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Paediatric vital signs
| Age |
RR |
HR |
| 0-3 months |
30-60 |
110-160 |
| 3-12 months |
25-50 |
100-150 |
| 1-4 years |
20-40 |
90-120 |
| 4-12 years |
20-30 |
70-110 |
| >12 years |
12-16 |
60-100 |
Data gathering – History
- Red flags
- Drowsy
- Reduced feeding (<50%)
- Reduced urine output
- Long pauses in breathing
- Blue lips
- Temp > 38c in a less than three month old
- Non-blanching rash
- Neck stiffness
- Others
- Vomiting
- Bowels
- Fever
- Travel
Data gathering – Examination
- Vital signs
- Temperature | RR | HR | CRT
- General
- Alertness
- Colour
- Temperature of extremities
- Mucous membranes
- Fontanelle
- Body systems
- Chest – signs of respiratory distress (nasal flaring, tachypnoea, use of accessory muscles)
- CV
- Abdomen
- ENT
Clinical management
- Treatment
- Follow-up
- Safety-net
- Fever > 5 days
- Child looks less well after review or carer is more worried since last review
- Red flags mentioned above
Risk factors
- PMH
- Lung/Heart/Neuromuscular disease
- Immunosuppressed
- Age
- Pregnancy and delivery
- Re-attendance
- Parental smoking
Differential diagnosis
- Meningococcal disease
- Non blanching rash, ill looking, purpura, CRT > 3s, neck stiffness, bulging fontanelle
- Herpes simplex encephalitis
- Focal neurological signs, focal seizures, reduced GCS
- Pneumonia
- Tachypnoea, nasal flaring, chest indrawing, cyanosis, crackles in chest, abdo/chest pain
- UTI (presentation depends on age)
- fever alone if under 3 months
- Vomiting, reduced feeding, lethargy, abdominal pain, urinary frequency, dysuria
- Septic arthritis
- Swelling of limb or joint, not using limb
- Kawasaki disease
- Fever >5d
- Bilateral conjunctivitis
- Mucous membranes – red throat, dry cracked lips, strawberry tongue
- Extremities – oedema, erythema, desquamation polymorphous rash, cervical lymphadenopathy