[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › Examining a child: order by age, preparing the child and child-specific measurement technique # Examining a child: order by age, preparing the child and child-specific measurement technique - Assessment Look first without touching, measure breathing and pulse while the child is calm, and use the route, site and size of equipment that fit the child's age. Updated Nov 13, 2026 ## Key points - Start with a hands-off look: appearance, work of breathing and skin colour can be judged in about 30 seconds. - Count breathing while the child is calm; sleep, pain and crying all change the rate. Infant breathing is often irregular. - Under 5 years the radial pulse is hard to feel: use the brachial or apical pulse. - Tympanic route: under 3 years pull the outer ear down; older children, up and back. - Under 2 years measure length lying down; from 2 years, standing height. Weigh in kilograms. - A cuff that is too small reads falsely high; too large reads falsely low. ## What it is A child's examination is planned around the child: what can be seen from a distance comes first, quiet measurements come before anything that may upset the child, and the technique changes with age. Infants and young children need different pulse sites, temperature routes and equipment from adults, and their normal heart and breathing rates are faster. Weight and length are part of every assessment, because growth is followed over time and many orders depend on weight. ## Reference values - Heart rate (beats/min): newborn 100–160; infant 80–140; toddler 80–130; preschool 80–110; school age 70–100; adolescent 60–100. - Respiratory rate (breaths/min): newborn to 1 month 30–60; 1 month to 1 year 26–60; 1–10 years 14–50; 11–18 years 12–22. - Axillary temperature can read up to 1 °C lower than oral; rectal is about 1 °C higher than oral. - Cuff width about 40 % of the arm circumference; bladder length 80–100 % of the circumference. - WHO growth charts are used from birth to 2 years; growth monitoring relies on a series of accurate measurements. ## What you need - A quiet, warm space and the parent close by. - Paediatric equipment: cuffs in several sizes, a small oximetry sensor that can be taped to a finger or toe, a thermometer for the chosen route. - An infant scale and a length board for children under 2; a stadiometer for older children. - The age-specific vital sign ranges and the growth charts the service uses. ## How to measure it (and why) - Watch the child from a distance first: alertness, tone, interaction, breathing effort and skin colour — it shows how sick the child is before you disturb them. - Let the child stay on the parent's lap where possible and show the equipment on a toy — a calm child gives truer readings. - Count breathing and pulse first, while the child is quiet — crying and fear raise both. - Under 5 years, feel the brachial pulse or listen at the apex for a full minute — the radial pulse is hard to find and rhythms vary. - Choose the temperature route by age and protocol; for the tympanic route pull the ear down under 3 years — this straightens a child's ear canal. - Pick the cuff by arm size, not by age — a wrong cuff gives a false blood pressure. - Tape the oximetry sensor to a finger or toe in small children — adult clips are too big and read poorly. - Weigh in kilograms; measure length lying down under 2 years and standing height after, and record which — the switch can change the classification. - Leave the most uncomfortable parts for the end, per institutional practice, and record findings against age ranges. ## How to read it - Interpret each value against the child's age range, never against adult values. - A heart or breathing rate outside the range in a calm child is more meaningful than the same value during crying. - Plot weight and length on the growth chart; a single value says less than the trend. - Abnormal appearance, effortful breathing or pale, mottled skin on the first look mean the child may be unstable. ## Next step: when to call for help - Abnormal appearance, increased work of breathing or poor skin colour on the first look: call for help before completing the examination. - Heart or breathing rate clearly outside the age range in a calm child: repeat, then report. - Low oxygen saturation with a well-applied sensor: report at once. - Weight loss or a growth trend that crosses lines on the chart: record and report to the team. ## Test yourself Think of the answer, then tap the question to see it. ## Which pulse site is preferred in a child under 5 years? The brachial or apical pulse, because the radial pulse is hard to feel at that age. ## How is the ear pulled for a tympanic temperature in a child under 3 years? Gently down; in older children and adults it is pulled up and back. ## Why count respirations before other measurements? Crying, pain and fear change the rate, so it is most accurate while the child is calm. ## How is a child under 2 years measured for growth? Length is measured lying down; standing height is used from 2 years. ## What happens if the blood pressure cuff is too small? The reading is falsely high; a cuff that is too large reads falsely low. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/nursing/examining-a-child-order-by-age-preparing-the-child-and-child-specific-measuremen/) ## Elsewhere in DurgiPedia - [Pediatric history: perinatal, growth, development and vaccines](https://durgical.com/en/clinical-exam/pediatric-history-perinatal-growth-development-and-vaccines/) - [Vital signs in children: how they change with age](https://durgical.com/en/clinical-exam/vital-signs-in-children-how-they-change-with-age/) ## Connections ## Related 3 - [Weight, height and daily weights](https://durgical.com/en/nursing/weight-height-and-daily-weights/) - [Growth and development monitoring in children](https://durgical.com/en/nursing/growth-and-development-monitoring-in-children/) - [Communicating with children by age, and with their parents](https://durgical.com/en/nursing/communicating-with-children-by-age-and-with-their-parents/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Skills, 1.3 Vital Signs (Open RN, CC BY 4.0)](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/01%3A_General_Survey/1.03%3A_Vital_Signs) (Open Resources for Nursing (Open RN) / LibreTexts, 2021); [Nursing Skills, 3.2 Blood Pressure Basics (Open RN, CC BY 4.0)](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/03%3A_Blood_Pressure/3.02%3A_Blood_Pressure_Basics) (Open Resources for Nursing (Open RN) / LibreTexts, 2021); [WHO Child Growth Standards: growth chart training](https://www.cdc.gov/growth-chart-training/hcp/training/who-child-growth-standards-training.html) (Centers for Disease Control and Prevention, 2024); [Kids really are just small adults: utilizing the pediatric triangle with the classic ABCD approach to assess pediatric patients (Cureus 12(3):e7424)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7182162/) (Cureus (open access, PMC7182162), 2020). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/examining-a-child-order-by-age-preparing-the-child-and-child-specific-measuremen/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/examining-a-child-order-by-age-preparing-the-child-and-child-specific-measuremen/