The Pediatric Physical Examination - General Principles and Standard Measurements - UpToDate

6/26/2020 The pediatric physical examination: General principles and standard measurements - UpToDate
Official reprint from UpToDate®

www.uptodate.com ©2020 UpToDate, Inc. and/or its affiliates. All Rights Reserved.
The pediatric physical examination: General principles and

standard measurements
Author: Jan E Drutz, MD
Section Editor: Teresa K Duryea, MD
Deputy Editor: Mary M Torchia, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: May 2020. | This topic last updated: Jan 29, 2020.
INTRODUCTION
Sophisticated technologic advances in medicine have proved to be remarkably beneficial in the diagnostic
process, yet the well-performed history and the physical examination remain the clinician's most important
tools. They are venerated elements of the art of medicine, the best series of diagnostic tests we have [1].
A relatively complete physical examination should be performed on each patient, regardless of the reason
for the visit. Numerous medical anecdotes relate instances in which the examination revealed findings
unrelated to and unexpected from the patient's chief complaint and major concerns. On occasion, a limited
or inadequate examination may miss a significant condition, mass lesion, or potentially life-threatening
condition.
The general principles, standard measurements, and overall approach to the pediatric patient are discussed
here. Examination of specific organ systems is discussed separately. (See "The pediatric physical
examination: HEENT" and "The pediatric physical examination: Chest and abdomen" and "The pediatric
physical examination: Back, extremities, nervous system, skin, and lymph nodes" and "The pediatric
physical examination: The perineum".)
GENERAL PRINCIPLES
The approach — After years of experience, seasoned examiners become aware of potential avoidable
pitfalls often encountered upon entering a patient's room. Before entering the room, the clinician should
review the patient's record and confirm the identity of the patient and others in the room. Most clinicians
have experienced the discomfort of walking into a room and greeting the patient, parent, or caregiver by the
wrong name.
https://www.uptodate.com/contents/the-pediatric-physical-examination-general-principles-and-standard-measurements/print 1/36
To avoid a potentially embarrassing situation, the examiner should always knock on the door and await a
response before entering. Small children standing on the other side can be injured easily by the door handle
or by the door's impact as it is being opened.
Regardless of whether the clinician and caregiver have met previously, it is appropriate to greet everyone in
a cordial manner, maintaining a professional yet friendly demeanor. Infants older than six months and
anxious toddlers who are leery of strangers often are more comfortable when held by their caregiver. To
gain the child's confidence and to avoid an early adversarial relationship, the clinician should try using a
calm approach, a reassuring smile, and a toy or bright object as a diversion. An appropriate distance should
be maintained during the history-taking portion. The clinician's approach should be cautious and
nonthreatening once the physical examination is about to begin.
Infants younger than six months who have no stranger anxiety and children older than 30 to 36 months who
are familiar with the examining clinician and/or who possess a trusting demeanor generally cooperate
during the examination without being held. Physical examination of 5- to 12-year-old children usually is easy
to perform because these children are not typically apprehensive and tend to be cooperative.
General appearance — The examiner may gain significant insight into important social and family
dynamics by observation alone when entering the patient's room. Terms used to describe a patient's
general appearance include degree of comfort (calm, nervous, shy), state of well-being (normal, ill-
appearing, distressed), activity level (sedate, alert, active, fidgety), physical appearance (neat, disheveled,
unkempt), behavior and attitude (happy, sad, irritable, combative), body habitus (overweight, underweight,
short, tall), and nutritional status (malnourished, normal, corpulent). The possibility of neglect should be
considered if the child and caregiver make no eye contact or the patient lacks animation and has no social
smile. Psychosocial intervention may be warranted in these circumstances. (See "Child neglect: Evaluation
and management".)
If a child appears ill, particular attention should be paid to the way the patient has positioned himself or
herself. A child who lies completely still on the examination table, is verbally responsive, but noticeably
winces when an attempt is made to change position may have an acute abdomen (see "Emergency
evaluation of the child with acute abdominal pain"). A dyspneic patient who is sitting upright and slightly
forward with the arms extended and hands resting on the knees might be experiencing an exacerbation of
asthma.
If an infant who is about to be examined is crying when the clinician enters the examination room, the pitch
and intensity of the cry should be noted. A boisterous hardy cry is somewhat reassuring, whereas a weak
and listless cry may indicate a seriously ill infant. A high-pitched, screeching cry could indicate increased
intracranial pressure, reaction to a painful injury, toxic reaction, strangulated inguinal hernia, or other serious
disorders.
Note the patient's breathing pattern and skin color. If the patient has rapid, shallow respiration yet appears
to be in no acute distress, the underlying cause could be primary pulmonary disease or respiratory
compensation for metabolic acidosis. (See "Approach to the child with metabolic acidosis".)
The examiner should evaluate the developmental status before touching the child. The patient's motor
function, interaction with surrounding objects and people, response to sounds, and speech pattern give
clues about whether the patient is normal or is in need of extensive developmental assessment. (See
"Developmental-behavioral surveillance and screening in primary care", section on 'Approach to
surveillance'.)
History — Historical information depends almost completely upon the caregiver for patients in the neonatal
age range through early childhood. To obtain pertinent information regarding a 5- to 12-year-old child, the
clinician must still rely primarily on the caregiver, although attention should be given to the relevant, and
often honest, comments made by the patient. When appropriate, interview the adolescent patient in the
absence of caregivers so that pertinent historical information, anticipatory guidance, and preventive health
care issues can be more openly discussed. (See "Guidelines for adolescent preventive services".)
Key elements in the history-taking process include establishing a warm, caring atmosphere and asking
questions in a nonconfrontational, unhurried manner. The terminology and language used by the examiner
should be appropriate for the educational level of the caregiver and the patient. Good eye contact and a
sense of undivided attention should be maintained. The clinician should sit opposite the caregiver and/or
patient at a comfortable distance, unencumbered by large objects, such as desks or tables. Outside
interruption by the medical staff and by telephone calls should be kept to a minimum. An effort should be
made to maintain an uninterrupted dialogue, to write few notes, and as much as possible to refrain from
turning one's back to the patient/family in order to look at the computer screen or written medical records.
Physical examination — The examiner should wash his or her hands thoroughly before beginning and
after completing the examination. Protective gloves should be worn when appropriate. Patients and
caregivers are well aware when the examiner fails to carry out this seemingly routine practice.
Skilled clinicians employ different techniques to gain pediatric patient cooperation. The use of toys,
distracting objects, and pictures helps in the examination of young children, infants, and toddlers. Engaging
the two- to four-year-old in stories or a discussion of imaginary animals frequently creates an effective
diversion. Food, in the form of chewable snacks or liquid refreshments, can be used as a means of
pacification, depending upon the stage of the examination.
When an otherwise normal-acting child older than four years fails to cooperate for an examination, even in
the presence of a familiar caregiver, it may be an indication of either an earlier traumatic encounter between
the patient and another examiner or a failure on the part of the current examining clinician to use the correct
approach. An underlying psychosocial problem or personality defect should be suspected when a child who
is older than four years is totally combative or extremely uncooperative.
For patients old enough to understand but who appear apprehensive, the examiner should explain what is
going to be done during the examination and allow them to look at and touch any of the instruments to be
used. Older patients should be warned in advance of potential pain or discomfort.
The examination of an infant, toddler, or child should be performed in the presence of a parent or guardian;
if the parent’s presence may interfere with the examination (eg, suspected child abuse), a chaperone should
be present [2]. The use of a chaperone for the examination of the anorectal and genital areas and/or
breasts of female adolescent patients should be a shared decision between the patient and the clinician
after the clinician has explained the reason for the examination and described how the examination will
proceed. The sex of the chaperone should be determined by the patient’s wishes and comfort (if possible).
If a patient is offered the use of a chaperone and declines, this should be documented in the chart.
If the patient has a complaint, sign, or symptom that appears to involve a particular part of the anatomy, that
part of the examination should be performed last. As an example, consider a patient complaining of right-
lower-quadrant abdominal pain thought to be attributable to appendicitis; by not examining that part of the
body first, the clinician may be able to divert the patient's attention away from the involved area and rule out
other possible causes for the pain.
Patient privacy should be respected. If a patient objects to being unclothed or to wearing an examination
gown, allow him or her to remain clothed until a specific part of the anatomy must be checked. When an
area needs to be examined, the patient should be asked to remove or pull free the garments that are
hindering visualization, palpation, or auscultation.
The order in which the physical examination is conducted often is age-specific and depends upon examiner
preference. For an infant and younger child, the clinician may prefer to begin by examining the eyes, noting
the red-light reflex, extraocular eye muscle movements, and visual tracking and then move to other parts of
the body or organ systems before finally performing the often sensitive ear examination. For the older, more
cooperative child, the examination might begin at the head and progress down the body, with the neurologic
examination performed last. In general, the portions of the pediatric examination that require the most
patient cooperation, such as blood pressure measurement, lung and heart auscultation, and eye and
neurologic examinations, are performed initially. These examinations are followed by the more bothersome
portions, including abdominal and ear examinations and measurement of head circumference.
STANDARD MEASUREMENTS
Growth parameters — Measurement of the standard growth parameters throughout childhood and
adolescence is essential for assessing normal development [3]. Data obtained should be plotted on
standard growth curves to determine progress.
Weight — Weight is measured at each periodic well-child visit (figure 1A-B and figure 2A-B) (calculator
1). The evaluation of children with abnormal weight or weight trajectory is discussed separately. (See "Poor
weight gain in children younger than two years in resource-rich countries: Etiology and evaluation" and
"Clinical evaluation of the obese child and adolescent" and "Poor weight gain in children older than two
years in resource-rich countries", section on 'Diagnostic approach'.)
Height (length) — Height (length) is measured at each periodic well-child visit. In the child younger than
two years, measuring body length when the child is in the supine position is preferable to trying to obtain an
accurate measurement while the child is standing (figure 3A-B) (calculator 2). In older children, the height
measurement should always be done with the patient standing (figure 4 and figure 5A-B) (calculator 3 and
calculator 4). The evaluation of children with abnormal height (length) is discussed separately. (See
"Diagnostic approach to children and adolescents with short stature" and "The child with tall stature and/or
abnormally rapid growth".)
Head circumference
● When to measure – Occipitofrontal circumference (OFC) should be measured in all children at health
maintenance visits between birth and three years of age. OFC should also be measured at each visit in
children of all ages with neurologic or developmental complaints.
Measurement of OFC in the newborn may be unreliable until the third or fourth day of life since it may
be affected by caput succedaneum, cephalohematoma, or molding [4].
● Measuring technique – Measurement should be attempted at the conclusion of the physical

