Pediatric Vital Signs – ED Quick Reference

Vital signs in children vary with age and clinical context. Use this page as a quick guide and always interpret values with the child’s overall appearance, work of breathing, perfusion, and history.

Where possible, use your local paediatric charts (e.g. PEWS/SATS charts or Broselow tape) for exact normal ranges and escalation triggers.

Body Temperature

Normal core temperature in most children is approximately 36.5–37.5 °C. Measurement method (axillary, tympanic, rectal) affects the reading.

Practical Fever Thresholds

Infants < 3 months: any temperature ≥ 38.0 °C is significant and needs urgent assessment.
Older infants/children: temperature ≥ 38.0 °C is generally considered fever.

Simple Grading (approximate)

Normal: 36.5–37.5 °C
Low-grade fever: 37.6–38.4 °C
Moderate–high fever: ≥ 38.5 °C
Mild hypothermia: 36.0–36.4 °C
Significant hypothermia: < 36.0 °C (urgent active warming and search for cause).

Red flags: fever in < 3 month old, fever with poor perfusion or altered mental status, petechial rash, respiratory distress, or prolonged fever > 5 days – consider sepsis/serious bacterial infection and escalate early.

Blood Pressure

Paediatric blood pressure varies with age, height and sex. In the ED, focus on: 1) identifying hypotension (late sign of shock) and 2) recognising severe hypertension with symptoms.

Very Rough Systolic BP Guide (approximate normal / hypotension)

Age	Approx. Normal SBP	Approx. Hypotension Threshold*
Term neonate (< 1 month)	≈ 60–80 mmHg	< 60 mmHg
Infant (1–12 months)	≈ 70–90 mmHg	< 70 mmHg
1–10 years	≈ 80–100+ mmHg	< 70 + (2 × age in years) mmHg
> 10 years	≈ 100–120 mmHg	< 90 mmHg

*Use local charts for exact thresholds; this is a simplified ED rule of thumb.

Hypertension (ED perspective)

Use age/height percentile charts to diagnose persistent hypertension; single high readings in a crying, painful child are common and may be transient.
Severe hypertension is suspected when BP is well above the expected range plus there are symptoms/signs of end-organ involvement (headache, visual change, seizures, encephalopathy, heart failure, AKI, etc.).
Treat suspected hypertensive emergencies in consultation with a paediatrician / nephrologist / ICU specialist.

Pulse / Heart Rate

Heart rate should always be interpreted with context – pain, fever, agitation and dehydration are common causes of tachycardia.

Approximate Normal Resting Heart Rates

Age	Approx. Normal HR (awake)
Newborn (0–28 days)	100–160 bpm
Infant (1–12 months)	100–160 bpm
Toddler (1–3 years)	90–150 bpm
Preschool (3–5 years)	80–140 bpm
School age (6–12 years)	70–120 bpm
Adolescent (13–18 years)	60–100 bpm

Deviations

Tachycardia: persistent HR above normal range can indicate pain, fever, hypovolaemia, sepsis, arrhythmia or anxiety – look for other signs of shock or distress.
Bradycardia: in children is often pre-terminal and usually secondary to hypoxia, raised ICP or severe systemic illness; urgent evaluation is required.
Irregular rhythm or very high HR (> 220 in infants, > 180 in older children at rest) – consider SVT or other arrhythmia and follow your paediatric ALS protocol.

Respiratory Rate

Respiratory rate is one of the most sensitive early markers of deterioration in children. Always count for a full minute if possible, when the child is calm.

Approximate Normal Respiratory Rates

Age	Normal RR (breaths/min)
Newborn (0–2 months)	30–60
Infant (2–12 months)	30–50
Toddler (1–3 years)	24–40
Preschool (3–5 years)	22–34
School age (6–12 years)	18–30
Adolescent (13–18 years)	12–20

Deviations

Tachypnoea: early sign of respiratory distress, acidosis or sepsis. Look for work of breathing (retractions, nasal flaring, grunting, head bobbing).
Bradypnoea: late and dangerous sign, often due to fatigue, CNS depression, raised ICP or impending arrest – urgent intervention.
Respiratory distress with normal/low RR can still be serious if there is poor effort, silent chest, or altered mental state.

Oxygen Saturation (SpO₂)

SpO₂ reflects the percentage of haemoglobin saturated with oxygen. Use a reliable probe and check waveform quality before acting on the number.

Typical Targets (room air, sea level)

Normal: 95–100% in most healthy children.
Borderline: 92–94% – assess clinically; may be acceptable in some chronic lung or congenital heart disease patients but abnormal in well children.
Low: ≤ 91% – investigate and treat; give oxygen and look for underlying cause (acute respiratory disease, heart disease, sepsis, anaemia, etc.).

Persistent SpO₂ < 90% or any hypoxia with increased work of breathing, cyanosis or altered consciousness requires urgent escalation and consideration of ventilation support.

Blood Glucose

Glucose is a vital “6th vital sign” in sick children. Always check a bedside glucose in any child who is unwell, fitting, drowsy, irritable or shocked.

Approximate Reference Ranges (capillary / venous)

General normal (most children, fasting): ≈ 3.5–5.6 mmol/L.
Borderline low: 3.0–3.4 mmol/L – monitor and treat if symptomatic or at risk.
Hypoglycaemia: < 3.0 mmol/L (or < 2.6 mmol/L in neonates) – treat urgently.
Marked hyperglycaemia: ≥ 11.1 mmol/L, especially with polyuria, polydipsia, weight loss or acidosis – consider diabetes/DKA.

Key ED Actions

Hypoglycaemia: give IV dextrose (e.g. 2 mL/kg of 10% dextrose) or oral fast-acting carbohydrate if awake and safe; re-check glucose and treat underlying cause.
Suspected DKA / hyperglycaemia: do blood gas, ketones, full DKA workup and follow local paediatric DKA protocol with senior input.

Always interpret vitals as a trend, not a single number. Repeated measurements, combined with your clinical impression and parental concern, are far more powerful than one reading.