-78

<70 + (age in years x 2)

Adolescent

15-18 years

93-131

45-85

<90

Table 6: Normal Blood Pressure

D – Disability

One of the assessments of level of consciousness in a child is the Pediatric Glasgow Coma Scale (GCS).

Response

Score

Verbal Child

Pre-Verbal Child

Eye opening

4

3

2

1

Spontaneously

To verbal command

To pain

None

Spontaneously

To speech

To pain

None

Verbal response

5

4

3

2

1

Oriented and talking

Confused but talking

Inappropriate words

Sounds only

None

Cooing and babbling

Crying and irritable

Crying with pain only

Moaning with pain only

None

Motor response

6

5

4

3

2

1

Obeys commands

Localizes with pain

Flexion and withdrawal

Abnormal flexion

Abnormal extension

None

Spontaneous movement

Withdraws when touched

Withdraws with pain

Abnormal flexion

Abnormal extension

None

Total Possible Score

3-15

   

Table 7: Pediatric Glasgow Coma Scale

When there is a suspected or known head injury, a GCS score of 13 to 15 is considered mild, 9 to 12 is moderate, and 3 to 8 is severe. In intubated or sedated children, motor response provides the most important information. The lower the motor response score, the more serious the deficit/injury.

E – Exposure

If the provider finds any abnormal symptoms in this category they should assess and treat the child for shock (see Unit Seven: Management of Pediatric Shock, particularly Interventions for Initial Management of Shock). During the primary assessment, if the child is stable and does not have a potentially life-threatening problem, continue with the secondary assessment.

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