examination as young children generally dislike having their head measured. The measuring tape
should encircle the head and include an area 1 to 2 cm above the glabella anteriorly and the most
prominent portion of the occiput posteriorly (picture 1).
In older infants, the accuracy of the measurement may be affected by thick hair and deformation or
hypertrophy of the cranial bones.
● Normal head growth – Normal head growth in infants and children is discussed separately. (See
"Normal growth patterns in infants and prepubertal children", section on 'Head growth'.)
● Reference standards – OFC should be plotted on a standardized head circumference chart. A

disproportionately large head may be indicative of hydrocephalus or macrocephaly. A
disproportionately small head may be indicative of neurologic deficits or microcephaly, although in
some children a small head size is normal. (See "Macrocephaly in infants and children: Etiology and
evaluation", section on 'Etiology' and "Microcephaly in infants and children: Etiology and evaluation".)
Standardized charts for monitoring OFC in children between 0 and 18 years of age include [5-8]:
• The Centers for Disease Control and Prevention (CDC) National Center for Health Statistics head
circumference charts for children 0 to 36 months of age (CDC growth charts) (figure 6A-B)
(calculator 5) – These charts are based on a nationally representative demographic sample.
The CDC recommends that the CDC growth charts be used for children older than two years [8].
• The World Health Organization (WHO) head circumference charts for children 0 to 5 years of age
(WHO growth standards) – These charts are based on data from the Multicentre Growth
Reference Study of breastfed children living under optimal environmental conditions.
The CDC recommends that the WHO growth charts be used for children 0 to 2 years (figure 7A-B)
(calculator 6) [8].
• The Nellhaus head circumference charts for children 0 to 18 years of age – These charts are
based on a 1968 international meta-analysis [5]. They are available in the full text of the reference
[5].
• The Fels head circumference charts for children 0 to 18 years – These charts are based on data
from the Fels Longitudinal Study of 888 white children from the United States [6]. They are
available in the full text of the reference [6].
• The United States Head Circumference Growth Reference charts for children 0 to 21 years of age
– These charts combine growth reference data from the CDC, Nellhaus, the Fels Longitudinal
Study, and others [7]. They are available in the full text of the reference [7].
• The Bushby charts for adults – These charts are based on data from 354 white adults (median age
40 years, range 17 to 83 years) in two British centers; OFC percentiles are related to height [9].
Bushby charts are available in the full text of the reference [9].
It may be inappropriate to use a single head circumference standard for children in all countries or
ethnic groups. A study that compared mean head circumference from a variety of studies including
>11,000,000 children from economically advantaged populations (1988 to 2013) with the WHO
reference standards found that the mean head circumferences in certain national or ethnic groups
were sufficiently different from the WHO means to affect diagnosis of microcephaly or
macrocephaly [10].
● Special populations
• Premature infants – Most clinicians use the standard growth curves to monitor the head growth of
premature infants, with correction for gestational age), until approximately 18 to 24 months of age
[11]. (See "Growth management in preterm infants", section on 'Monitoring of growth'.)
• Children with conditions associated with macrocephaly – The standard growth curves are not
appropriate for monitoring the head size of children with certain medical conditions associated with
macrocephaly (eg, achondroplasia, neurofibromatosis). (See "Achondroplasia", section on
'Management' and "Neurofibromatosis type 1 (NF1): Pathogenesis, clinical features, and
diagnosis".)
• Children with conditions associated with microcephaly – The standard growth curves are not
appropriate for monitoring the head size of children with craniosynostosis, craniofacial syndromes,
and children with certain medical conditions associated with microcephaly (eg, Williams-Beuren
syndrome). Growth curves for children with Williams-Beuren syndrome are available through the
American Academy of Pediatrics.
Chest circumference — Chest circumference is measured at the time of the newborn examination, but
it is not a part of the routine examination for well-child visits. The chest circumference is measured at the
nipple line. Chest circumference is 1 to 2 cm smaller than head circumference in most newborns and
children 12 to 18 months old.
Vital signs
Temperature — Routine measurement of the patient's temperature is not always necessary. When a
temperature measurement is needed, the technique and appropriate site for measurement are age
dependent. Rectal temperature recordings in infants and young children are preferred [12], although axillary
recordings are acceptable; axillary measurements are consistently lower than rectal measurements, but the
absolute difference varies too widely for a standard conversion [13]. Oral temperature readings
(approximately 1°F [0.6°C] below rectal temperatures) should not be obtained until the child is old enough to
understand how to hold and retain an oral thermometer under the tongue. (See "Fever in infants and
children: Pathophysiology and management", section on 'Temperature measurement'.)
Rectal temperature measurements should be taken with the patient in the prone position with the legs
slightly flexed at the hips and knees; the thermometer is directed anteriorly at an angle of approximately 20°
to the surface of the examination table [14,15]. Battery-operated and electronic thermometers for recording
oral or rectal temperatures generally are reliable and fast. The use of infrared tympanic membrane and
temporal artery thermometers is discussed separately. (See "Fever in infants and children: Pathophysiology
and management", section on 'Temperature measurement'.)
Respiratory rate — The respiratory rate varies with activity in infants and young children, and in these
patients is best assessed by counting for a full 60 seconds [16-19]. Accurate determination of the
respiratory rate should be attempted only when the patient is asleep or at rest. It can be obtained by
