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Review
. 2011 Mar 19;377(9770):1011-8.
doi: 10.1016/S0140-6736(10)62226-X.

Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies

Susannah Fleming  1 , Matthew Thompson, Richard Stevens, Carl Heneghan, Annette Plüddemann, Ian Maconochie, Lionel Tarassenko, David Mant
Affiliations
Review

Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies

Susannah Fleming et al. Lancet. .

Abstract

Background: Although heart rate and respiratory rate in children are measured routinely in acute settings, current reference ranges are not based on evidence. We aimed to derive new centile charts for these vital signs and to compare these centiles with existing international ranges.

Methods: We searched Medline, Embase, CINAHL, and reference lists for studies that reported heart rate or respiratory rate of healthy children between birth and 18 years of age. We used non-parametric kernel regression to create centile charts for heart rate and respiratory rate in relation to age. We compared existing reference ranges with those derived from our centile charts.

Findings: We identified 69 studies with heart rate data for 143,346 children and respiratory rate data for 3881 children. Our centile charts show decline in respiratory rate from birth to early adolescence, with the steepest fall apparent in infants under 2 years of age; decreasing from a median of 44 breaths per min at birth to 26 breaths per min at 2 years. Heart rate shows a small peak at age 1 month. Median heart rate increases from 127 beats per min at birth to a maximum of 145 beats per min at about 1 month, before decreasing to 113 beats per min by 2 years of age. Comparison of our centile charts with existing published reference ranges for heart rate and respiratory rate show striking disagreement, with limits from published ranges frequently exceeding the 99th and 1st centiles, or crossing the median.

Interpretation: Our evidence-based centile charts for children from birth to 18 years should help clinicians to update clinical and resuscitation guidelines.

Funding: National Institute for Health Research, Engineering and Physical Sciences Research Council.

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Figures

Figure 1
Figure 1
Flowchart of the systematic search process
Figure 2
Figure 2
Centiles of respiratory rate for normal children from birth to 18 years of age
Figure 3
Figure 3
Comparison of respiratory rate centiles with paediatric reference ranges from the Advanced Paediatric Life Support (APLS) and Pediatric Advanced Life Support (PALS) guidelines.
Figure 4
Figure 4
Centiles of heart rate for normal children from birth to 18 years of age
Figure 5
Figure 5
Comparison of heart rate centiles with paediatric reference ranges from the Advanced Paediatric Life Support (APLS) and Pediatric Advanced Life Support (PALS) guidelines.
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