Assessment and Monitoring
Assess developmentally
A pediatric assessment is organized around the child's developmental stage, not an adult head-to-toe script. Gather history from the caregiver first while the child settles, then perform the exam least invasive first: observe and auscultate while the child is quiet, then palpate, and save ears, throat, and other intrusive steps for last. Examine toddlers on a parent's lap; use warmth, feeding, and distraction with infants.
Know the norms
Vital signs shift with age: a newborn breathing 30-60/min with a heart rate of 100-160/min is expected, while adolescent values approach adult ranges. Compare numbers to age-specific norms before calling them abnormal. Cuff fit matters: the bladder should encircle 80-100% of arm circumference and cover about two-thirds of the upper arm; a cuff that is too small falsely raises the reading.
Pain is a vital sign. Use NIPS or N-PASS for neonates, FLACC from about 2 months to 7 years, faces scales from about 3 years, and numeric scales from about 8 years. Self-report is preferred whenever the child can give it.
Traps
Questions reward the nurse who treats the child as a whole: an infant crying at 170 beats/min may simply be crying. Watch for distractors that apply adult thresholds, start with the otoscopic exam, or ignore the family's report of a change from baseline. Serial measurements such as weight, head circumference, and urine output (1-2 mL/kg/hr) matter more than a single value.
Rule of thumb
If a value looks abnormal, calm the child and reassess, then compare against the child's own baseline before escalating.