Measurements in The Normal Child

1
Measurements inThe Normal Child

• Alun Scourfield

2
Parameters of normality

• Exclude
• Birth weight
• Measurements of physical development(Ht,Wt,HC)
• Milestones
• Measurements in the context of looking at the
  well child and feverish child.

3
Temperature

• Measure
• oral ,rectal,axillary(digital thermometer)
• Advise against oral or rectal under age 5yrs
• Generally,37.2C axilla,37.5C oral,38C
  rectal---normal threshold
• Recommend digital,chemical dot and
  tympanic(forehead strips not recommended)
• Tympanic thermometers
• May measure as much as 0.74?below--1.34?but
  instructions give a range of values suggesting
  they are close to core temp.
• Recommended by Delphi panel(to NICE)

4
Pulse rate

• Varies with temp----(1C ? 20 beats/min ?)
• 130 beats/min at birth
• 110 beats/min at 1yr
• 100 beats/min at 3yrs
• 80 beats/min at 8yrs

5
Respiratory rate

• 40 breaths /min at birth
• 2nd year 25/min
• 5th year 20/min
• 13 or 4 ratio with pulse in health.

6
Blood pressure

• Rarely measured !--cuff size ?
• 80/50 in the newborn
• 85/60 at 4yrs
• 95/65 at 8yrs
• 110/70 at 10yrs
• 110/75 at 13yrs

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Reference grid
Age Resp rate(breaths/min) HR (beats/min) Systolic BP
?1Year 30--40 110---160 70--90
2-5yrs 25--30 95---140 80---100
5-12yrs 20---25 80---120 90--110
gt12yrs 15---20 60---100 100---120
8
Capillary refill time

• How reliable ?---less than two seconds .
• Measure of what ?
• Effect of ambient temperature /fever?
• Observer error(even with stop watch)

9
Hydration

• Significant dehydration defined as 5 or more
  loss in weight---clinical signs apparent
• Urine output an indicator
• 2 of four of the following
• capillary refill time gt2 secs
• absent tears
• dry mucous membranes
• ill looking
• RefPEDIATRICS Vol. 99 No. 5 May 1997