Pediatric Vital Signs

How to Read Your Child’s Vital Signs

Your child’s vital signs can give you important health clues. Many things can affect the numbers. But if they’re outside the normal range, it could be a sign of possible health issues.

Note that normal vital sign values for children are different than they are for adults. They also vary depending on age, sex, and weight.

The four vital signs are:

Temperature

A fever means your child’s temperature is higher than usual. It’s the main way their body fights an infection.

How to check

Use a digital thermometer to take your child’s temperature in the mouth, or rectally in the bottom. A rectal temperature gives the more accurate reading. That’s the way you should do it if your baby is younger than 3 months. With older infants and children, an oral reading is fine unless your doctor tells you otherwise. Always clean the thermometer in soapy water and rinse with cool water before you use it. Never use the same thermometer to take an oral and rectal temperature.

To take a rectal temperature:

  • Place your child on their belly across your lap.
  • Put a small amount of petroleum jelly on the end of a thermometer.
  • Insert it half an inch into the anal opening.
  • Remove the thermometer when it beeps and read the temperature. (It’s normal for the baby to poop after the thermometer is removed.)

To take an oral temperature:

  • Slip the end of the thermometer under your child’s tongue.
  • Have your child close their lips around the thermometer.
  • Remove it when it beeps and check the temperature.

Normal temperature

A normal temperature is 98.6 F if taken in the mouth, and 99.6 F if taken in the bottom. If the oral temperature is above 99.5 F or the rectal reading is 100.4 F or higher, your child has a fever.

Call your doctor ASAP if your baby is younger than 3 months and has a rectal temperature of 100.4 F or higher. Even if your baby doesn’t have any other symptoms, a fever in infants can be serious.

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Heart Rate

Also called a pulse, this is how many times the heart beats each minute. It’s faster when your child is active and slower when they’re seated or asleep. Your doctor will check the heart rate during well-child visits. If you need to monitor your child’s heart rate because of a medical condition, your doctor will tell you how and how often to check it.

You should also check your child’s pulse if they:

How to check

Make sure your child has been seated for at least 5 minutes before you start. Place your first two fingers on the front of their neck or the inside of the wrist, armpit, or elbow crease. You should feel thumps against your fingers. Set a timer for 30 seconds and count the beats. Double that number, and that’s your child’s heart rate.

Normal heart rate:

  • Infant (to 12 months): 100-160 beats per minute (bpm)
  • Toddler (1-3 years): 90-150 bpm
  • Preschooler (3-5 years): 80-140 bpm
  • School-aged child (5-12 years): 70-120 bpm
  • Adolescent (12-18 years): 60-100 bpm

A heart rate that’s slower than usual can signal a problem. For infants, it can mean:

A slower than usual heart rate in kids can also mean there’s an issue in the structure of their heart.

Respiratory Rate

This is how many breaths your child takes per minute. This number may go up when they’re excited, nervous, in pain, or have a high fever. A fast or slow respiratory rate means your child may have trouble breathing. Call your pediatrician if you have any concerns.

How to check

Set a timer for 30 seconds and count the number of times your child’s chest rises. Double that number to get their respiratory rate.

Normal rate (breaths per minute):

  • Infant (0-12 months): 30-60
  • Toddler (1-3 years): 24-40
  • Preschooler (3-5 years): 22-34
  • School-aged child (5-12 years): 18-30
  • Adolescent (12-18 years): 12-16

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If your baby or child’s pulse is fast or they have any of the following symptoms, it could mean they’re having trouble breathing:

  • Bluish color around the mouth
  • Pale or gray skin
  • A grunting sound with each breath out
  • Nose flares
  • Wheezing
  • Sweating
  • Tiredness
  • Upper chest sinks in with each breath
  • Not eating or drinking well
  • Vocalizing less

Respiratory distress is serious. It means your child isn’t getting enough oxygen. This might be because of:

  • An infection
  • Chronic illness
  • A blocked airway

Call your doctor or 911, or get to the emergency room right away. Stay calm and try to keep your child calm while keeping them in a comfortable position.

Blood Pressure

Blood pressure is the force of blood as it flows through the vessels that move blood from the heart to the body. Children can get high blood pressure just as adults do. If your child grows up with high blood pressure, or hypertension, it could make them more likely to have a stroke, heart attack, heart failure, and kidney disease.

Blood pressure is measured using two numbers:

  • Systolic is the first number. It measures how much pressure is on your artery walls each time your heart beats.
  • Diastolic is the second number. It measures how much pressure is on your artery walls between heartbeats, when your heart is at rest.

Your child might have high blood pressure because of:

  • A heart defect
  • Kidney disease
  • A genetic condition
  • A hormone disorder
  • Being overweight

Hypotension is blood pressure that’s too low. It can make your child feel nauseated, dizzy, or faint.

Your child may have low blood pressure because of:

How to check

Your child’s doctor will start to check blood pressure at age 3. Your child may need to have it checked sooner if they:

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If your doctor tells you to check your child’s blood pressure at home, use an automatic monitor with a cuff that fits on the upper arm. Take the monitor with you to your next appointment so your doctor can check that you use it correctly.

Normal levels

These numbers differ for children, depending on their age, height, and sex. The top number is systolic pressure, and the bottom one is diastolic pressure. Both numbers should be below the limit.

For boys:

1 year old: less than 98/52

2 years old: less than 100/55

3 years old: less than 101/58

4 years old: less than 102/60

5 years old: less than 103/63

6 years old: less than 105/66

7 years old: less than 106/68

8 years old: less than 107/69

9 years old: less than 107/70

10 years old: less than 108/72

11 years old: less than 110/74

12 years old: less than 113/75

For girls:

1 year old: less than 98/54

2 years old: less than 101/58

3 years old: less than 102/60

4 years old: less than 103/62

5 years old: less than 104/64

6 years old: less than 105/67

7 years old: less than 106/68

8 years old: less than 107/69

9 years old: less than 108/71

10 years old: less than 109/72

11 years old: less than 111/74

12 years old: less than 114/75

For boys and girls 13 and older: less than 120/80.

Abnormal Vital Signs

If your child’s vital signs are off, you may need to see a doctor. Vital signs can vary based on time of day and the emotional state of your child. If your child has a drastic change, that could be a sign of a problem.

Your doctor will have a better idea of what’s outside of normal and can monitor your child over time if needed.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on August 25, 2020

Sources

SOURCES:

Cleveland Clinic: “Vital Signs.”

KidsHealth: “How to Take Your Child’s Pulse.”

American Academy of Pediatrics: “Ages & Stages,” “Signs and Symptoms of Fever,” “Fever,” “How to Take a Child’s Temperature,” “Screening and Treating Kids for High Blood Pressure: AAP Report Explained,” “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents,” “Fast, Slow and Irregular Heartbeats (Arrhythmia).”

American Academy of Pediatrics, American College of Emergency Physicians. APLS: The Pediatric Emergency Medicine Resource, Jones & Bartlett Learning, 2004.

University of Rochester Medical Center: “Signs of Respiratory Distress in Children.”

American Academy of Family Physicians: “Fever in Infants and Children,” “High Blood Pressure.”

Mayo Clinic: “High Blood Pressure in Children.”

National High Blood Pressure Education Program: “A Pocket Guide to Blood Pressure Measurement in Children.”

American Heart Association: “Monitoring Your Blood Pressure at Home,” “Understanding Blood Pressure Readings.”

Stanford Children’s Health: “Vital Signs: Know Your Numbers.”

Nationwide Children’s: “Respiratory Distress.”

Nicklaus Children’s Hospital: “Low Blood Pressure in Children.”

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