Reference — Pediatrics
Pediatric Vital Signs Reference
Pediatric vital signs differ significantly from adult norms and vary by age group. A heart rate that is normal in an infant would be tachycardic in a school-age child. This reference provides age-specific ranges for heart rate, respiratory rate, blood pressure, and temperature — essential for NCLEX and bedside practice.
Educational use only. Vital sign ranges represent averages; individual variation and clinical context always apply. A single abnormal value must be interpreted with the clinical picture. Always follow current PALS guidelines and institutional protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Vital Signs by Age Group — Quick Reference
| Age Group | Heart Rate (bpm) | Resp Rate (/min) | Systolic BP (mmHg) |
|---|---|---|---|
| Newborn (0–1 mo) | 110–160 | 30–60 | 60–90 |
| Infant (1–12 mo) | 100–160 | 30–60 | 70–100 |
| Toddler (1–3 yr) | 90–150 | 24–40 | 80–110 |
| Preschool (3–5 yr) | 80–140 | 22–34 | 80–110 |
| School-Age (6–12 yr) | 70–120 | 18–30 | 85–120 |
| Adolescent (12–18 yr) | 60–100 | 12–20 | 100–130 |
Temperature normal range (all pediatric ages): 36.5–37.5°C (97.7–99.5°F) axillary. Fever is defined as >38°C (>100.4°F).
Heart Rate
- Heart rates decline with age — infants have the highest resting rates, adolescents approach adult norms
- Tachycardia — most commonly caused by fever, dehydration, pain, anxiety, or sepsis; may also indicate cardiac arrhythmia
- Bradycardia — in children, bradycardia most often indicates hypoxia; always administer oxygen and assess airway first
- Clinical tip: A heart rate elevated beyond age-expected norms in a quiet, afebrile child is always a red flag — assess perfusion and mental status
PALS Action Threshold:
Bradycardia with poor perfusion (HR <60 in infant/child with CPR quality issues) → initiate chest compressions regardless of heart rate value. Hypoxia is the cause until proven otherwise.
Respiratory Rate
- Respiratory rates decline with age — infants breathe much faster than adolescents
- Tachypnea — most sensitive early sign of respiratory distress in children; also occurs with fever (each 1°C increase raises RR by 4–5 breaths/min)
- Always count for a full 60 seconds — pediatric respiratory patterns are irregular; short counts are inaccurate
- Associated findings: Tachypnea + retractions + nasal flaring = respiratory distress; tachypnea + grunting = impending failure
Blood Pressure
- Blood pressure increases with age — lower in infants; approaches adult norms in adolescents
- Hypotension in children is a late, ominous sign — by the time blood pressure drops, a child has lost 25–30% of circulating volume
- Minimum acceptable systolic BP (rule of thumb): 70 + (2 × age in years) for children 1–10 years
- Cuff size matters: Cuff too small = falsely high reading; cuff too large = falsely low reading; bladder should cover 80% of upper arm circumference
- Hypertension: ≥95th percentile for age, sex, and height on three separate occasions
Formula — Minimum Acceptable SBP:
Ages 1–10 yr: 70 + (2 × age in years) = lower limit of acceptable systolic BP. Example: 5-year-old → 70 + (2 × 5) = 80 mmHg minimum acceptable systolic.
Temperature
- Normal: 36.5–37.5°C (97.7–99.5°F) across all pediatric ages
- Fever: >38°C (>100.4°F) rectal; axillary measurements 0.5–1°C lower than core temperature
- Infants <3 months with fever: Treated as a potential serious-bacterial-infection emergency requiring urgent evaluation — blood and urine testing with inflammatory markers; ill-appearing infants and neonates <8 days still get a full septic workup (including LP) and empiric IV antibiotics, while well-appearing infants 8–60 days follow the risk-stratified 2021 AAP guideline (routine LP at 8–21 days, shared decision-making at 22–28 days, LP not routine at 29–60 days when urine and inflammatory markers are reassuring); do not attribute fever to teething or vaccines
- Route preference by age: Rectal (most accurate, <2 yr); temporal artery (all ages); axillary (<1 yr, screening only); oral (cooperative children >5 yr); tympanic (unreliable in infants <6 mo)
- Hyperthermia vs. fever: Hyperthermia (heat stroke) does not respond to antipyretics — cool immediately
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →