Vital Signs by Age: Normal Pediatric and Adult Ranges for EMS

Vital signs are the measurements that tell you how a patient's body is coping right now: the pulse, the breathing, the blood pressure, the oxygen saturation, the skin, the pupils and, when the call needs them, the temperature and the blood glucose. Normal values change a great deal with age. A heart rate of 150 can be ordinary in a newborn and worrying in an adult, so a number only means something against the norm for the patient's age, and against the patient's own earlier readings.

The vital signs EMS takes

A full set commonly includes the pulse, respirations, blood pressure and pulse oximetry, with skin color, temperature and moisture, and the pupils. Blood glucose and body temperature are added when the presentation calls for them. Many services also record a pain score, which is the patient's report rather than a measurement. Mental status is not a vital sign in the strict sense, but it is checked alongside them and it often changes first.

Pulse

In adults and older children, feel for the radial pulse at the wrist. In an infant, use the brachial pulse on the inside of the upper arm. If you cannot find a peripheral pulse, check a central one: the carotid in the neck or the femoral in the groin. Count for 30 seconds and double it when the rhythm is regular, and count a full 60 seconds when it is irregular. Record three things: the rate, the rhythm (regular or irregular) and the strength (strong, weak or thready). A monitor or a pulse oximeter displays a rate too, but it is worth confirming with your fingers at least once, because a machine can count artifact or miss beats that do not produce a pulse.

Respirations

Count breathing without telling the patient you are doing it, because people change their breathing when they know it is being watched. Many providers keep their fingers on the wrist as if still taking the pulse. Watch the chest rise, or the abdomen in an infant, whose breathing is mostly diaphragmatic. Count for 30 seconds and double it in an adult, but count a full 60 seconds in an infant: young infants normally breathe irregularly, with short pauses, and a short count can mislead you. Record the depth, the effort (retractions, nasal flaring, use of the neck muscles, tripod positioning) and any sounds such as wheezing, stridor, grunting or gurgling, not only the rate.

Blood pressure

Use a cuff that fits. The commonly taught guidance is a cuff bladder about 40% of the arm's circumference in width and about 80% of it in length. A cuff that is too small reads falsely high, and one that is too large reads falsely low, which matters most in children and in very large or very thin adults. Listening with a stethoscope gives both the systolic and the diastolic pressure. In a noisy ambulance you may only be able to palpate one, feeling for the radial pulse to return as the cuff deflates; that gives the systolic alone, it usually reads a little lower than a pressure taken by listening, and it is recorded as palpated.

Automated cuffs are convenient and are good for trending, but they can be unreliable with an irregular rhythm, motion, shivering and very low pressures. When a reading is surprising, or does not fit the patient in front of you, take one by hand.

Calculate a mean arterial pressure from a blood pressure

Pulse oximetry (SpO2)

A pulse oximeter estimates the share of hemoglobin carrying oxygen. Most healthy people at sea level read in the mid to high 90s, and many references put a normal reading at 95 to 100%. Patients with chronic lung disease may live lower. Trust the number only when the device shows a good waveform or signal: cold fingers, poor perfusion, motion and some nail polish all degrade it. Carbon monoxide gives a falsely normal reading, and a 2021 FDA safety communication warned that oximeters may overestimate saturation in people with darker skin. The reading also lags behind a change in breathing. The saturation targets used in treatment are your protocol's, and our oxygen therapy guide covers the published ones.

Skin

Look at the skin's color, feel its temperature and note its moisture. Warm, dry skin of normal color is the expected finding. Pale, cool and clammy skin is a sign of the body pulling blood away from the skin, often in shock. Flushed skin, cyanosis (a blue or gray color, which is a late finding) and mottling (a patchy, lacy pattern) are all worth recording. In darker skin, look for pallor or cyanosis at the inside of the lips, the gums, the nail beds and the inner eyelids. Capillary refill, the time for color to return after you press on a nail bed or the skin, has a commonly taught upper limit of about 2 seconds. It is most useful in children; cold surroundings and older age make it unreliable in adults.

Pupils

Check the size of each pupil, whether they are equal, and whether each one constricts briskly when you shine a light into it. A small difference in pupil size is normal in a minority of people, commonly cited as about 1 in 5, and is called physiologic anisocoria. In a patient with a head injury or an altered mental status, though, a new difference between the pupils is not assumed to be normal, and pupils that are fixed, very small or very large are reported as found.

Temperature

The traditional average body temperature is 98.6 °F (37 °C), but normal varies by about a degree with the time of day, the patient's age and where the temperature is taken. A fever is commonly defined as 100.4 °F (38 °C) or higher. Rectal readings are the most accurate route in infants; oral, tympanic (ear), temporal artery (forehead) and axillary (armpit) readings are easier and less exact. A normal or low temperature does not rule out a serious infection in an infant or an older adult, who may not mount a fever.

Blood glucose

Check a blood glucose where the presentation calls for it, commonly including an altered mental status, known diabetes, a seizure, signs that look like a stroke, and a sick infant or child, following your protocol. For reference, the American Diabetes Association's standards define a normal fasting glucose as below 100 mg/dL and hypoglycemia as a glucose below 70 mg/dL, and newborns run on different figures. These are definitions, not instructions; what you do about a reading is your protocol's decision.

Pain

Pain is the patient's report, not a measurement, and it is recorded as the patient states it. Adults and older children usually use a 0 to 10 numeric scale, where 0 is no pain and 10 the worst pain imaginable. Younger children often do better pointing at a row of faces, such as the Wong-Baker FACES scale. For a preverbal child, or anyone who cannot rate their own pain, behavioral scales such as FLACC (face, legs, activity, cry, consolability) score what you can observe. A patient with severe pain and normal vital signs is still in severe pain; the vital signs do not overrule the report.

