Checking a pulse on a child (ages one year old to puberty) is vital when assessing responsiveness in an emergency. The proper location shifts away from the site used for infants, favoring a more reliable, central pulse site. Understanding the correct procedure informs emergency decisions, such as whether to begin cardiopulmonary resuscitation (CPR) or seek immediate medical help.
The Carotid Artery: Primary Emergency Site
The carotid artery, located in the neck, is the primary site recommended for checking the pulse in a non-responsive child. This artery is part of the central circulation system, carrying a significant volume of blood directly to the brain. Because of this role, the carotid pulse is often detectable even when a child’s blood pressure is low or when peripheral pulses are too weak to be felt.
To locate the carotid artery, find the groove on the side of the child’s neck, positioned between the windpipe and the large vertical muscle. This placement makes the artery close to the skin’s surface and easily accessible during an emergency assessment.
Peripheral sites like the radial or femoral artery can be used for routine checks when a child is conscious, but they are less reliable in emergencies. The carotid artery provides a stronger, more consistent pulse in an unresponsive child. If the pulse is absent or too slow, this central location indicates that the heart is failing to circulate blood effectively.
Correct Assessment Technique
The physical procedure for checking the carotid pulse requires a light, yet firm, touch. Use only the pads of two fingers, typically the index and middle fingers, to press gently into the groove on the side of the neck. Avoid using the thumb, as this digit has its own detectable pulse that could lead to a false reading.
The technique involves sliding the fingers down from the child’s jawline toward the middle of the neck until the pulse is felt. The assessment should last for a minimum of five seconds but no more than ten seconds in an emergency setting. This brief duration is necessary to quickly determine if a pulse is present so that life-saving measures can be initiated without delay.
A pulse rate below 60 beats per minute is considered too slow and may indicate the need for CPR, especially if the child shows signs of poor circulation. Normal resting heart rates vary significantly, ranging from 80 to 140 beats per minute for a toddler, and 70 to 120 beats per minute for a school-aged child. The immediate goal of this brief assessment is identifying a pulse that is clearly absent or significantly low.
Why Pulse Check Locations Change With Age
The standard location for checking a pulse shifts across the lifespan due to changes in body size, anatomy, and fat distribution. In infants (up to one year old), the brachial artery on the inside of the upper arm is the preferred site. Infants have shorter necks and more subcutaneous fat, making the carotid pulse difficult to isolate reliably.
Once a child reaches the age of one, their neck length increases and fat diminishes, making the carotid artery more accessible. The body’s proportions begin to resemble those of an adult, allowing for the use of the centrally located carotid pulse for emergency assessment. This artery provides a strong pressure wave that is much easier to detect than peripheral pulses during a cardiac event.
While the radial pulse at the wrist can be used for routine checks in older children and adults, it is often difficult to feel when blood pressure drops, making it unreliable in an emergency. The carotid artery remains the standard for emergency pulse checks from childhood through adulthood. Its physiological consistency justifies the transition from the brachial site in infants to the carotid site in children and adolescents.