auscultation, palpation, or direct observation. Observation of chest wall movements is preferable to
auscultation because auscultation may stimulate the child, falsely elevating the rate [16]. The normal range
for the respiratory rate depends upon the age of the child. A systematic review of 20 studies provided
respiratory rate percentiles for healthy children who were typically awake and at rest (table 1) [20]. A
sustained breathing rate in excess of the upper limit of normal generally indicates primary respiratory tract
disease; it may also occur secondary to a metabolic disorder, infectious disease, high fever, or underlying
heart disease. Although the respiratory rate may increase with fever [21-23], the relationship between
temperature and respiratory rate is not linear. Thus, a simple rule for use in clinical decision making is not
possible.
Heart rate — According to one author, "those who wish to know the inner body feel the pulse and thus
have the fundamentals for diagnosis" [24]. The heart rate can be measured by direct auscultation or
palpation of the heart or by palpation of peripheral arteries (carotids, femorals, brachial, or radials).
Like the respiratory rate, the normal heart rate varies with age. A systematic review of 59 studies provided
heart rate percentiles for healthy children who were typically awake and at rest (table 1) [20]. A heart rate
above the upper limit of normal may indicate primary cardiac disease; it also can occur secondary to an
underlying systemic or metabolic disorder, infectious disease, or high fever.
Blood pressure — Yearly blood pressure measurements are measured in children ages three years and
older. Obtaining an accurate blood pressure reading in children under the age of three often is difficult. In
most circumstances, routine blood pressure measurements should not be attempted in these children
unless they have evidence of underlying renal disease, such as a tumor, nephrotic syndrome,
glomerulonephritis, pyelonephritis, or renal artery stenosis. Another reason for measuring the blood
pressure in children under the age of three is the finding or suspicion of underlying cardiovascular disease,
such as coarctation of the aorta or patent ductus arteriosus (PDA). (See "Clinical manifestations and
diagnosis of coarctation of the aorta" and "Clinical manifestations and diagnosis of patent ductus arteriosus
in term infants, children, and adults".)
Blood pressure devices include the standard extremity cuff and mercury bulb sphygmomanometer, the
hand-held aneroid manometer, and the Doppler and oscillometric devices. Patients old enough to
understand should be shown the blood pressure device before the examiner attempts to take a
measurement. The patient should be allowed to play with the device or feel the cuff inflate to gain his or her
cooperation. The proper technique for blood pressure measurement is discussed separately. (See
"Definition and diagnosis of hypertension in children and adolescents", section on 'Measurement of blood
pressure'.)
As with pulse and respiratory rates in children, blood pressure varies with age. Standard reference charts
that give the ranges of normality should be consulted [25]:
● Blood pressure standards for boys (table 2)

● Blood pressure standards for girls (table 3)
The systolic pressure measured in the lower extremity generally is approximately 20 mmHg higher than that
measured in the upper extremity. (See "Definition and diagnosis of hypertension in children and
adolescents".)
● High blood pressure – In addition to the disorders mentioned above, elevated blood pressures are
associated with neuroblastomas, pheochromocytomas, thyroid disease, neurofibromatosis, Cushing
disease, intoxication from or ingestion of various substances, increased intracranial pressure, and
myriad other disorders. It is wise to keep in mind that elevated systolic pressures alone frequently are
noted in patients after vigorous exercise, excessive agitation, or during febrile illnesses. (See
"Epidemiology, risk factors, and etiology of hypertension in children and adolescents", section on
'Secondary hypertension'.)
● Low blood pressure – Abnormally low blood pressure recordings are noted in patients with heart failure
from numerous causes and in patients in shock from causes such as sepsis or hypovolemia. A rapid
change in the patient's position from supine to standing or sitting may result in orthostatic hypotension.
(See "Initial evaluation of shock in children".)
● Wide pulse pressure – Widened pulse pressures can occur in patients with aortic regurgitation,
arteriovenous fistulas, patent ductus arteriosus, or hyperthyroidism. (See "Aortic regurgitation in
children" and "Clinical manifestations and diagnosis of patent ductus arteriosus in term infants,
children, and adults" and "Clinical manifestations and diagnosis of Graves disease in children and
adolescents".)
● Narrow pulse pressure – Narrowed pulse pressures are found in patients with subaortic or aortic valve
stenosis and occasionally in those with hypothyroidism. (See "Subvalvar aortic stenosis (subaortic
stenosis)" and "Valvar aortic stenosis in children" and "Acquired hypothyroidism in childhood and
adolescence".)
SUMMARY
● Assessment of the general appearance should include the child's state of well-being, activity level,
physical appearance, behavior and attitude, body habitus, nutritional status, preferred position
(particularly for ill-appearing children), pitch and intensity of the cry (in crying infants), breathing pattern,
skin color, and developmental status. (See 'General appearance' above.)
● The history is generally obtained from the caregiver for infants and preschool children. Children aged 5
through 12 may contribute to the history if they are willing and able. Adolescent patients should be
interviewed in the absence of caregivers when appropriate. (See 'History' above.)
● The order in which the physical examination is conducted often is age specific and depends upon
examiner preference. The portions of the examination that require the most cooperation usually are
performed first, and the more bothersome portions are performed last. If the patient has a localized
complaint, sign, or symptom, that part of the examination should be performed last. (See 'Physical
examination' above.)
● Measurement of the weight, length/height, and head circumference is essential for assessing normal
development. Data obtained should be plotted on standard growth curves to determine progress. (See
'Growth parameters' above.)
• Weight (boys) (figure 1A-B)

