Bates’ Visual Guide to Physical Examination

Volume 2: 2.3 Vital Signs Video Transcript

Narrator: While blood pressure is routinely measured in children older than 2 years, it can also be obtained from infants but only if indicated. You will need skills in distraction or play to help obtain this measurement. The most easily used measure of systolic blood pressure in infants is the Doppler method, which detects arterial blood flow vibrations, converts them to systolic blood pressure levels and transmits them to a digital readout device.

You may have trouble obtaining an accurate pulse rate in squirming infants. The best strategy is to palpate either the femoral arteries in the inguinal area or the brachial arteries in the antecubital fossa or two auscultated the heart. This measurement is important because the heart rate of infants is more sensitive to the effects of illness, exercise and emotion than that of adults.

The respiratory rate in infants has a greater range compared to adults. In fact, it may vary considerably from moment to moment with alternating periods of rapid and slow breathing. In infants, the normal rate ranges between 30-60 breaths per minute. Ideally, the respiratory pattern should be observed for at least 60 seconds to assess both the rate and pattern.

Because fever is so common in children, obtain an accurate body temperature when you suspect infection. Auditory canal temperatures are considered accurate. The technique for obtaining rectal temperature is relatively simple. Place the infant or child prone on the examining table on the parent’s lap or on your own lap. Separate the buttocks with the thumb and forefinger on one hand, and with the other hand gently insert a well-lubricated rectal thermometer to a depth of 2-3 cm. Keep the thermometer in place for at least 2 minutes. The average rectal temperature is higher in infancy and early childhood, usually 99°F until after 3 years and may fluctuate as much as a 3° during a single day.