Reviewed September 30, 2026 by the editorial team. Educational content; follow your facility's protocols.
Vital signs by age chart
These ranges come from the American Heart Association Pediatric Advanced Life Support (PALS) reference tables. Heart rate is shown awake and asleep because a sleeping child's rate is normally lower. Age groups follow PALS: neonate under 28 days, infant 1 month to 1 year, toddler 1 to 2 years, preschool 3 to 5 years, school age 6 to 11 years, adolescent 12 to 15 years.
| Age group | Heart rate awake (bpm) | Heart rate asleep (bpm) | Respiratory rate (breaths/min) | Systolic BP (mm Hg) |
|---|---|---|---|---|
| Neonate (under 28 days) | 100-205 | 90-160 | 30-53 | 67-84 (at 96 hours) |
| Infant (1-12 months) | 100-180 | 90-160 | 30-53 | 72-104 |
| Toddler (1-2 years) | 98-140 | 80-120 | 22-37 | 86-106 |
| Preschool (3-5 years) | 80-120 | 65-100 | 20-28 | 89-112 |
| School age (6-11 years) | 75-118 | 58-90 | 18-25 | 97-115 (6-9 y); 102-120 (10-11 y) |
| Adolescent (12-15 years) | 60-100 | 50-90 | 12-20 | 110-131 |
Earlier PALS tables (2015) listed an awake infant heart rate of 100-190. Some hospitals use their own charts or pediatric early warning scores, so follow your facility's reference.
Blood pressure and hypotension thresholds
Children keep their blood pressure normal for a long time while they compensate for shock, mainly by raising heart rate and constricting peripheral vessels. Low blood pressure is therefore a late and serious finding. PALS uses the systolic thresholds below to define hypotension.
Diastolic reference values in the same PALS table run from about 37-56 mm Hg in infants to 64-83 mm Hg in young adolescents.
| Age | Hypotension if systolic BP is below |
|---|---|
| Term neonate (0-28 days) | 60 mm Hg |
| Infant (1-12 months) | 70 mm Hg |
| Child 1-10 years | 70 + (2 x age in years) mm Hg |
| Older than 10 years | 90 mm Hg |
Example: for a 4-year-old, 70 + (2 x 4) = 78 mm Hg. A systolic pressure under 78 mm Hg meets the PALS definition of hypotension.
Normal temperature and fever in children
The American Academy of Pediatrics defines fever as a temperature of 100.4 °F (38 °C) or higher. The reading depends on the route, so always document the method next to the number.
A fever in an infant younger than 3 months needs prompt medical evaluation, even if the baby looks well.
| Route | Typical normal range | Best use |
|---|---|---|
| Rectal | 36.6-38.0 °C (97.9-100.4 °F) | Most accurate; preferred in infants under 3 months |
| Ear (tympanic) | 35.8-38.0 °C (96.4-100.4 °F) | From about 6 months of age |
| Oral | 35.5-37.5 °C (95.9-99.5 °F) | From about 4 years, when the child can hold the probe under the tongue |
| Axillary | 36.5-37.5 °C (97.7-99.5 °F) | Screening only; least accurate |
Temperature ranges by route come from the Canadian Paediatric Society position statement as summarized in the PedsCases reference chart. Temporal artery (forehead) thermometers can be used at any age per AAP.
Adult normal values for comparison
Adolescents approach adult values by the mid-teens. Use these adult ranges for patients 16 and older unless your facility sets a different cut-off.
| Vital sign | Normal adult range at rest |
|---|---|
| Heart rate | 60-100 beats per minute |
| Respiratory rate | 12-18 breaths per minute (many texts use 12-20) |
| Blood pressure | 90/60 to 120/80 mm Hg |
| Temperature | 97.8-99.1 °F (36.5-37.3 °C) |
How to measure vital signs in children
Order matters. Crying and fear raise heart rate and respiratory rate within seconds, so start with the least invasive checks and leave the most upsetting ones for last.
- Count respirations first, while the child is calm or asleep. Watch the chest and abdomen for a full 60 seconds, because infants breathe irregularly and have short pauses.
- Take an apical pulse for a full minute in infants and toddlers. In older children you can use the radial pulse.
- Check oxygen saturation with a probe sized for the child, and wait for a steady waveform before you read the number.
- Use a blood pressure cuff whose bladder width is about 40% of the arm circumference and whose length covers 80-100% of it. A cuff that is too small reads falsely high.
- Take temperature last and pick the route by age, as shown in the temperature table.
- Note the child's state (asleep, calm, crying, febrile) next to the values so the next nurse can interpret them.
Red flags to report
A single value slightly outside the range in a playful, pink, well-perfused child is often not urgent. Trends and combinations matter more. Escalate right away when you see:
- Respiratory rate persistently above the range, or signs of work of breathing: retractions, nasal flaring, grunting, head bobbing
- Oxygen saturation below 92% beyond the immediate newborn period
- Tachycardia that does not settle when the child is calm and afebrile
- Bradycardia in a child with poor breathing or low oxygen, which can signal imminent arrest
- Systolic pressure below the PALS hypotension threshold for age
- Capillary refill longer than 2 seconds, cool or mottled extremities, weak peripheral pulses
- Fever of 100.4 °F (38 °C) or more in an infant under 3 months
- Lethargy, irritability that cannot be consoled, or reduced response to parents
Reference ranges support, never replace, clinical judgment and your facility's escalation protocol or pediatric early warning score.
Scales that go with this guide
Frequently asked questions
What is a normal heart rate for a child?
It depends on age. Per PALS, an awake toddler (1-2 years) is normal at 98-140 bpm, a preschooler at 80-120, a school-age child at 75-118 and an adolescent at 60-100. Rates are lower during sleep.
What is a normal respiratory rate for an infant?
PALS lists 30-53 breaths per minute for infants under 1 year. Count for a full 60 seconds because infant breathing is irregular.
What blood pressure is too low for a child?
PALS defines hypotension as a systolic pressure below 60 mm Hg in term neonates, below 70 in infants, below 70 + (2 x age in years) for ages 1-10, and below 90 after age 10.
What temperature is a fever in a child?
The AAP defines fever as 100.4 °F (38 °C) or higher. Any fever in an infant under 3 months needs prompt medical evaluation.
Why is low blood pressure a late sign in children?
Children compensate for low blood volume by increasing heart rate and constricting blood vessels. Blood pressure often stays normal until compensation fails, so tachycardia and delayed capillary refill usually appear first.
At what age do vital signs reach adult values?
Heart rate and respiratory rate reach adult ranges around adolescence. PALS lists 60-100 bpm and 12-20 breaths per minute for ages 12-15, the same as typical adult ranges.
More guides and tools
All scales:
Sources: Pediatric Vital Signs Reference Chart (PALS ranges, CPS temperature) - PedsCases / Maine EMS · Pediatric Vital Signs protocol, AHA-PALS 2020 values - San Francisco EMS Agency · How to Take a Child's Temperature - HealthyChildren.org (AAP) · Vital Signs: normal adult ranges - Cleveland Clinic. Text written by our editorial team. Reviewed September 30, 2026.