The best place to check a pulse on an infant is the inside of the upper arm, over the brachial artery. This spot sits roughly halfway between the shoulder and the elbow, on the inner side of the arm. Unlike older children and adults, infants have short, chubby necks that make the neck pulse extremely difficult to find, so the upper arm is the standard location recommended for babies under one year old.
Why the Upper Arm, Not the Neck
For adults and older children, the side of the neck (carotid artery) is the go-to pulse point. In infants, that site is unreliable. A study examining caregivers’ ability to detect a pulse in sleeping infants found that only 23% could find a carotid pulse, compared to 86% who successfully felt a pulse at the brachial artery on the upper arm. The difference is dramatic, and it’s the reason every major resuscitation guideline specifies the brachial artery for babies one year and younger.
Beyond being hard to locate, pressing on an infant’s neck can inadvertently compress the airway or stimulate nerve reflexes that slow the heart rate. The upper arm carries none of those risks.
How to Find and Feel the Brachial Pulse
Lay your baby on their back. Gently bend one of their arms so the hand is up near the ear, which opens the inner arm and makes the artery easier to reach. Place your index and middle fingers on the soft inside of the upper arm, in the groove between the bicep and the bone. You’re aiming for the space roughly midway between the shoulder and the elbow crease.
Press gently until you feel a rhythmic beat. You don’t need much pressure. Pushing too hard can actually compress the artery flat and make the pulse disappear. Never use your thumb to check a pulse, because the thumb has its own pulse that can fool you into counting your own heartbeat instead of your baby’s.
If you’re having trouble, try shifting your fingers slightly toward the elbow or shoulder. The artery runs along the length of the inner arm, so small adjustments usually help. Keeping your baby calm and still makes the pulse much easier to detect.
Checking With a Stethoscope
If you have a stethoscope at home, you can listen to the heartbeat directly through the chest wall. In babies from birth to about age three, the strongest heartbeat sound (called the apical pulse) is located in the fourth intercostal space, which is the gap between the fourth and fifth ribs on the left side of the chest. Place the stethoscope just to the left of the breastbone at that level, slightly below and to the left of the nipple line.
Listening with a stethoscope is more precise than feeling a pulse by hand, especially when a baby’s heart rate is very fast and individual beats are hard to distinguish by touch alone.
Normal Heart Rate for Infants
Infant heart rates are significantly faster than adult heart rates. A large systematic review of observational studies found that the median heart rate at birth is about 127 beats per minute. It climbs to roughly 145 beats per minute around one month of age, then gradually decreases to about 113 beats per minute by age two.
To count, watch a clock and count the beats you feel for 30 seconds, then multiply by two. If your baby is crying, feeding, or squirming, the rate will be higher. Try to check when your baby is calm or sleeping to get a resting rate. A resting heart rate anywhere between about 100 and 160 beats per minute is typical for most infants in the first year, though the range narrows as they get older.
The Femoral Pulse as a Backup
Healthcare providers sometimes check the femoral pulse, located in the crease of the groin where the leg meets the torso. The femoral artery runs just below the skin crease at the groin. This site is used less often by parents because it requires removing clothing and can be harder to locate without training, but it’s a reliable backup if the brachial pulse is difficult to feel. In clinical settings, a weak or absent femoral pulse can also be an important clue to certain heart conditions present from birth.
When a Pulse Is Too Slow
A heart rate below 60 beats per minute in an infant is a medical emergency. At that rate, the heart is not pumping enough blood to support the brain and organs, even though a pulse is technically present. American Heart Association guidelines instruct that CPR should be started on an infant whose heart rate drops below 60 beats per minute and who shows signs of poor blood flow, such as pale or bluish skin, limpness, or unresponsiveness. If you ever check your baby’s pulse and count fewer than 60 beats per minute, call emergency services immediately.
Quick Reference: Step by Step
- Position: Lay your baby on their back, bend one arm up toward the ear
- Locate: Find the inner arm between the shoulder and elbow
- Press: Use your index and middle fingers, never your thumb
- Pressure: Press gently until you feel the beat, then ease off slightly
- Count: Time 30 seconds and multiply by two for beats per minute
- Normal range: Roughly 100 to 160 bpm in the first year, depending on age and activity