Paediatric ECG Checklist PATIENT LABEL

Date _ _ _ _ _ _ _ _ _ Time _ _ _ _ _ _
● Indication for ECG _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

● ECG strip Standardisation: Speed (25mm/sec) Yes No

Voltage (10mm/mV) Yes No

● Rate _ _ _ bpm

● Rhythm sinus other (please specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _)

Sinus rhythm has: P wave preceding each QRS complex with normal PR interval; normal P wave axis of 0-90
degree; upright P wave in leads I and aVF.
Sinus arrhythmia? – Normal finding. Does not need a cardiology referral
Sinus tachycardia? – consider sepsis, shock, TFTs, medication, drugs
Sinus bradycardia? – consider raised ICP, medication

● QRS axis Normal Abnormal

Mean QRS (°) range of QRS (°)
Newborn 125
1 wk. to 1 mo. 110 30 – 180
1 mo. to 3 mo. 70 10 – 125
3 mo. to 3 yrs. 60 10 – 110
3yr 60 20 – 120
Adult 50 -30 – 105

Plot net deflection of leads I and aVF, positive or negative depending on whether the deflection is up or down,
along their leads. The angle between the two is the QRS axis, the direction of cardiac impulse.

Left axis deviation is seen in AVSD, LVH, tricuspid atresia. Right axis deviation is seen in RVH

● PR interval Short Normal Long

Measure from the start of the P wave to the start of the QRS complex. Delta wave
Normal range110 - 200msec / 5 small squares.

If short, is a delta wave present? Yes No

Short PR: Pre-excitation, with delta waves e.g. WPW and some metabolic conditions
Prolonged PR: 1st degree heart block or drug toxicity, viral or rheumatic myocarditis and other myocardial
dysfunctions, aortic root abscesses, Lyme disease and certain congenital heart diseases.

● QRS Normal Abnormal (wide)

RSR’
Measure from the start to the end of the QRS complex.
Normal: <100 msec / 2.5 small squares

Wide QRS: characteristic of ventricular conduction disturbances:

 RBBB = RSR’ pattern in right precordial lead V1. In ASD with right ventricular volume overload there is
a dominant R’; and rarely with other heart disease e.g. Ebstein’s anomaly. A qR pattern in V1 (small q
wave, tall R wave) is also highly specific for RVH.

 LBBB: is very rare in children who have not had cardiac surgery
Acknowledgment: Adapted from the Great Ormond Street and Evelina London ECG proformas (Version 3.8)
 Paediatric ECG Checklist PATIENT LABEL

● ST segment Normal Abnormal

If abnormal, please specify_ _ _ _ _ _ _ _ _ _ _ _ _ _
Measure from the end of the QRS to the start of the T wave

Pericarditis Brugada type 1

● T wave Normal (Upright in V5 and V6)

Abnormal (please specify)

● QTc (in leads II or V5) = _ _ _ _ _ _ _ milliseconds

Use the Tangent method to determine the end of the T wave
Use Bazett’s formula QTc = QT/√R-R
Manual QTc should be greater than 340 and less than 450msec

QTc is prolonged in: Long QT syndromes, head injury/concussion,

drugs (e.g. amiodarone, TCA’s, fluconazole, erythromycin, methadone
metoclopramide, haloperidol, ondansetron, SSRI’s) or rarely
myocarditis

● Voltage criteria Signs of LVH in V6? Yes No Signs of RVH in V1? Yes No
LVH (abnormal left ventricular large voltage) – Use only V6 (the left most precordial lead).
RVH (abnormal right ventricular large voltage) – Use only V1 (the right most precordial lead)
Upright T wave in V1: In first week of life is normal. Between 4 days and 4 years of age this is ABNORMAL
and suggests RVH.

0-1mo 1 mo – 12 mo 1 y – 12 y
V1 R amplitude (upper limit of normal) 25mm 20mm 18mm
V6 R amplitude (upper limit of normal) 21 mm 20 mm 24 mm

Is this ECG: Normal Abnormal

Abnormal findings: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

If abnormal or clinical concern discuss with the local consultant / registrar. Cardiology opinion can be
sought following this, with cardiology ECG opinion after local consultant review via ecg.review@olchc.ie

Action taken: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Signed _ _ _ _ _ _ _ _ _ Name & registration number_ _ _ _ _ _ _ _ _ _ _ _ Designation _ _ _ _ _ _ _ _

Attach this proforma to the patient’s ECG and keep with the medical notes.
Resources:
https://litfl.com/paediatric-ecg-interpretation-ecg-library/
https://dontforgetthebubbles.com/approaching-the-paediatric-ecg/
https://dontforgetthebubbles.com/ten-not-to-be-missed-paediatric-ecgs/
Acknowledgment: Adapted from the Great Ormond Street and Evelina London ECG proformas (Version 3.8)