1. Presentation title SUB TITLE HERE Pediatric Considerations: Kids & Vital Signs Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford RN, MSN

2. Children in the Clinic Children are NOT small adults Anxiety & fear can affect vital signs  Allow parents & family members to stay with child  Allow child to stay in parent’s arm or lap May need special equipment & techniques to take vital signs  Temperature  Pulse  Respirations  Blood Pressure

3. VS – It’s All About The Numbers! Terminal Digit Preference HCW may show a preference for certain numbers in Pulse, Respirations, & auscultated BP readings*  Zeros, even numbers, odd numbers  Research study on BP revealed 99% of auscultated SBP/DBP readings ended in zero, demonstrating lack of adherence to AHA recommendations* HCW should be aware of this possible tendency (*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)

4. Ear (Tympanic) Temperature Can be affected by heat & cold:  Heating & cooling measures  Heat & ice packs, heating blankets  Child wrapped in blanket for a long time  Extreme outside and inside temperatures  Very hot or very cold rooms  Very hot or very cold days  Bathing or swimming  May need to wait 20 minutes for accurate temp

5. Ear (Tympanic) Temperature Can also be affected by:  Impacted ear wax & ear infections  Whether an ear tug is used Should NOT be used if child had ear surgery

6. Ear (Tympanic) Temperature Insert covered thermometer probe into ear canal & use ear tug to position properly:  Children 1 year & older: Gently pull top of ear back, up, & out  Children less than 1 year: Gently pull top of ear straight back  Point tip towards nose Less than 2 yrs: point tip between eyebrows & sideburns http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS

7. Ear (Tympanic) Temperature What Patients Think About Ear Temperatures  Parents like them!  Fast, easy, clean, and safe  Children react better!  Faster measurement  Stay in parent’s lap or arms  No holding or restraining  No positioning

8. Pulse - Brachial Used for infants and small children Place fingertips of first 2 or middle 3 fingers over the brachial pulse area  Inside of the elbow Lightly press your fingertips on the pulse area

9. Normal Pulse Rates Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006) Babies to age 1:100–160 Children ages 1 to 10:60–140 Children age 10 & older:60–100

10. Respiratory Rate Count for 60 sec If panting, use stethoscope to count Agitation can result in inaccurate RR

11. Normal Respiratory Rates Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006) AGEBREATHS/MIN Newborn to 6 weeks30 - 60 Infant (6 weeks to 6 months)25 - 40 Toddler ( 1 to 3 years)20 - 30 Young Children ( 3 to 6 years)20 - 25 Older Children (10 to 14 years)15 - 20

12. Blood Pressure Automated BP machines cannot be used in children with:  Seizures, shaking, or shivers  Weak pulses  Agitation  Any situation where the arm cannot be kept still

13. Blood Pressure Allow child to remain in parent’s arm or lap Use the right-sized cuff Switch automated BP machine to the pediatric setting  Adult setting is too high for children!

14. Normal BP Measurements Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006) AGENormal BP Newborn to 6 weeks *Systolic 50 - 70 Infant (6 weeks to 6 months) *Systolic 70 - 95 Toddler ( 1 to 3 years) *Systolic 80 - 100 Young Children ( 3 to 6 years)Systolic 80 - 110 Older Children (10 to 14 years)Systolic 90 - 120 (* BP is often not taken on children less than 3 years of age)

15. Children in the Clinic YOU can make the difference:  Welcoming presence  Decrease the child’s anxiety & fears  Reassure the parents & family  Accurate vital signs