Pediatrics Vital Signs Overview

Pediatric Vital Signs Changes

• Heart Rate (HR) and Respiratory Rate (RR) decrease with age; Blood Pressure (BP) increases.
• Newborn to 6 months BP norm: 65-90 / 45-65 mmHg
• 6 months to 3 years BP norm: 80-105 / 55-70 mmHg
• 4 to 12 years BP norm: 95-120 / 60-75 mmHg
• Over 12 years BP norm: 110-120 / 65-85 mmHg

Methods for Assessing Pediatric Vital Signs

• Temperature: Use axillary or oral methods; normal range is 97.9-99°F (36.6-37.2°C).
• Heart Rate: Measure apical pulse for a full minute in neonates and children with cardiac issues.
• Use 4th intercostal space for children up to 7 years; 5th intercostal for those over 7 years.
• Respirations: Observe full breathing cycle for a minute. Up to 7 years: diaphragmatic breathers; over 7 years: thoracic breathers.
• Blood Pressure: Measured on the right arm; cuff size should be 40% of arm circumference. Infants measured on the leg.

Tanner Stages of Development

• Stage 1: No sexual hair in both genders.
• Stage 2: Downy hair for males; breast budding for females.
• Stage 3: Scant terminal hair; further breast enlargement in females.
• Stage 4: Full terminal hair in males; papillae form secondary mound in females.
• Stage 5: Adult-type terminal hair in males and mature breasts in females.

Cyanosis in Newborns

• Normal Finding: Acrocyanosis (cyanosis in extremities and lips), resolves with warming.
• Abnormal Finding: Central cyanosis (cyanosis in mouth, head, torso), indicative of low oxygen levels.

Fontanelles Closure

• Anterior fontanelle closes around 18 months.
• Posterior fontanelle closes between 2-3 months (6-8 weeks).

Ear Examination

• Pediatric ear assessment requires pulling down and back for proper view.

Breathing Patterns in Children

• Abdominal breathers until about 6-7 years; nose-breathing obligate for infants.

Palpation of PMI (Point of Maximal Impulse)

• Under 4 years: palpate at the 4th intercostal space.
• Over 4 years: palpate at the 5th intercostal space.

Hip Dysplasia Assessments

• Ortolani Test: Reduces a dislocated hip; positive if femoral head slips into the socket with a palpable clunk.
• Barlow’s Test: Attempts to dislocate the hip; positive if the hip slides out of the acetabulum.
• Galeazzi Sign: Assesses leg length and knee position; unequal skin folds indicate potential hip dislocation.

Scoliosis Evaluation

• Adams Bend Forward Test: Lateral curvature of the spine; degree ≥ 7 requires further evaluation.

Normal vs Abnormal Thorax in Infants

• Infant thorax: anterior/posterior diameter equal to transverse until 1 year; chest circumference matches head circumference.
• Signs of respiratory distress include tachypnea and nasal flaring.

Infant Reflexes

• Babinski Reflex: Dorsiflexion of the great toe, fanning of other toes; disappears by 12-18 months.
• Moro Reflex: Disappears by 4 months.

Newborn Abdomen Assessment

• Normal abdomen shape: rounded and protuberant; potbellied appearance in children up to 4 years.
• Abnormal shapes include:
  • Distended: potential intestinal obstruction or organomegaly.
  • Scaphoid: may indicate malnutrition.
• Normal umbilical hernia resolves by 3 weeks; diastasis recti heals on its own.

Abnormal Findings in Newborn Abdomen

• Pyloric Stenosis: Thickening of pylorus leading to vomiting; palpable mass may be found.
• Intussusception: Part of the intestine slips into another; characterized by a sausage-shaped mass, vomiting, and current jelly stools; considered an emergency.

Pediatric Heart Rate Ranges

• Infants: Normal heart rate is 120-160 beats per minute (bpm).
• Adolescents: Normal heart rate is 60-100 bpm.
• Heart rate decreases with age due to cardiovascular system maturation.

Anterior Fontanel Closure

• The anterior fontanel typically closes between 18-24 months.
• This closure allows for rapid brain growth in infancy.

Measuring Respiratory Rate

• Measure respiratory rate by observing the chest rise and fall for one full minute while the child is at rest.
• A full minute ensures accurate measurement due to irregular breathing patterns in children.

Tanner Stages

• Tanner stages are used to assess physical development based on external sexual characteristics.
• Staging ranges from 1 (prepubertal) to 5 (full maturity), helping track puberty progression.

Ortolani Test

• A positive Ortolani test is indicated by a "clunk" sound during hip abduction, suggesting a dislocated hip that reduces into the acetabulum.
• Used to screen for developmental dysplasia of the hip in newborns.

Identifying Central Cyanosis

• Central cyanosis in newborns is identified by bluish discoloration of lips, tongue, and central body areas.
• Indicates a lack of oxygen in the bloodstream and represents a medical emergency.

Breathing Transition in Children

• Children typically switch from abdominal to thoracic breathing around 7 years old.
• Younger children predominantly use abdominal muscles for breathing.

Palpable Thrills in Heart Murmurs

• A palpable thrill suggests a heart murmur of grade 4/6 or higher, indicating significant heart defects.
• Thrills are felt vibrations on the chest wall associated with turbulent blood flow.

Point of Maximal Impulse (PMI)

• In children under 4 years old, the PMI is located in the 4th intercostal space, midclavicular line.
• The heart’s position differs in younger children due to smaller chest sizes.

Adam's Forward Bend Test

• A positive Adam's forward bend test shows ribcage height asymmetry, indicating scoliosis.
• Used for visual assessment of spinal curvature.

Babinski Reflex

• The Babinski reflex causes the toes to fan out when the sole of the foot is stroked.
• This reflex is normal in infants but typically disappears by age 1.

Intussusception vs. Pyloric Stenosis

• Intussusception: Sudden severe abdominal pain and "currant jelly" stools.
• Pyloric stenosis: Projectile vomiting and an olive-shaped abdominal mass.
• Both conditions are common in infants with distinct clinical presentations.

Infant Thorax Characteristics

• An infant's thorax is barrel-shaped with horizontal ribs.
• This shape supports rapid growth and meets breathing needs.

Ear Examination in Children

• Position the ear by pulling the auricle down and back during an examination.
• This straightens the ear canal, aiding visualization in children under 3 years old.

Acrocyanosis in Newborns

• Acrocyanosis presents as bluish discoloration of hands and feet.
• It is a normal and benign condition in newborns caused by immature circulatory regulation.

Newborn Blood Pressure

• Normal blood pressure range for newborns is 65-85/45-55 mmHg.
• Newborns typically have lower blood pressure than older children and adults.

Pediatric Intramuscular Injection Site

• The recommended site for intramuscular injections in children under 2 years is the vastus lateralis muscle in the thigh.
• This site has adequate muscle mass with a lower risk of nerve or blood vessel injury.

Annual Influenza Vaccination

• Children should start receiving annual influenza vaccinations at 6 months old.
• Early vaccination helps protect against influenza and its complications.

Barlow Test

• The Barlow test assesses hip instability or dislocation in infants.
• A positive test is indicated by feeling the hip dislocate from the acetabulum with gentle posterior pressure.

Posterior Fontanel Closure

• The posterior fontanel should close by 2-3 months of age.
• It is smaller compared to the anterior fontanel and closes earlier.