Bates’ Visual Guide to Physical Examination

Volume 3: 3.3 Vital Signs Video Transcript

Narrator: If not already taken, measure the blood pressure in children older than 2 years. Select a blood pressure cuff as you would an adult. It should be wide enough to cover 2/3 of the upper arm or leg. Because hypertension is more common in children than previously thought, it is important to obtain an accurate measurement. Therefore, keep in mind that children have elevated blood pressure during exercise, crying and anxiety. If the blood pressure is initially elevated, you can measure it again at the end of the examination. Elevated readings must always be confirmed by subsequent measurements.

Obtain an accurate pulse rate. Measure the heart rate over a 60-second interval. Here is an overview of the ranges of normal heart rates. The respiratory rate ranges from 20-40 per minute during early childhood and 15-25 during late childhood, reaching adult levels around age 15. Alternatively, you may use your stethoscope to measure respiratory rate on the chest or in front of the mouth. You can observe for 60 seconds as the child sits quietly with shirt removed.

In children, auditory canal temperature recordings are preferred over other methods because they can be obtained quickly with essentially no discomfort. Body temperature in children is less constant than in adults.