• Weight (girls) (figure 2A-B)
• Length (figure 3A-B)
• Height (figure 5A-B)
• Head circumference (figure 7A-B)
● Routine measurement of the patient's temperature is not always necessary at health supervision visits.
When a temperature measurement is needed, the technique and appropriate site for measurement are
age dependent. (See 'Temperature' above.)
● The respiratory rate can be obtained by auscultation, palpation, or direct observation. (See 'Respiratory
rate' above.)
● The heart rate can be measured by direct auscultation or palpation of the heart or peripheral arteries
(carotids, femorals, brachial, or radials). (See 'Heart rate' above.)
● Yearly blood pressure measurements are routinely obtained in children ages three years and older.
Blood pressure measurements also should be obtained in children younger than three years if there is
evidence or suspicion of underlying renal or cardiovascular disease. (See 'Blood pressure' above.)
Use of UpToDate is subject to the Subscription and License Agreement.
REFERENCES
1. Sackett DL, Rennie D. The science of the art of the clinical examination. JAMA 1992; 267:2650.
2. Committee on Practice and Ambulatory Medicine. Use of chaperones during the physical examination
of the pediatric patient. Pediatrics 2011; 127:991.
3. Committee on Psychosocial Aspects of Child and Family Health 1995-1996. Guidelines for health sup
ervision III, American Academy of Pediatrics, Elk Grove Village, IL 1997.
4. Rios A. Microcephaly. Pediatr Rev 1996; 17:386.
5. Nellhaus G. Head circumference from birth to eighteen years. Practical composite international and
interracial graphs. Pediatrics 1968; 41:106.
6. Roche AF, Mukherjee D, Guo SM, Moore WM. Head circumference reference data: birth to 18 years.
Pediatrics 1987; 79:706.
7. Rollins JD, Collins JS, Holden KR. United States head circumference growth reference charts: birth to
21 years. J Pediatr 2010; 156:907.
8. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC). Use
of World Health Organization and CDC growth charts for children aged 0-59 months in the United
States. MMWR Recomm Rep 2010; 59:1.
9. Bushby KM, Cole T, Matthews JN, Goodship JA. Centiles for adult head circumference. Arch Dis Child
1992; 67:1286.
10. Natale V, Rajagopalan A. Worldwide variation in human growth and the World Health Organization
growth standards: a systematic review. BMJ Open 2014; 4:e003735.
11. Wright CM, Williams AF, Elliman D, et al. Using the new UK-WHO growth charts. BMJ 2010;
340:c1140.
12. Niven DJ, Gaudet JE, Laupland KB, et al. Accuracy of peripheral thermometers for estimating
temperature: a systematic review and meta-analysis. Ann Intern Med 2015; 163:768.
13. Anagnostakis D, Matsaniotis N, Grafakos S, Sarafidou E. Rectal-axillary temperature difference in

febrile and afebrile infants and children. Clin Pediatr (Phila) 1993; 32:268.
14. Bates B. A Guide to Physical Examination and History Taking, 6th ed, Lippincott, Philadelphia 1995.
15. Rowe PC. Pediatric procedures. In: Principles and Practice of Pediatrics, Oski FA, DeAngelis CD, Feig
in RD, Warshaw JB (Eds), Lippincott, Philadelphia 1990. p.2010.
16. Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA
1998; 279:308.
17. Simoes EA, Roark R, Berman S, et al. Respiratory rate: measurement of variability over time and
accuracy at different counting periods. Arch Dis Child 1991; 66:1199.
18. Gadomski AM, Khallaf N, el Ansary S, Black RE. Assessment of respiratory rate and chest indrawing
in children with ARI by primary care physicians in Egypt. Bull World Health Organ 1993; 71:523.
19. Berman S, Simoes EA, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child 1991;
66:81.
20. Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children
from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377:1011.
21. Gadomski AM, Permutt T, Stanton B. Correcting respiratory rate for the presence of fever. J Clin
Epidemiol 1994; 47:1043.
22. Nijman RG, Thompson M, van Veen M, et al. Derivation and validation of age and temperature
specific reference values and centile charts to predict lower respiratory tract infection in children with
fever: prospective observational study. BMJ 2012; 345:e4224.
23. Kilonback A. Assessing respiratory rate for children with fever. BMJ 2012; 345:e4249.
24. Veith I (translator). The Yellow Emperor's Classic of Internal Medicine, University of California Press, B
erkeley, CA 2002.
25. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a
working group report from the National High Blood Pressure Education Program. National High Blood
Pressure Education Program Working Group on Hypertension Control in Children and Adolescents.
Pediatrics 1996; 98:649.
Topic 2865 Version 25.0
GRAPHICS
Weight-for-age percentiles, boys 0 to 24 months, WHO growth

standards
WHO: World Health Organization.
Reproduced from: Centers for Disease Control and Prevention based on data from the WHO Child Growth
Standards.
Graphic 50006 Version 3.0
Weight-for-age percentiles, boys, 2 to 20 years, CDC growth charts:

United States
CDC: Centers for Disease Control and Prevention.
From: National Health Center for Health Statistics in collaboration with the National Center for Chronic
Disease Prevention and Health Promotion (2000).
Weight-for-age percentiles, girls 0 to 24 months, WHO growth

standards
Standards.
Weight-for-age percentiles, girls, 2 to 20 years, CDC growth charts:

United States
From: National Health Center for Health Statistics in collaboration with the National Center for
Chronic Disease Prevention and Health Promotion (2000).
Length-for-age percentiles, boys 0 to 24 months, WHO growth

standards
Standards.
Length-for-age percentiles, girls 0 to 24 months, WHO growth

standards
Standards.
Height measurement technique
The child's shoes and any hats or hair ornaments are removed. The child faces
away from the wall with the heels together and the back as straight as possible.
The head, shoulders, buttocks, and heels should be in contact with the vertical
surface. With the child looking straight ahead, the head projection is placed at
the crown of the head. The child steps away from the wall, and the height
measurement is recorded to the nearest 0.1 cm.
Stature-for-age percentiles, boys, 2 to 20 years, CDC growth charts:

United States
From National Health Center for Health Statistics in collaboration with the National Center for Chronic
Stature-for-age percentiles, girls, 2 to 20 years, CDC growth charts:

United States
From National Health Center for Health Statistics in collaboration with the National Center for Chronic
Measurement of head circumference
Measuring head circumference. The measuring tape passes just above the
eyebrows and around the prominent posterior aspect of the head.
Reproduced with permission from: Keith Cotton. Copyright ©2008 Wolters Kluwer
Health.
Head circumference-for-age percentiles, boys birth to 36 months,

CDC growth charts
Head circumference-for-
age percentiles, girls birth to 36 months, CDC growth charts
Reproduced from: US Centers for Disease Control and Prevention. Growth Charts. Available at:
https://www.cdc.gov/growthcharts/ (Accessed on April 8, 2020).
Head circumference-for-age percentiles, boys 0 to 24 months, WHO

growth standards
Standards.
Head circumference-for-age percentiles, girls 0 to 24 months, WHO

growth standards
Standards.
Pediatric respiratory rate and heart rate lower limit, normal range, and upper limit by
age*
Respiratory rate (breaths/minute) Heart rate (beats/minute)
Age Lower limit Normal range Upper limit Lower limit Normal range Upper limit
(1 st (10 th to 90 th (99 th (1 st (10 th to 90 th (99 th
percentile) percentile) percentile) percentile) percentile) percentile)
0 to 3 months 25 34 to 57 66 107 123 to 164 181
3 to <6 months 24 33 to 55 64 104 120 to 159 175
6 to <9 months 23 31 to 52 61 98 114 to 152 168
9 to <12 22 30 to 50 58 93 109 to 145 161

