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Age related reference ranges for respiration rate

and heart rate from 4 to 16 years

L A Wallis, M Healy, M B Undy, I Maconochie

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Correspondence to:

Dr L A Wallis, PO Box

901, Wellington, 7654,

South Africa; leewallis@

Accepted 30 June 2005

Published Online First

27 July 2005

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Arch Dis Child 2005;90:1117–1121. doi: 10.1136/adc.2004.068718

Background: Clinical vital signs in children (temperature, heart rate, respiration rate, and blood pressure) are

an integral part of clinical assessment of degree of illness or normality. Despite this, only blood pressure and

temperature have a reliable evidence base. The accepted ranges of heart and respiration rate vary widely.

Methods: This study examined 1109 children aged 4–16 years in their own schools. Age, sex, height,

weight, and resting respiration rate and heart rate were recorded. The data were used to produce age

related reference ranges for everyday clinical use.

Results: Reference intervals are presented for the range of heart rate and respiration rate of healthy resting

children aged 4–16 years. The recorded values are at variance with standard quoted ranges in currently

available texts.

Clinical decision making relies on the history, examination,

and results of selected investigations. As part of

the general clinical examination, four vital signs are

routinely recorded: heart rate, respiration rate, blood pressure,

and temperature.

In order to derive clinically meaningful information for the

paediatric patient, we must compare the vital signs recorded

against a normal or reference range. Normal values for

temperature are well established1 and there is good evidence

for normal values of blood pressure at various ages.2–4 With

regard to respiration rate (RR) and heart rate (HR), however,

there is little evidence on which to base our ‘‘normal’’ values.

Despite this, textbooks produce tables of reference values for

various age groups, based on small numbers of patients.

Bates’ guide to physical examination and history taking5 states that

the normal values for RR in a newborn ‘‘should be 30–60,

reducing to 20–40 in early childhood and 15–25 in older

children’’. The same book states that the normal HR for a

newborn should be 140, reducing to 115 between 6 months

and 1 year, 110 between 1 and 2 years, 103 between 2 and 6,

95 aged 6 to 10, and 85 between 10 and 14 years. Both the

Forfar and Arneill6 and Nelson7 textbooks also quote ranges of


These values produce widely differing ranges of what may

be termed normal for healthy children. In a 1 year old, for

instance, the range of RR values is from 25 to 60: a rate of 30

would be considered normal in some of these texts, while

others consider this bradypnoea and recommend intervention.

In view of the lack of evidence behind the values that are

commonly quoted, we undertook a study in Plymouth, UK, to

investigate the reference ranges of heart rate and respiration

rate in healthy, resting schoolchildren.

The aim of this study was to produce up to date reference

ranges of heart rate and respiration rate for healthy resting

children aged 4–16 years.


Plymouth was chosen as the site of the study as it is a fairly

typical medium sized town, situated at sea level in the

southwest of the UK. It has a population of 240 000 and a

fairly typical socioeconomic mix.8

Ethical approval was obtained through the South Devon

Local Regional Ethics Committee. Following sample size

calculations and estimates of likely consent rates, eight

schools in Plymouth, Devon were approached; six agreed to

take part in the study. The schools were chosen at random

from lists of primary and secondary schools supplied by the

local education board: four primary and four secondary

schools were selected. Random number generation of

subjects was undertaken by computer.

All children aged 4–16 years were asked to participate.

After explanation to the children and their parents (in the

form of a letter, and a presentation at the schools’

assemblies), parental consent was sought for each child; in

addition, children over 12 were asked to give their own

consent. Children were excluded from the study if consent

was refused or the form was not returned.

All children were seen in their school by a single

investigator (LAW), in the presence of a female nurse

chaperone. Children were brought out of their classrooms

and left to sit quietly in a warm waiting area for 10 minutes.

The children then sat quietly in a warm, well lit classroom

while their RR was measured by 60 seconds of direct

observation of the clothed chest wall (by LAW). A partially

completed breath in the 60 second time period was counted

as a whole breath.

Each child then had their HR measured for 60 seconds

using a Datex S5 Lite monitor. A finger probe was used in all

cases. Recording did not commence until a suitable trace with

a regular, pulsatile waveform was achieved continuously for

20 seconds. Data were transferred real time to a computer,

using Datex software: recordings were made at 5 second

intervals for 60 seconds. The mean of these recordings was

registered as the child’s HR.

Height and weight were recorded. Height was measured

barefoot using a Leicester height measure: weight was also

taken barefoot, with scales calibrated by the Department of

Medical Physics at Derriford Hospital, Plymouth.

Children who were unwell on the day of the study (but

were well enough to attend school) were still included in the

sample, as were children with diagnosed or undiagnosed

medical conditions. No attempt was made to identify these

children in the database.

Abbreviations: HR, heart rate; RR, respiration

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