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The normal numbers students keep checking, plus what they mean at the bedside and which changes should make you pause early.
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Student note
SpO₂ is the oxygen number from the probe. Cap refill is how quickly colour comes back after you press the skin. Escalate means getting help early instead of waiting until the picture is obvious.
RR first
Respiratory rate is often the first clue that a child is getting worse.
BP is late
Low blood pressure is late in children, so do not use a normal BP as reassurance on its own.
Right cuff
Use the right cuff size for BP, or the number you get may mislead you.
Trend matters
The trend matters more than one isolated reading, especially if you know the child's usual baseline.
The numbers you need to know, compared by age group
| Age group | Heart rate (bpm) | Resp rate (/min) | Systolic BP (mmHg) | Cap refill |
|---|---|---|---|---|
| Newborn 0–28 days | 100–160 | 30–60 | 60–90 | <3 sec |
| Infant 1–12 months | 100–150 | 25–50 | 70–100 | <2 sec |
| Toddler 1–3 years | 90–140 | 20–40 | 80–110 | <2 sec |
| Pre-school 3–5 years | 80–120 | 20–30 | 85–110 | <2 sec |
| School-age 6–11 years | 70–110 | 16–24 | 90–120 | <2 sec |
| Adolescent 12–18 years | 60–100 | 12–20 | 100–135 | <2 sec |
What to expect at the bedside for each age group
Newborn (0–28 days)
Breathing can look irregular in a well newborn. Short pauses can be normal, but pauses with colour change or bradycardia are not.
Infant (1–12 months)
Babies rely heavily on nose breathing, so a blocked nose alone can make feeding and breathing look much harder.
Toddler (1–3 years)
Toddlers may cry, fight the obs, and hate strangers. Watch them first if you can, and use parents to help you get a truer baseline.
Pre-school (3–5 years)
Simple explanations and distraction usually help more than long instructions.
School-age (6–11 years)
They can usually follow the plan if you explain it well. Giving them some choice often improves cooperation.
Adolescent (12–18 years)
Obs are getting closer to adult ranges, but privacy, dignity, and confidentiality matter even more.
Children are not small adults when it comes to breathing and circulation
Airway anatomy
Breathing mechanics
Circulation
Perfusion clues
What to do when the probe number drops
Clinical pearl
For most children, sats are usually 95–100%, but always think about the child's condition and local guidance. If the reading drops below 94%, do not just stare at the probe. Reassess the child properly, check the trace is believable, and think about whether oxygen or escalation is needed. Normal temperature is still 36.5–37.5°C across all ages.
The signs that come before the obs chart looks dramatic
Clinical pearl
Cap refill, colour, effort, and behaviour often change before the obs chart looks dramatic. A child who is quiet, floppy, unusually still, or not responding normally to parents can be much more concerning than one isolated number that still looks "fine".
Red flags — escalate immediately
What it is and why the trend matters
Clinical pearl
Your trust will have a PEWS chart, or something close to it. It turns behaviour, breathing, and circulation into a score that helps show how worried the team should be. The score matters, but the direction matters even more: a rising score is often the real warning sign.
Sources & References
NICE (2016) — Sepsis: recognition, diagnosis and early management (NG51)Advanced Life Support Group (2021) — Advanced Paediatric Life Support (7th edn)RCPCH (2020) — Paediatric vital signs and clinical assessment guidanceResuscitation Council UK (2021) — 2021 Resuscitation GuidelinesAlso practice with