Normal Values in Children

As you are conducting the Primary Assessment in PALS, it is critical to know the normal values of heart rate, breathing, and blood pressure for a given age. Decisions of what is normal and what needs to be treated are based on these normal values. For example, an adolescent breathing 40 times a minute is abnormal, but would be normal for an infant. 

A -> Airway

Advanced interventions for keeping the airway open may include:

  • Laryngeal mask airway
  • Endotracheal 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

Normal Respiratory Rates

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

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

Neonate

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

Normal Blood Pressure

D -> Disability

One of the assessments of level of consciousness in a child is the Glasgow Coma Scale.

Response

Score

Verbal Child

Preverbal 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

Pediatric Glasgow Coma Scale

E -> Exposure

Any abnormal symptoms in this category should initiate the shock sequence.

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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