Reference cards

The numbers you look up.

Not everything is worth memorising. These are the tables you want in front of you — on a call, or the night before the exam — rather than half-remembered.

Pediatric vital signs by age

Awake and at rest. A crying, frightened or febrile child runs faster than this on every row, which is why a single set of numbers means very little in a child — the trend and the overall picture mean far more.

Age	Heart rate	Respiratory rate	Systolic BP
Newborn (0–1 mo)	100–180	30–60	> 60
Infant (1–12 mo)	100–160	25–50	> 70
Toddler (1–3 y)	90–150	20–30	> 72–76
Preschool (3–6 y)	80–140	20–25	> 76–82
School age (6–12 y)	70–120	15–20	> 82–90
Adolescent (12–18 y)	60–100	12–20	> 90
Adult, for comparison	60–100	12–20	90–140

The formula worth knowing. For a child aged 1 to 10, the lower limit of an acceptable systolic pressure is roughly 70 + (2 × age in years). A 4-year-old below about 78 is hypotensive. Published ranges differ between textbooks and protocols by a few beats either way; learn the set your program uses.

And the thing the table cannot show you. Children compensate extremely well and then fail suddenly. A normal blood pressure in a sick child is not reassurance — it is the last thing to go. Tachycardia, poor perfusion and a change in how the child behaves all arrive long before the pressure moves, and bradycardia in a child is a pre-arrest sign, usually from hypoxia.

Glasgow Coma Scale

Three components, scored independently and summed. Minimum 3, maximum 15 — there is no zero, because a dead patient still scores 3.

Score	Eye opening	Verbal response	Motor response
6	—	—	Obeys commands
5	—	Oriented	Localises pain
4	Spontaneous	Confused	Withdraws from pain
3	To voice	Inappropriate words	Flexion (decorticate)
2	To pain	Incomprehensible sounds	Extension (decerebrate)
1	None	None	None

Report the parts, not just the total. E3 V4 M6 and E1 V1 M11 cannot both happen, but very different patients can share a total of 13. The motor score carries most of the prognostic weight, and the components are what the receiving team wants.

The trend beats the number. One GCS is a data point; two, ten minutes apart, is information. A patient dropping from 14 to 11 is the finding, whatever the absolute figure. Below 8 is the classic threshold for an airway that will not protect itself.

Flexion versus extension. Decorticate flexion brings the arms in toward the core, which is the memory hook. Decerebrate extension straightens and rotates them outward, and is the worse of the two.

APGAR

Scored at 1 minute and again at 5 minutes after birth. Five signs, each 0, 1 or 2, for a total out of 10.

Sign	0	1	2
Appearance (color)	Blue or pale all over	Body pink, hands and feet blue	Completely pink
Pulse	Absent	Under 100	Over 100
Grimace (reflex)	No response	Grimace	Cries, coughs, sneezes
Activity (tone)	Limp	Some flexion	Active motion
Respirations	Absent	Slow, irregular, weak cry	Strong cry

The trap. Blue hands and feet with a pink body is acrocyanosis, and it is normal in the first minutes of life. It scores 1, not 2. Scoring it as 2 is by far the most common reason an APGAR comes out one point too high.

It never delays care. APGAR is recorded, not acted on. A baby who needs drying, warming, stimulation or ventilation gets it immediately — you do not wait for the one-minute mark to decide, and you do not stop resuscitating to score.

Pediatric assessment triangle

An impression formed from the doorway, before you touch the child — which also buys you a calm child for the hands-on assessment that follows.

Side	What you are looking at	Abnormal suggests
Appearance	Tone, interactiveness, consolability, gaze, speech or cry	Something systemic: hypoxia, hypoglycemia, sepsis, a head injury, a poisoning
Work of breathing	Audible sounds, retractions, nasal flaring, head bobbing, tripoding	A respiratory problem, and which part of the airway it is in
Circulation to skin	Pallor, mottling, cyanosis	Shock, or a cardiac problem

Reading the combinations. Appearance alone abnormal points at something systemic. Appearance plus breathing is respiratory failure. Appearance plus skin is shock. All three is cardiopulmonary failure — the child who is about to arrest. It gives you severity and a direction, never a diagnosis, and it supplements the hands-on assessment rather than replacing it.

Appearance is the one that matters most. A child who will not look at you, will not be consoled by a parent, or has gone quiet when they should be protesting is a sick child, whatever the numbers say.