How to Take Pediatric Vital Signs

As a pediatric nurse, one of the first things you will realize is that a crying child will not be an easy assessment. Normally in nursing school you are taught to perform a head to toe assessment, and this is definitely the preferred way, however when it comes to children you have to get creative. This is because children can sometimes be fearful of healthcare providers, associating them with “shots, vaccines, medicine…”. All things children mostly dislike, haha. Which is why today I will be teaching you how to take pediatric vital signs. Rule of thumb as a pediatric nurse, always keep it least to most intrusive. This means, minimal interventions first leading up to more involvement with the child.

Before starting your vital signs, the first thing you want to do is

Create a safe and comfortable environment

The first step in how to take pediatric vital signs is to select an area or room that is not too stimulating or scary for the child. It would be great to have fun, kid-friendly distractions for the child (such as cartoons, coloring sheets, colorful walls, animals or activities on the walls). This makes the child feel safe and comfortable.

Make sure the room is warm enough so when you do perform your assessment or take your pediatric vital signs the patient is not freezing when you expose an area of their body such as their abdomen. Same thing goes for your hands and any instruments you use (stethescope) when you are assessing your patient and performing palpation. Nobody likes to be touched with cold hands so you can imagine how this can make a child feel uncomfortable and send them into a crying frenzy.

Now it’s time to take your pediatric vital signs.

1. Respirations

Remember, you want to start off with the least invasive first. Therefore, observing for respirations would be your first step. While you are observing the respiratory rate, you are also taking the time here to assess the patient for any difficulty breathing, retractions, color, position, attitude and their ability to focus. If the patient is moving a lot (which may happen with small children) you will progress using minimal touch and auscultate the patients lungs and heart.

When it comes time to auscultating, I would make sure to prep my patient before placing the stethoscope on their chest of abdomen. Allow your patient to play with the stethoscope and become familiar with the unknown. This is key in taking pediatric vital signs. Allow them to play with the equipment prior to using it. This will help them feel more comfortable. Have them listen to their heart or lungs first (sure they have no idea what they are listening to but its still fun!). Right before you place the stethoscope over their skin tell them to be very quiet because you need to listen for the “chicken they ate last night” or joke around and say “wait a minute… did you have chicken nuggets last night?? I hear a chicken in there! and maybe give them a little tickle. This truly helps children feel like the doctor is fun and funny and calms any fears they may have. Of course, keep it age appropriate. That same trick won’t work for a 16-year-old, ha ha.

2. Pulse

Second would be pulse. With children younger than five it is recommended to auscultate the apical pulse for 1 full minute, rather than palpate a pulse. You can auscultate the apical pulse while you are auscultating the lungs. You can also place a pulse Ox strip on a childs finger, or toe to obtain pulse as well as oxygen saturation. Beware: some small children (infants, in particular) HATE this and will scream at the top of their lungs. Therefore, keep in mind you may have to wrap it around their toe and place a sock on it (hopefully they forget its there) and possibly leave the room for a minute so the heart rate can normalize.

If this doesn’t help the patient you will have to make sure you chart the patient was crying and screaming while the pulse was taken. This is important so the provider knows a high heart rate isn’t while the patient is at rest (which would be concerning). Pulse rate will vary depending on age of the patient. Neonates and infants have much higher, irregular heart rates than older children so, make sure you practice and know your normal ranges for different ages. You will learn your norms with time but until then, I suggest always having a badge buddy that tells you the most up to date normal vital signs for each age group. (I still do this and I have over 8 years experience!)

3. Blood Pressure

Next up in pediatric vital signs is blood pressure. You would probably think that blood pressure is pretty invasive, in the sense that it will trigger a patient to cry since you have to handle their arm and wrap the cuff around it, but it actually is recommended before temperature due to the fact children usually associate a thermometer to a “shot”. If you are taking a tympanic temperature, infants will cry because they don’t like anything in their ears. Also, you don’t want the child to begin crying and screaming from a temperature and then BP be slightly off. Therefore, we will do blood pressure first.

Blood pressure can be taken on the upper arm (brachial artery), or other areas such as the thigh (popliteal artery) or lower leg (posterior tibial artery). However, the upper arm is the preferred and most common site for blood pressure. Keep in mind, as with the pulse, blood pressure varies based on the age of the child. Children generally aren’t fans of the blood pressure cuff, since it squeezes their arm and they tend to freak out. However, try to make it fun and tell them it is measuring their muscles! or it is giving them a realllllllyyy big, big hug. You can also tell them that the only way you can find out if they are stronger than *insert their favorite superhero here* is if they stay super still. These techniques work wonders!

4. Temperature

Time to take your patient’s temperature! By now, you should have somewhat of an idea if you’re expecting a high temperature. or not via your other vitals and quick visual assessment. Is your patient shivering? Does your patients skin feel warm? Does your patient have rosy cheeks? Is your patient having tachycardia? These symptoms can very well indicate a fever.

There are a few ways you can obtain a temperature and it all depends on the age of the child. Definitely ask what protocol is followed in your facility or unit as it ranges from one to another. Rectal, axillary, oral and tympanic are four of the most common and reliable ways to take a temperature of a child. You may have seen or heard care takers mention they took the temperature with a strip on the forehead or a thermal forehead measurer but I would not rely on these methods. Keep in mind the developmental stage of the child. A child less than 5 years of age will most likely not understand the concept on an oral temperature and you may not get an accurate result.

Remember what your patient is coming in for and their history. Why? Because certain locations of temperature might be contraindicated. For example, a patient coming in for ear pain will not appreciate a tympanic temperature! Ouchie.

5. Pain

Lastly, we reach our fifth and final vital sign. Pain. Various pain scales are available depending on the child’s age and developmental level. Not only will you ask the level of pain on a scale from 0-10 but you will also ask the description and location of pain. This is crucial for your plan of care. Certain areas will require different interventions whether it is further imaging, type of medication and warm or cold compresses.

That’s a wrap for today’s blog post. Hope you guys found it helpful and feel more prepared on how to take pediatric vital signs. The key is to keep it light and fun. Have you ever had a bad experience taking vital signs on a pediatric patient? Have you learned a different way or different techniques on how to keep them calm? Share below!

’till next time,

The RN Educator