Pediatric Vital Signs by Age on the NCLEX
Normal HR, RR, and BP ranges by age group, measurement technique, and the values that mean deterioration.
You cannot pick the sick kid on the NCLEX without age-based norms. Ranges narrow toward adult values as the child grows.
Normal ranges by age
Newborn: HR 110-160, RR 30-60, SBP roughly 60-90. Infant (1-12 mo): HR 90-160, RR 25-40. Toddler (1-3 yr): HR 80-140, RR 20-30. Preschool (3-5 yr): HR 70-120, RR 20-25. School age (6-12 yr): HR 70-110, RR 18-22. Adolescent: HR 60-100, RR 12-20. Ranges are approximate; trend and clinical picture beat a single number.
Measurement technique
Apical pulse for a full minute in children under 2. Count respirations a full minute in infants (periodic breathing is normal in newborns). BP cuff bladder should cover about 80-100% of arm circumference; too small reads falsely high. Order in an infant: least invasive first. RR while quiet → apical HR → BP → temp last.
When to worry
Hypotension is a late sign of shock in children - they compensate with tachycardia first. Rough hypotension cutoff age 1-10: SBP < 70 + (2 x age in years). Infant HR under 60 with poor perfusion: start compressions. Tachypnea is often the first sign of sepsis, pneumonia, or dehydration. Bradycardia in a sick infant usually means hypoxia until proven otherwise. Grunting, nasal flaring, and retractions signal respiratory distress at any rate.
Frequently asked
Sleeping infant with HR 95?
Acceptable if perfusion is good. Sleeping heart rates run 10-20 below awake norms. Assess before acting.
Why is hypotension late in kids?
Children maintain cardiac output by raising heart rate. When BP finally falls, they are decompensating. Treat the tachycardia stage.
Febrile child with fast HR?
Expected. HR rises roughly 10 beats per degree of fever. Recheck after antipyretics before escalating.
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