months
12 to <18 21 28 to 46 53 88 103 to 140 156

months
18 to <24 19 25 to 40 46 82 98 to 135 149

months
2 to <3 years 18 22 to 34 38 76 92 to 128 142
3 to <4 years 17 21 to 29 33 70 86 to 123 136
4 to <6 years 17 20 to 27 29 65 81 to 117 131
6 to <8 years 16 18 to 24 27 59 74 to 111 123
8 to <12 years 14 16 to 22 25 52 67 to 103 115
12 to <15 years 12 15 to 21 23 47 62 to 96 108
15 to 18 years 11 13 to 19 22 43 58 to 92 104
* The respiratory and heart rates provided are based upon measurements in awake, healthy infants and children at rest. Many clinical
findings besides the actual vital sign measurement must be taken into account when determining whether a specific vital sign is
normal in an individual patient. Values for heart rate or respiratory rate that fall within normal limits for age may still represent
abnormal findings that are caused by underlying disease in a particular infant or child.
Data from: Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18
years of age: A systematic review of observational studies. Lancet 2011; 377:1011.
Blood pressure levels for boys by age and height percentile
Systolic BP (mmHg) Diastolic BP (mmHg)

BP
Height percentile or measured height Height percentile or measured height
(percentile)
5% 10% 25% 50% 75% 90% 95% 5% 10% 25% 50% 75% 90% 95%
1 year
Height (in) 30.4 30.8 31.6 32.4 33.3 34.1 34.6 30.4 30.8 31.6 32.4 33.3 34.1 34.6
Height (cm) 77.2 78.3 80.2 82.4 84.6 86.7 87.9 77.2 78.3 80.2 82.4 84.6 86.7 87.9
50 th 85 85 86 86 87 88 88 40 40 40 41 41 42 42
90 th 98 99 99 100 100 101 101 52 52 53 53 54 54 54
95 th 102 102 103 103 104 105 105 54 54 55 55 56 57 57
95 th + 12 114 114 115 115 116 117 117 66 66 67 67 68 69 69

mmHg
2 years
Height (in) 33.9 34.4 35.3 36.3 37.3 38.2 38.8 33.9 34.4 35.3 36.3 37.3 38.2 38.8
Height (cm) 86.1 87.4 89.6 92.1 94.7 97.1 98.5 86.1 87.4 89.6 92.1 94.7 97.1 98.5
50 th 87 87 88 89 89 90 91 43 43 44 44 45 46 46
90 th 100 100 101 102 103 103 104 55 55 56 56 57 58 58
95 th 104 105 105 106 107 107 108 57 58 58 59 60 61 61
95 th + 12 116 117 117 118 119 119 120 69 70 70 71 72 73 73

mmHg
3 years
Height (in) 36.4 37.0 37.9 39.0 40.1 41.1 41.7 36.4 37.0 37.9 39.0 40.1 41.1 41.7
Height (cm) 92.5 93.9 96.3 99.0 101.8 104.3 105.8 92.5 93.9 96.3 99.0 101.8 104.3 105.8
50 th 88 89 89 90 91 92 92 45 46 46 47 48 49 49
90 th 101 102 102 103 104 105 105 58 58 59 59 60 61 61
95 th 106 106 107 107 108 109 109 60 61 61 62 63 64 64
95 th + 12 118 118 119 119 120 121 121 72 73 73 74 75 76 76

mmHg
4 years
Height (in) 38.8 39.4 40.5 41.7 42.9 43.9 44.5 38.8 39.4 40.5 41.7 42.9 43.9 44.5
Height (cm) 98.5 100.2 102.9 105.9 108.9 111.5 113.2 98.5 100.2 102.9 105.9 108.9 111.5 113.2
50 th 90 90 91 92 93 94 94 48 49 49 50 51 52 52
90 th 102 103 104 105 105 106 107 60 61 62 62 63 64 64
95 th 107 107 108 108 109 110 110 63 64 65 66 67 67 68
95 th + 12 119 119 120 120 121 122 122 75 76 77 78 79 79 80

mmHg
5 years
Height (in) 41.1 41.8 43.0 44.3 45.5 46.7 47.4 41.1 41.8 43.0 44.3 45.5 46.7 47.4
Height (cm) 104.4 106.2 109.1 112.4 115.7 118.6 120.3 104.4 106.2 109.1 112.4 115.7 118.6 120.3
50 th 91 92 93 94 95 96 96 51 51 52 53 54 55 55
90 th 103 104 105 106 107 108 108 63 64 65 65 66 67 67
95 th 107 108 109 109 110 111 112 66 67 68 69 70 70 71
95 th + 12 119 120 121 121 122 123 124 78 79 80 81 82 82 83

mmHg
6 years
Height (in) 43.4 44.2 45.4 46.8 48.2 49.4 50.2 43.4 44.2 45.4 46.8 48.2 49.4 50.2
Height (cm) 110.3 112.2 115.3 118.9 122.4 125.6 127.5 110.3 112.2 115.3 118.9 122.4 125.6 127.5
50 th 93 93 94 95 96 97 98 54 54 55 56 57 57 58
90 th 105 105 106 107 109 110 110 66 66 67 68 68 69 69
95 th 108 109 110 111 112 113 114 69 70 70 71 72 72 73
95 th + 12 120 121 122 123 124 125 126 81 82 82 83 84 84 85

mmHg
7 years
Height (in) 45.7 46.5 47.8 49.3 50.8 52.1 52.9 45.7 46.5 47.8 49.3 50.8 52.1 52.9
Height (cm) 116.1 118.0 121.4 125.1 128.9 132.4 134.5 116.1 118.0 121.4 125.1 128.9 132.4 134.5
50 th 94 94 95 97 98 98 99 56 56 57 58 58 59 59
90 th 106 107 108 109 110 111 111 68 68 69 70 70 71 71
95 th 110 110 111 112 114 115 116 71 71 72 73 73 74 74
95 th + 12 122 122 123 124 126 127 128 83 83 84 85 85 86 86

mmHg
8 years
Height (in) 47.8 48.6 50.0 51.6 53.2 54.6 55.5 47.8 48.6 50.0 51.6 53.2 54.6 55.5
Height (cm) 121.4 123.5 127.0 131.0 135.1 138.8 141.0 121.4 123.5 127.0 131.0 135.1 138.8 141.0
50 th 95 96 97 98 99 99 100 57 57 58 59 59 60 60
90 th 107 108 109 110 111 112 112 69 70 70 71 72 72 73
95 th 111 112 112 114 115 116 117 72 73 73 74 75 75 75
95 th + 12 123 124 124 126 127 128 129 84 85 85 86 87 87 87

mmHg
9 years
Height (in) 49.6 50.5 52.0 53.7 55.4 56.9 57.9 49.6 50.5 52.0 53.7 55.4 56.9 57.9
Height (cm) 126.0 128.3 132.1 136.3 140.7 144.7 147.1 126.0 128.3 132.1 136.3 140.7 144.7 147.1
50 th 96 97 98 99 100 101 101 57 58 59 60 61 62 62
90 th 107 108 109 110 112 113 114 70 71 72 73 74 74 74
95 th 112 112 113 115 116 118 119 74 74 75 76 76 77 77
95 th + 12 124 124 125 127 128 130 131 86 86 87 88 88 89 89

