The pulse is a measurement of the heart rate, created by the left ventricle pumping blood into the major arteries, which generates a palpable wave of pressure. Checking a child’s pulse is a fundamental skill for caregivers because the heart rate is a primary indicator of circulation and overall health. Children, especially infants, possess a smaller physiological reserve than adults, meaning their condition can change rapidly when ill or injured. Understanding how to quickly and accurately locate and interpret the pulse provides valuable information about a child’s circulatory status.
Finding the Pulse on Infants (Under Age 1)
The preferred location for checking a pulse on a child under one year old is the Brachial artery, situated on the inner side of the upper arm. This site is favored because the infant’s short neck makes the carotid artery difficult to access, and the radial artery in the wrist is too small to feel reliably. To locate the brachial pulse, gently lay the infant on their back and use your index and middle fingers to press lightly on the inside of the arm, midway between the elbow and the shoulder. Press with a gentle but firm touch; too much force can compress the artery and make the pulse impossible to detect.
A secondary location is the Femoral artery, located in the groin crease. This pulse can be found by placing two fingers halfway between the pubic bone and the hip bone, just below the crease where the leg meets the abdomen. Both the brachial and femoral arteries are major blood vessels that run close to the skin surface in infants, making them the most reliable points for palpation. In emergency situations, such as when performing Cardiopulmonary Resuscitation (CPR), the brachial pulse is the site recommended by pediatric guidelines for assessing circulation.
Finding the Pulse on Children (Age 1 and Older)
For children aged one year and older, the primary location for a routine pulse check is the Radial artery at the wrist. This artery runs along the thumb side of the inner wrist, and the pulse is located by placing the index and middle fingers just below the base of the thumb. This site is generally easier to access and less disruptive for an older, cooperative child.
The Carotid artery in the neck is the preferred site for checking a pulse in an older child during an emergency or when the child is unconscious. To find the carotid pulse, slide your index and middle fingers into the soft groove on the side of the windpipe, near the neck muscles. It is important to only check one side of the neck at a time, as simultaneously pressing both carotid arteries can potentially decrease blood flow to the brain. The larger size and more developed muscle mass in older children make these peripheral pulses more distinct than they are in an infant.
Accurate Measurement and Interpreting Rates
To determine the heart rate, the pulse must be counted accurately. Always use the pads of the index and middle fingers for palpation, and never use the thumb, as the thumb has its own strong pulse that can lead to an inaccurate count. Once the pulse is located, use a watch with a second hand or a stopwatch to count the number of beats felt within a specific time frame.
The most common method involves counting the beats for 15 seconds and then multiplying that number by four to calculate the beats per minute (BPM). Alternatively, counting for a full 30 seconds and multiplying by two provides a slightly more reliable measurement, especially if the rhythm feels irregular. While counting, a caregiver should also note the pulse’s quality (strong or weak) and if the rhythm is regular or irregular.
A child’s normal resting heart rate decreases significantly as they age, so interpretation must be based on the child’s specific age group. For infants (1 to 11 months), a normal resting rate falls within the range of 80 to 160 BPM. Toddlers (1 to 3 years) generally have a resting heart rate between 80 and 140 BPM, while school-age children (6 to 12 years) usually rest between 60 and 110 BPM.
A heart rate that is consistently too fast (tachycardia) may signal issues like fever, dehydration, or anxiety. Conversely, a rate that is too slow (bradycardia) can indicate a more concerning underlying problem. Immediate medical attention is required if a child’s pulse is absent, or if the rate is significantly below 60 BPM accompanied by signs of poor circulation, such as pale or bluish skin and extreme lethargy. Any sudden change in rate or a noticeable irregularity in the pulse’s rhythm should prompt a call to a healthcare provider.