A pulse is the rhythmic expansion and contraction of an artery as the heart pumps blood through the circulatory system. Monitoring this rate offers immediate insight into a child’s heart function and overall circulation. A child’s resting heart rate is significantly faster than an adult’s and varies widely depending on age, activity level, and emotional state. Locating and measuring the pulse accurately in young patients is foundational to assessing their health status, especially during times of illness or emergency.
Locating the Pulse in Infants (Under 1 Year)
For infants younger than one year of age, the most reliable and accessible location for checking the pulse is the Brachial Artery. This artery is found on the inside of the upper arm, running between the elbow and the shoulder. The Brachial Artery is preferred because it is a large, central artery that lies close to the skin’s surface, making it easier to feel.
Locating this site involves gently extending the infant’s arm and placing two fingers in the groove between the biceps and triceps muscles on the inner side. Finding the carotid pulse is often challenging or unreliable due to the thick layer of subcutaneous fat and the anatomical structure of an infant’s neck.
If the Brachial pulse is difficult to find, the Femoral Artery serves as a secondary option. The Femoral Artery is located in the groin area, in the crease where the inner thigh joins the abdomen. While a strong pulse here indicates good circulation, it can be more difficult to access quickly, particularly if the infant is dressed.
Locating the Pulse in Small Children (1 Year and Older)
As a child grows past the age of one, the preferred locations for pulse checks shift toward those used in adults, primarily the Carotid Artery. The Carotid Artery is located on the side of the neck, running alongside the trachea. A pulse check at this site is effective because it is a large artery directly supplying the brain, making it a good indicator of central circulation.
When checking the Carotid pulse, apply only light pressure, and never press on both sides of the neck at the same time. Pressing both carotid arteries simultaneously can restrict blood flow to the brain, potentially causing a drop in heart rate or fainting. The Femoral Artery in the groin remains a reliable alternative, particularly in emergency scenarios where the child is unresponsive.
For routine, non-emergency monitoring in older toddlers and small children who are conscious and cooperative, the Radial Artery may also be used. The Radial pulse is felt on the thumb-side of the inner wrist, just below the base of the hand. While this is the most common site for adults, it can be harder to palpate in younger children due to their smaller wrists and increased movement.
Proper Technique for Accurate Measurement
The technique for palpating and counting the pulse remains consistent across all age groups, regardless of the location chosen. Use the tips of the index and middle fingers to feel for the pulsation, never the thumb, which has its own strong pulse that can lead to an inaccurate count. The pads of these fingers should be placed gently over the artery.
The amount of pressure applied must be light enough to avoid collapsing the artery but firm enough to detect the underlying beat. Too much pressure will cause the pulse to disappear, while too little pressure may make it undetectable. Once the pulse is located, a full and accurate measurement is best achieved by counting the number of beats for a complete 60 seconds.
If time constraints prevent a full minute count, a practical alternative is to count the beats for 30 seconds and then multiply that number by two. Counting for only 15 seconds and multiplying by four is a faster option, though it introduces a greater chance of error, especially if the heart rhythm is irregular.
Interpreting Pulse Rate and When to Seek Help
The number of beats counted per minute provides the heart rate, which must be interpreted within the context of the child’s age and state of rest. Normal resting heart rates for children are much higher than those for adults and decrease progressively as they grow older. These rates speed up significantly with activity, fever, or excitement, and slow down during sleep.
Normal Resting Heart Rates
For a newborn (birth to 1 month), a typical resting rate ranges from 100 to 160 beats per minute, though it can be higher when the baby is upset or crying. Infants (one month to one year) generally have a resting rate between 80 and 140 beats per minute. Toddlers (one to three years old) commonly fall into a range of 80 to 130 beats per minute.
Medical attention is warranted if the pulse rate is persistently outside these expected ranges or if the rhythm appears irregular. In emergency situations, a heart rate less than 60 beats per minute is a critical finding in a child who is unresponsive. This slow rate, especially when accompanied by signs of poor circulation such as pale or blue skin, indicates the need to immediately call emergency services and begin cardiopulmonary resuscitation (CPR) if trained.