mmHg
10 years
Height (in) 51.3 52.2 53.8 55.6 57.4 59.1 60.1 51.3 52.2 53.8 55.6 57.4 59.1 60.1
Height (cm) 130.2 132.7 136.7 141.3 145.9 150.1 152.7 130.2 132.7 136.7 141.3 145.9 150.1 152.7
50 th 97 98 99 100 101 102 103 59 60 61 62 63 63 64
90 th 108 109 111 112 113 115 116 72 73 74 74 75 75 76
95 th 112 113 114 116 118 120 121 76 76 77 77 78 78 78
95 th + 12 124 125 126 128 130 132 133 88 88 89 89 90 90 90

mmHg
11 years
Height (in) 53.0 54.0 55.7 57.6 59.6 61.3 62.4 53.0 54.0 55.7 57.6 59.6 61.3 62.4
Height (cm) 134.7 137.3 141.5 146.4 151.3 155.8 158.6 134.7 137.3 141.5 146.4 151.3 155.8 158.6
50 th 99 99 101 102 103 104 106 61 61 62 63 63 63 63
90 th 110 111 112 114 116 117 118 74 74 75 75 75 76 76
95 th 114 114 116 118 120 123 124 77 78 78 78 78 78 78
95 th + 12 126 126 128 130 132 135 136 89 90 90 90 90 90 90
mmHg
12 years
Height (in) 55.2 56.3 58.1 60.1 62.2 64.0 65.2 55.2 56.3 58.1 60.1 62.2 64.0 65.2
Height (cm) 140.3 143.0 147.5 152.7 157.9 162.6 165.5 140.3 143.0 147.5 152.7 157.9 162.6 165.5
50 th 101 101 102 104 106 108 109 61 62 62 62 62 63 63
90 th 113 114 115 117 119 121 122 75 75 75 75 75 76 76
95 th 116 117 118 121 124 126 128 78 78 78 78 78 79 79
95 th + 12 128 129 130 133 136 138 140 90 90 90 90 90 91 91

mmHg
13 years
Height (in) 57.9 59.1 61.0 63.1 65.2 67.1 68.3 57.9 59.1 61.0 63.1 65.2 67.1 68.3
Height (cm) 147.0 150.0 154.9 160.3 165.7 170.5 173.4 147.0 150.0 154.9 160.3 165.7 170.5 173.4
50 th 103 104 105 108 110 111 112 61 60 61 62 63 64 65
90 th 115 116 118 121 124 126 126 74 74 74 75 76 77 77
95 th 119 120 122 125 128 130 131 78 78 78 78 80 81 81
95 th + 12 131 132 134 137 140 142 143 90 90 90 90 92 93 93

mmHg
14 years
Height (in) 60.6 61.8 63.8 65.9 68.0 69.8 70.9 60.6 61.8 63.8 65.9 68.0 69.8 70.9
Height (cm) 153.8 156.9 162.0 167.5 172.7 177.4 180.1 153.8 156.9 162.0 167.5 172.7 177.4 180.1
50 th 105 106 109 111 112 113 113 60 60 62 64 65 66 67
90 th 119 120 123 126 127 128 129 74 74 75 77 78 79 80
95 th 123 125 127 130 132 133 134 77 78 79 81 82 83 84
95 th + 12 135 137 139 142 144 145 146 89 90 91 93 94 95 96

mmHg
15 years
Height (in) 62.6 63.8 65.7 67.8 69.8 71.5 72.5 62.6 63.8 65.7 67.8 69.8 71.5 72.5
Height (cm) 159.0 162.0 166.9 172.2 177.2 181.6 184.2 159.0 162.0 166.9 172.2 177.2 181.6 184.2
50 th 108 110 112 113 114 114 114 61 62 64 65 66 67 68
90 th 123 124 126 128 129 130 130 75 76 78 79 80 81 81
95 th 127 129 131 132 134 135 135 78 79 81 83 84 85 85
95 th + 12 139 141 143 144 146 147 147 90 91 93 95 96 97 97

mmHg
16 years
Height (in) 63.8 64.9 66.8 68.8 70.7 72.4 73.4 63.8 64.9 66.8 68.8 70.7 72.4 73.4
Height (cm) 162.1 165.0 169.6 174.6 179.5 183.8 186.4 162.1 165.0 169.6 174.6 179.5 183.8 186.4
50 th 111 112 114 115 115 116 116 63 64 66 67 68 69 69
90 th 126 127 128 129 131 131 132 77 78 79 80 81 82 82
95 th 130 131 133 134 135 136 137 80 81 83 84 85 86 86
95 th + 12 142 143 145 146 147 148 149 92 93 95 96 97 98 98

mmHg
17 years
Height (in) 64.5 65.5 67.3 69.2 71.1 72.8 73.8 64.5 65.5 67.3 69.2 71.1 72.8 73.8
Height (cm) 163.8 166.5 170.9 175.8 180.7 184.9 187.5 163.8 166.5 170.9 175.8 180.7 184.9 187.5
50 th 114 115 116 117 117 118 118 65 66 67 68 69 70 70
90 th 128 129 130 131 132 133 134 78 79 80 81 82 82 83
h
th
95 132 133 134 135 137 138 138 81 82 84 85 86 86 87
95 th + 12 144 145 146 147 149 150 150 93 94 96 97 98 98 99

mmHg
The 50 th, 90 th, and 95 th percentiles were derived by using quantile regression on the basis of normal-weight children (BMI
<85 th percentile). BP stages are defined as elevated BP ≥90 th percentile but <95 th percentile; stage 1 HTN: ≥95 th percentile
or 130/80 to 139/89 mmHg; and stage 2 HTN: ≥95 th percentile + 12 mmHg or >140/90 mmHg.
BP: blood pressure; BMI: body mass index; HTN: hypertension.
Reproduced with permission from: Pediatrics, Vol. 140, doi: 10.1542/peds.2017-1904. Copyright © 2017 by the AAP.
Blood pressure levels for girls by age and height percentile
Systolic BP (mmHg) Diastolic BP (mmHg)

BP
Height percentile or measured height Height percentile or measured height
(percentile)
5% 10% 25% 50% 75% 90% 95% 5% 10% 25% 50% 75% 90% 95%
1 year
Height (in) 29.7 30.2 30.9 31.8 32.7 33.4 33.9 29.7 30.2 30.9 31.8 32.7 33.4 33.9
Height (cm) 75.4 76.6 78.6 80.8 83.0 84.9 86.1 75.4 76.6 78.6 80.8 83.0 84.9 86.1
50 th 84 85 86 86 87 88 88 41 42 42 43 44 45 46
90 th 98 99 99 100 101 102 102 54 55 56 56 57 58 58
95 th 101 102 102 103 104 105 105 59 59 60 60 61 62 62
95 th + 12 113 114 114 115 116 117 117 71 71 72 72 73 74 74

mmHg
2 years
Height (in) 33.4 34.0 34.9 35.9 36.9 37.8 38.4 33.4 34.0 34.9 35.9 36.9 37.8 38.4
Height (cm) 84.9 86.3 88.6 91.1 93.7 96.0 97.4 84.9 86.3 88.6 91.1 93.7 96.0 97.4
50 th 87 87 88 89 90 91 91 45 46 47 48 49 50 51
90 th 101 101 102 103 104 105 106 58 58 59 60 61 62 62
95 th 104 105 106 106 107 108 109 62 63 63 64 65 66 66
95 th + 12 116 117 118 118 119 120 121 74 75 75 76 77 78 78