Normal vital signs by age

The table below gives the ranges most EMS programs teach for children, from the American Heart Association's PALS (Pediatric Advanced Life Support) provider manual, 2020 edition, and the figures most EMS textbooks print for adults. The pediatric figures were checked against the PALS 2020 tables as reproduced in San Francisco EMS protocol 14.1; other published tables, many of them citing PALS 2015, differ in a few cells. Where a column comes from somewhere else, the cell says so. PALS gives heart rates for a child awake and asleep; a sleeping child normally runs slower.

Read the table as a guide, not a set of hard edges. The rows overlap, the age bands are not identical across the PALS tables for heart rate, breathing and blood pressure, and the figures have changed between PALS editions: older editions, for example, gave a newborn heart rate of 85 to 205. Pediatric and EMS textbooks print their own versions, and your program may teach slightly different numbers. A crying, frightened or feverish child will often sit above the awake range for as long as the crying, fear or fever lasts, without that number being a problem in itself.

The lower limit of normal systolic pressure in children

PALS defines hypotension in children by age, as a systolic pressure below roughly the 5th percentile for that age. Because it is a 5th percentile, a child above it is not necessarily well perfused: most children in shock keep a normal pressure for a long time.

When a fast heart rate is not sinus tachycardia

A fast heart rate is usually the body's appropriate response to fever, pain, fear, blood loss or low oxygen, and it is called sinus tachycardia. A rate far above the normal range can instead be an abnormal rhythm. The PALS tachycardia algorithm teaches that a heart rate at or above 220 in an infant under one year, or at or above 180 in a child aged one year or older, points toward supraventricular tachycardia (SVT) rather than sinus tachycardia. In adults, ACLS teaching is that a tachyarrhythmia becomes the likelier cause at a rate of about 150 or more. These figures point toward a rhythm question that the monitor answers; they do not diagnose one.

Our PALS algorithms guide covers what the algorithm does next.

Why the trend matters more than one number

The first set of vital signs is a baseline, not an answer. Its main value is that every later set can be compared with it. A heart rate that creeps up over three sets, a breathing rate that climbs, or a pulse pressure (systolic minus diastolic) that narrows can show a patient getting worse while every single reading is still inside the normal range. A patient who is compensating can look reassuring on paper right up to the point the blood pressure falls, and by then compensation is failing.

• Take a baseline set early, then repeat it: commonly every 15 minutes for a stable patient and every 5 for an unstable one, or as your protocol directs.
• Take another set after every intervention, so you can tell whether it worked.
• Compare each set with the last and with the patient's own normal where you know it. A patient whose usual systolic is 170 may be poorly perfused at 110.
• Look at combinations as well as single readings. The shock index, the heart rate divided by the systolic pressure, rises as the rate climbs and the pressure starts to give, sometimes before either looks alarming alone. The usual normal adult range is about 0.5 to 0.7, with an index above 0.9 associated with critical illness; the adult range does not apply to children or in pregnancy, and a normal index does not rule out shock.
• Remember what blunts the numbers. Beta blockers, other rate-controlling drugs and pacemakers can stop the heart rate rising. Older adults have less reserve and may have a usually high blood pressure. Fit young adults compensate well and can look deceptively stable.

Calculate the shock index from a heart rate and a systolic pressure

Children and newborns

Children are not small adults, and their vital signs are harder to take and easier to misread. Look before you touch: a general impression from across the room, using the pediatric assessment triangle, comes before the cuff and the probe, because putting equipment on a frightened child changes the numbers you are trying to measure. Let a calm child stay on a caregiver's lap. Use a pediatric cuff that fits, count breathing for a full minute in an infant, and judge every reading against the child's age.

A newborn is assessed with the Apgar score at 1 and 5 minutes after birth, which records heart rate, breathing, tone, reflex response and color. It describes the baby's condition and does not direct resuscitation; our NRP guide covers what does.

Score the Apgar for a newborn at 1 and 5 minutes

Many things in pediatric care depend on a weight, and a child's age is the usual starting point for estimating one when nobody knows it.

Estimate a child's weight from their age

Common mistakes

• Writing down the first number and never taking a second set. One reading is a snapshot; the trend is the story.
• Being reassured by a normal blood pressure, in a child above all. It is often the last thing to change.
• Using the wrong cuff size, or trusting an automated reading that does not fit the patient.
• Counting an infant's breathing for 15 seconds and multiplying, which misses the normal pauses and the abnormal ones.
• Trusting a pulse oximeter reading without a good waveform, or after a fire or a faulty heater where carbon monoxide is possible.
• Judging a child against adult numbers. A respiratory rate of 30 is fast for an adult and ordinary for a toddler.
• Treating the monitor rather than the patient. Look at the patient's appearance, mental status, breathing and skin every time you take a set.

The short version

• Vital signs: pulse, respirations, blood pressure, SpO2, skin and pupils, with temperature and glucose where indicated and pain as the patient's report.
• Normal ranges change with age. PALS is the usual EMS reference for children; most EMS texts give an adult heart rate of 60 to 100 and a respiratory rate of 12 to 20.
• PALS defines hypotension in a child aged 1 to 10 as a systolic below 70 + (2 x age in years). It is a lower limit, not a target.
• Children hold their blood pressure until late. A low pressure in a child is a late sign.
• The trend matters more than any single reading. Take a baseline, repeat it, and compare.
• The ranges are typical values for healthy, calm patients, sources differ, and no single number decides care. Your protocol and medical direction do.