Academic Medical Home - Comer Pediatrics
Heart Rate and Pulse Measurement
Revised 05/17/2011
For children < 2 years old: auscultate the heart with a stethoscope.
For children ≥ 2 years old: auscultate the heart with a stethoscope, palpate the radial pulses, or use pulse oximetry if
readily available.
Count the number of beats in 15-30 seconds and multiply accordingly (if 15 seconds, multiply by 4; if 30 seconds, multiply
by 2). If the heart rhythm is irregular or you suspect an abnormality, count for a full minute.
Some important considerations:
Several factors can temporarily change a child’s heart rate and make a given measurement a poor reflection of the patient’s
baseline heart rate:
 If the patient is agitated, crying, or has been very active (e.g. ambulating or climbing on a chair), the heart rate will
temporarily increase above baseline.
 If the patient is sleeping, the heart rate will slightly decrease below baseline.
Ideally, the heart rate should be measured while the patient is resting quietly or sleeping. If the patient is agitated or crying:
 Attempt to defer the measurement to a later time, once the child has been sitting quietly for several minutes.
 If deferment is not possible, record a best estimate and document what the patient was doing at the time of the
measurement.
References
Sources not recommending any particular method of counting heart beats:
 Kleigman, RM et al. Nelson Textbook of Pediatrics, 18th ed. 2007.
 Park, MK. Pediatric Cardiology for Practitioners, 5th ed. 2008.
 Anderson, RH. Pediatric Cardiology, 2nd ed. 2002.
 Strange, G. Pediatric Emergency Medicine, 3rd Ed. 2009.
Sources supporting a six-second method of counting heart beats for physicians:
 Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP) course materials: “Key
Points for Lessons 1 Through 9 in Textbook of Neonatal Resuscitation, 5th Edition.” Neonatal Resuscitation
Program (NRP) website. Available at http://www.aap.org/nrp/apppendix/E/KeyPointsforLessons1Through9.pdf.
Accessed May 2011.
 Theophilopoulos DT et al. Accuracy of different methods for heart rate determination during simulated neonatal
resuscitations. J Perinatol 18 (1998), pp. 65–67. (in study of simulated neonatal resuscitations, NRP’s 6-scond
method resulted in fewer errors compared to when clinicians used their own method)
Sources recommending a 30-second method of counting heart beats for nurses:
 Lynn, P. Taylor’s Clinical Nursing Skills: A Nursing Process Approach, 2 nd ed. 2008. (recommends 30 seconds by
palpation, 60 seconds by auscultation)
 Jarvis C. Physical Examination and Health Assessment, 5 th ed. 2007. (recommends 30 seconds for routine, a full
minute if suspect an abnormality)
Sources recommending a 60-second method of counting heart beats for nurses:
 Hockenberry, M et al. Wong’s Nursing Care of Infants and Children, 9 th ed. 2011. (recommends 60 seconds in
infants and young children)
 Kyle, T. Essentials of Pediatric Nursing. 2008.
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