mmHg
3 years
Height (in) 35.8 36.4 37.3 38.4 39.6 40.6 41.2 35.8 36.4 37.3 38.4 39.6 40.6 41.2
Height (cm) 91.0 92.4 94.9 97.6 100.5 103.1 104.6 91.0 92.4 94.9 97.6 100.5 103.1 104.6
50 th 88 89 89 90 91 92 93 48 48 49 50 51 53 53
90 th 102 103 104 104 105 106 107 60 61 61 62 63 64 65
95 th 106 106 107 108 109 110 110 64 65 65 66 67 68 69
95 th + 12 118 118 119 120 121 122 122 76 77 77 78 79 80 81

mmHg
4 years
Height (in) 38.3 38.9 39.9 41.1 42.4 43.5 44.2 38.3 38.9 39.9 41.1 42.4 43.5 44.2
Height (cm) 97.2 98.8 101.4 104.5 107.6 110.5 112.2 97.2 98.8 101.4 104.5 107.6 110.5 112.2
50 th 89 90 91 92 93 94 94 50 51 51 53 54 55 55
90 th 103 104 105 106 107 108 108 62 63 64 65 66 67 67
95 th 107 108 109 109 110 111 112 66 67 68 69 70 70 71
95 th + 12 119 120 121 121 122 123 124 78 79 80 81 82 82 83

mmHg
5 years
Height (in) 40.8 41.5 42.6 43.9 45.2 46.5 47.3 40.8 41.5 42.6 43.9 45.2 46.5 47.3
Height (cm) 103.6 105.3 108.2 111.5 114.9 118.1 120.0 103.6 105.3 108.2 111.5 114.9 118.1 120.0
50 th 90 91 92 93 94 95 96 52 52 53 55 56 57 57
90 th 104 105 106 107 108 109 110 64 65 66 67 68 69 70
95 th 108 109 109 110 111 112 113 68 69 70 71 72 73 73
95 th + 12 120 121 121 122 123 124 125 80 81 82 83 84 85 85

mmHg
6 years
Height (in) 43.3 44.0 45.2 46.6 48.1 49.4 50.3 43.3 44.0 45.2 46.6 48.1 49.4 50.3
Height (cm) 110.0 111.8 114.9 118.4 122.1 125.6 127.7 110.0 111.8 114.9 118.4 122.1 125.6 127.7
50 th 92 92 93 94 96 97 97 54 54 55 56 57 58 59
90 th 105 106 107 108 109 110 111 67 67 68 69 70 71 71
95 th 109 109 110 111 112 113 114 70 71 72 72 73 74 74
95 th + 12 121 121 122 123 124 125 126 82 83 84 84 85 86 86

mmHg
7 years
Height (in) 45.6 46.4 47.7 49.2 50.7 52.1 53.0 45.6 46.4 47.7 49.2 50.7 52.1 53.0
Height (cm) 115.9 117.8 121.1 124.9 128.8 132.5 134.7 115.9 117.8 121.1 124.9 128.8 132.5 134.7
50 th 92 93 94 95 97 98 99 55 55 56 57 58 59 60
90 th 106 106 107 109 110 111 112 68 68 69 70 71 72 72
95 th 109 110 111 112 113 114 115 72 72 73 73 74 74 75
95 th + 12 121 122 123 124 125 126 127 84 84 85 85 86 86 87

mmHg
8 years
Height (in) 47.6 48.4 49.8 51.4 53.0 54.5 55.5 47.6 48.4 49.8 51.4 53.0 54.5 55.5
Height (cm) 121.0 123.0 126.5 130.6 134.7 138.5 140.9 121.0 123.0 126.5 130.6 134.7 138.5 140.9
50 th 93 94 95 97 98 99 100 56 56 57 59 60 61 61
90 th 107 107 108 110 111 112 113 69 70 71 72 72 73 73
95 th 110 111 112 113 115 116 117 72 73 74 74 75 75 75
95 th + 12 122 123 124 125 127 128 129 84 85 86 86 87 87 87

mmHg
9 years
Height (in) 49.3 50.2 51.7 53.4 55.1 56.7 57.7 49.3 50.2 51.7 53.4 55.1 56.7 57.7
Height (cm) 125.3 127.6 131.3 135.6 140.1 144.1 146.6 125.3 127.6 131.3 135.6 140.1 144.1 146.6
50 th 95 95 97 98 99 100 101 57 58 59 60 60 61 61
90 th 108 108 109 111 112 113 114 71 71 72 73 73 73 73
95 th 112 112 113 114 116 117 118 74 74 75 75 75 75 75
95 th + 12 124 124 125 126 128 129 130 86 86 87 87 87 87 87

mmHg
10 years
Height (in) 51.1 52.0 53.7 55.5 57.4 59.1 60.2 51.1 52.0 53.7 55.5 57.4 59.1 60.2
Height (cm) 129.7 132.2 136.3 141.0 145.8 150.2 152.8 129.7 132.2 136.3 141.0 145.8 150.2 152.8
50 th 96 97 98 99 101 102 103 58 59 59 60 61 61 62
90 th 109 110 111 112 113 115 116 72 73 73 73 73 73 73
95 th 113 114 114 116 117 119 120 75 75 76 76 76 76 76
95 th + 12 125 126 126 128 129 131 132 87 87 88 88 88 88 88

mmHg
11 years
Height (in) 53.4 54.5 56.2 58.2 60.2 61.9 63.0 53.4 54.5 56.2 58.2 60.2 61.9 63.0
Height (cm) 135.6 138.3 142.8 147.8 152.8 157.3 160.0 135.6 138.3 142.8 147.8 152.8 157.3 160.0
50 th 98 99 101 102 104 105 106 60 60 60 61 62 63 64
90 th 111 112 113 114 116 118 120 74 74 74 74 74 75 75
95 th 115 116 117 118 120 123 124 76 77 77 77 77 77 77
95 th + 12 127 128 129 130 132 135 136 88 89 89 89 89 89 89
mmHg
12 years
Height (in) 56.2 57.3 59.0 60.9 62.8 64.5 65.5 56.2 57.3 59.0 60.9 62.8 64.5 65.5
Height (cm) 142.8 145.5 149.9 154.8 159.6 163.8 166.4 142.8 145.5 149.9 154.8 159.6 163.8 166.4
50 th 102 102 104 105 107 108 108 61 61 61 62 64 65 65
90 th 114 115 116 118 120 122 122 75 75 75 75 76 76 76
95 th 118 119 120 122 124 125 126 78 78 78 78 79 79 79
95 th + 12 130 131 132 134 136 137 138 90 90 90 90 91 91 91

mmHg
13 years
Height (in) 58.3 59.3 60.9 62.7 64.5 66.1 67.0 58.3 59.3 60.9 62.7 64.5 66.1 67.0
Height (cm) 148.1 150.6 154.7 159.2 163.7 167.8 170.2 148.1 150.6 154.7 159.2 163.7 167.8 170.2
50 th 104 105 106 107 108 108 109 62 62 63 64 65 65 66
90 th 116 117 119 121 122 123 123 75 75 75 76 76 76 76
95 th 121 122 123 124 126 126 127 79 79 79 79 80 80 81
95 th + 12 133 134 135 136 138 138 139 91 91 91 91 92 92 93

