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Parameters and Evaluations When Examining the Heart of a Child
The clinical examination of the child includes significant and very important parameters such as the average pulse at rest, blood pressure of the upper and lower extremities, the limits of relative dullness of the heart and the limits of absolute dullness of the heart.
Average resting heart rate (beats per minute)
Newborn 140-160
6 months 130-135
1 year 120-125
2 years 110
3 years 105
4 years 100
5 years 98-100
6-7 years 90-85
10 years 78-85
12 years 70-75
Practically speaking, the normal rate should not exceed 10% of the average pulse rate values listed here.
Blood pressure (mmHg) (upper extremities)
A newborn
� Systolic 70-76
� diastolic 35
For children under 12 months
� Systolic 76+(2xn); where n is the child’s age in months
� Diastolic to 1/3 systolic pressure
1 year
� Systolic 90-100
� diastolic 60
For children older than 1 year
� Systolic minimum is 90+(2xn) where n is age in years; the maximum is 100+(2xn) where n is the age in years.
� Diastolic to 1/3 systolic
Blood pressure mmHg (lower extremities)
A newborn
� Systolic 70-76
� diastolic 35
For children under 9 months
� Systolic 76+(2xn) where n is age in months
� Diastolic to 1/3 systolic
In children older than 9-10 months
� Blood pressure is 5-20 mmHg higher than the upper extremity
Limits of cardiac relative dullness
Right border
� Right parasternal line for children under 2 years of age
� Right parasternal line or somewhere above the right parasternal line for children aged 2 to 7 years
� Between the right parasternal line and the right sternal line for children aged 7 to 12 years
� Right sternal line for children older than 12 years.
upper limit
� II rib, for children up to 2 years
� II intercostal space for children aged 2 to 7 years
� III rib for children aged 7-12 years
� III intercostal space for children older than 12 years.
Left edge
� 2 cm outward from the left midclavicular line for children younger than 2 years
� 1 cm outward from the left midclavicular line for children aged 2-7 years
� 0.5 cm outward from the left midclavicular line for children aged 7-12 years
� 0.5 cm medial to the left midclavicular line for children older than 12 years
Transverse size
� 6-9 cm for children under 2 years
� 8-12 cm for children aged 2-7 years
� 9-14cm for children older than 7 years.
The limits of the heart absolute dullness
Right border
� Left chest line for children under 2 years
� Left chest line for children aged 2 to 7 years
� III intercostal space for children aged 7-12 years
� Left chest line for children over 12 years old
upper limit
� II intercostal space for children under 2 years of age
� III rib for children aged 2 to 7 years
� III intercostal space for children aged 7-12 years
� IV rib for children older than 12 years
Left edge
� 1.0-0.5 cm outward from the left midclavicular line for children younger than 2 years
� Left key line for children aged 2-7 years
� Between the left clavicular line and the left parasternal line for children aged 7-12 years
� Left parasternal line for children older than 12 years.
Can you imagine how interesting it would be to diagnose a child who can’t even complain to you?
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