mmHg
14 years
Height (in) 59.3 60.2 61.8 63.5 65.2 66.8 67.7 59.3 60.2 61.8 63.5 65.2 66.8 67.7
Height (cm) 150.6 153.0 156.9 161.3 165.7 169.7 172.1 150.6 153.0 156.9 161.3 165.7 169.7 172.1
50 th 105 106 107 108 109 109 109 63 63 64 65 66 66 66
90 th 118 118 120 122 123 123 123 76 76 76 76 77 77 77
95 th 123 123 124 125 126 127 127 80 80 80 80 81 81 82
95 th + 12 135 135 136 137 138 139 139 92 92 92 92 93 93 94

mmHg
15 years
Height (in) 59.7 60.6 62.2 63.9 65.6 67.2 68.1 59.7 60.6 62.2 63.9 65.6 67.2 68.1
Height (cm) 151.7 154.0 157.9 162.3 166.7 170.6 173.0 151.7 154.0 157.9 162.3 166.7 170.6 173.0
50 th 105 106 107 108 109 109 109 64 64 64 65 66 67 67
90 th 118 119 121 122 123 123 124 76 76 76 77 77 78 78
95 th 124 124 125 126 127 127 128 80 80 80 81 82 82 82
95 th + 12 136 136 137 138 139 139 140 92 92 92 93 94 94 94

mmHg
16 years
Height (in) 59.9 60.8 62.4 64.1 65.8 67.3 68.3 59.9 60.8 62.4 64.1 65.8 67.3 68.3
Height (cm) 152.1 154.5 158.4 162.8 167.1 171.1 173.4 152.1 154.5 158.4 162.8 167.1 171.1 173.4
50 th 106 107 108 109 109 110 110 64 64 65 66 66 67 67
90 th 119 120 122 123 124 124 124 76 76 76 77 78 78 78
95 th 124 125 125 127 127 128 128 80 80 80 81 82 82 82
95 th + 12 136 137 137 139 139 140 140 92 92 92 93 94 94 94

mmHg
17 years
Height (in) 60.0 60.9 62.5 64.2 65.9 67.4 68.4 60.0 60.9 62.5 64.2 65.9 67.4 68.4
Height (cm) 154.4 154.7 158.7 163.0 167.4 171.3 173.7 154.4 154.7 158.7 163.0 167.4 171.3 173.7
50 th 107 108 109 110 110 110 111 64 64 65 66 66 66 67
90 th 120 121 123 124 124 125 125 76 76 77 77 78 78 78
h
th
95 125 125 126 127 128 128 128 80 80 80 81 82 82 82
95 th + 12 137 137 138 139 140 140 140 92 92 92 93 94 94 94

mmHg
The 50 th, 90 th, and 95 th percentiles were derived by using quantile regression on the basis of normal-weight children (BMI
<85 th percentile). BP stages are defined as elevated BP ≥90 th percentile but <95 th percentile; stage 1 HTN: ≥95 th percentile
or 130/80 to 139/89 mmHg; and stage 2 HTN: ≥95 th percentile + 12 mmHg or >140/90 mmHg.
BP: blood pressure; BMI: body mass index; HTN: hypertension.
Reproduced with permission from: Pediatrics, Vol. 140, doi: 10.1542/peds.2017-1904. Copyright © 2017 by the AAP.
Contributor Disclosures
Jan E Drutz, MD Nothing to disclose Teresa K Duryea, MD Nothing to disclose Mary M Torchia,
MD Grant/Research/Clinical Trial Support: Pfizer [Group B Streptococcus].
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed
by vetting through a multi-level review process, and through requirements for references to be provided to support the
content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of
evidence.
Conflict of interest policy

The Pediatric Physical Examination - General Principles and Standard Measurements - UpToDate

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Pediatric Physical Examination - General Principles and Standard Measurements - UpToDate

Uploaded by

Copyright:

Available Formats

6/26/2020 The pediatric physical examination: General principles and standard measurements - UpToDate

Official reprint from UpToDate®

The pediatric physical examination: General principles and

● Measuring technique – Measurement should be attempted at the conclusion of the physical

● Reference standards – OFC should be plotted on a standardized head circumference chart. A

Reference Study of breastfed children living under optimal environmental conditions.

● Blood pressure standards for boys (table 2)

• Weight (boys) (figure 1A-B)

Use of UpToDate is subject to the Subscription and License Agreement.

4. Rios A. Microcephaly. Pediatr Rev 1996; 17:386.

13. Anagnostakis D, Matsaniotis N, Grafakos S, Sarafidou E. Rectal-axillary temperature difference in

Topic 2865 Version 25.0

Weight-for-age percentiles, boys 0 to 24 months, WHO growth

WHO: World Health Organization.

Graphic 50006 Version 3.0

Weight-for-age percentiles, boys, 2 to 20 years, CDC growth charts:

CDC: Centers for Disease Control and Prevention.

Graphic 71721 Version 6.0

Weight-for-age percentiles, girls 0 to 24 months, WHO growth

WHO: World Health Organization.

Graphic 63877 Version 5.0

Weight-for-age percentiles, girls, 2 to 20 years, CDC growth charts:

CDC: Centers for Disease Control and Prevention.

Graphic 53325 Version 5.0

Length-for-age percentiles, boys 0 to 24 months, WHO growth

WHO: World Health Organization.

Graphic 67950 Version 5.0

Length-for-age percentiles, girls 0 to 24 months, WHO growth

WHO: World Health Organization.

Graphic 80511 Version 3.0

Height measurement technique

Graphic 56127 Version 1.0

Stature-for-age percentiles, boys, 2 to 20 years, CDC growth charts:

CDC: Centers for Disease Control and Prevention.

Graphic 63399 Version 5.0

Stature-for-age percentiles, girls, 2 to 20 years, CDC growth charts:

CDC: Centers for Disease Control and Prevention.

Graphic 77249 Version 4.0

Measurement of head circumference

Graphic 70799 Version 2.0

Head circumference-for-age percentiles, boys birth to 36 months,

Graphic 80863 Version 3.0

Graphic 59076 Version 5.0

Head circumference-for-age percentiles, boys 0 to 24 months, WHO

WHO: World Health Organization.

Graphic 58632 Version 3.0

Head circumference-for-age percentiles, girls 0 to 24 months, WHO

WHO: World Health Organization.

Graphic 74503 Version 3.0

Respiratory rate (breaths/minute) Heart rate (beats/minute)

0 to 3 months 25 34 to 57 66 107 123 to 164 181

3 to <6 months 24 33 to 55 64 104 120 to 159 175

6 to <9 months 23 31 to 52 61 98 114 to 152 168

9 to <12 22 30 to 50 58 93 109 to 145 161

12 to <18 21 28 to 46 53 88 103 to 140 156

18 to <24 19 25 to 40 46 82 98 to 135 149

2 to <3 years 18 22 to 34 38 76 92 to 128 142

3 to <4 years 17 21 to 29 33 70 86 to 123 136

4 to <6 years 17 20 to 27 29 65 81 to 117 131

6 to <8 years 16 18 to 24 27 59 74 to 111 123

8 to <12 years 14 16 to 22 25 52 67 to 103 115

12 to <15 years 12 15 to 21 23 47 62 to 96 108

Graphic 78097 Version 11.0