Clinical measurements

Normal temperature range

Do not use tympanic thermometer if person has hole in eardrum

Table 2.1 Normal temperature ranges

How taken	Normal temp (°C)
Oral (mouth)	36.5–37.5 °C
Axillary (under arm)	36.0–37.0 °C
Rectal	37.0–37.8 °C
Tympanic (ear)	36.8–37.8 °C

Respiratory rate (RR) and heart rate (pulse)

Listen to heart sounds in same places as you do an ECG
If heart sounds unusual or different from other children or adults

Get colleague to check
Check notes to see if detected before. If new — refer for assessment

Table 2.2 Respiratory rate and pulse rate by age

Age of	Respiratory rate range (breaths/min)	Pulse rate range (beats/min)
Newborn	25–60 breaths/min	120–185 beats/min
3 months	25–60 breaths/min	115–180 beats/min
6 months	20–55 breaths/min	110–180 beats/min
1 year	20–45 breaths/min	105–180 beats/min
2 years	20–40 breaths/min	95–175 beats/min
4 years	17–30 breaths/min	80–150 beats/min
6 years	16–30 breaths/min	75–140 beats/min
8 years	16–30 breaths/min	70–130 beats/min
10 years	15–25 breaths/min	60–130 beats/min
12 years	15–25 breaths/min	60–120 OR pregnant 80–110 beats/min
14 years	14–25 breaths/min	60–115 OR pregnant 80–110 beats/min
17 years and over	14–25 breaths/min	60–115 OR pregnant 80–110 beats/min
Royal Children’s Hospital (2020) Acceptable ranges for physiological variables

Taking BP reading — adults

Attention

Never check BP on limb with AV fistula
Normal BP for an adult varies depending on gender, age and levels of fitness
As a general principle

Systolic pressure should be less than 130mmHg
Diastolic pressure should be less than 80mmHg

Best if person has

Not smoked or drunk tea, coffee or caffeine soft drinks for 30 minutes
Been sitting quietly for at least 10 minutes

If part of cardiovascular examination or no previous recording — check BP on both arms

Attention to difference in recording (if any) and then use the arm with the higher reading

What you do

Choose right sized cuff for person’s arm

Depends on length and circumference (width) of upper arm. Inflatable air bladder in cuff must have —width at least 40% of arm circumference and length at least 80% of arm circumference. Almost long enough to go all the way around arm

Sit person comfortably with arm resting on table or pillow, just above level of their waist
Make sure air bladder is flat, fixed firmly and right over artery in upper arm
If manual recording make sure

Stethoscope bell is put right over brachial artery in elbow crease
Manometer/mercury needle level on zero when you start to blow up cuff

If you can’t hear systolic or diastolic sounds the first time — make sure you let all the air out of cuff, wait one minute before trying again
Adults diastolic (last sound you hear) reading is taken from time sound disappears

Taking BP reading — children

Attention

Try to take BP when child content. If child upset — may need to repeat when settled
Cuff needs to cover ⅔ of child’s upper arm. If cuff too narrow or too wide — reading may be wrong

Remember: Diastolic reading taken in children when sound changes from clear to muffled (sound sometimes continues to 0 in children)

What you do

Follow same general principles as for adults
Diagnosis of high BP requires high measurement on more than 1 occasion
BP depends on height — Table 2.3 and Table 2.4. Assume child is on 50th percentile for height and adjust target if child is very short or very tall

Subtract 5mmHg for children on the 5th percentile height-for-age
Add 5mmHg for children on 95th percentile height-for-age

Medical consult if BP outside of target

Table 2.3 BP — girls under 18 years (percentiles)

Graph with systolic and diastolic BP girls.

BP levels for girls — data table

Table 2.4 BP — boys under 18 years (percentiles)

Graph with systolic and diastolic BP boys.

BP levels for boys — data table

Body measurements — adults

Body mass index (BMI) and waist circumference are better indicators of disease risk than weight

Calculating Body Mass Index (BMI) for adults

What you need

Correctly calibrated standing scales
Something to measure height accurately (eg stadiometer)

What you do

Calculate BMI — weight (kg) ÷ height² (m)

For example — 82kg ÷ (1.63 x 1.63m) = 82 ÷ 2.66 = 30.83 OR see Table 2.5

See Table 2.6 for interpretation and actions

Table 2.5 BMI chart for men and women over 18 years

BMI classifications: less than 18.5, underweight;18.5-24.9, normal; 25 or more, overweight; 30 or more, obese.

Table 2.6 BMI Interpretation and actions

BMI	What it means	What to do
Less than 18.5	Underweight	Medical consult Advise healthy eating, keeping active Refer to dietitian
18.5-24.9	Healthy weight	Advise healthy eating, keeping active
25-29.9	Overweight	Advise to lose weight or not gain more weight — healthy eating, increased activity
30 or more	Obese	Medical consult Advise to lose weight — see management of obesity Refer to dietitian

Measuring waist

Do not use waist measurement for children under 10 years or pregnant women
Some people have normal BMI but bigger than normal waist circumference. This is a risk — advise to lose weight, be active
For children 10-17 years, use waist for height ratio

Attention

Adults can have a normal BMI but still have an unhealthy abdominal fat (pot belly) or have a higher BMI because of muscular build. A higher BMI may be more acceptable for people over 65 years
Large waist measurement associated with increased risk of some cancers, heart disease and type 2 diabetes

What you do

Put tape between lowest rib and top of hipbone, roughly in line with the belly button — Figure 2.1
Make sure tape is snug, without pressing into skin. Keep it even, don’t let it slope down on one side
Ask person to breathe out normally and measure against skin

Figure 2.1

See table Table 2.7 for interpretation of results and actions

Table 2.7 Waist circumference interpretation and actions

Waist circumference (cm)	What it means	What to do
Male less than 94 Female less than 80	Normal	Maintain healthy weight — healthy eating, keep active
Male 94–102 Female 80–88	Increased risk of chronic disease	Keep active Not gain more weight
Male more than 102 Female more than 88	Greatly increased risk of chronic disease	Lose weight — healthy eating, increased activity Refer to dietitian

Measuring growth in children and youth

Check weight AND length/height
Also check

Head circumference — 0–2 years
BMI — 2–17 years
Waist for height ratio — 10–17 years

Weight

Measure and record weight in file notes at each visit
Babies, children under 2 years — on baby scales, naked (no nappy or singlet)
2–5 years — on adult scales, wearing dry nappy or underpants only
5 years and over — on adult scales in light clothing and no shoes

Length or height

Babies and children under 2 years — lying down (length) with 2 people holding, using fixed board or measuring mat, without nappy
2 years and over — standing up (height) using stadiometer, without shoes. Record to nearest 0.1cm

Waist for height

Use for children and youth over 10 years to assess risk of chronic disease
Measure waist on a horizontal line 2cm above belly button
Divide waist measurement (cm) by height (cm)
Refer for further assessment if result more 0.5

BMI

Calculate BMI — weight (kg) ÷ height² (m)

For example — 22kg ÷ (1.1 x 1.1m) = 22 ÷ 1.22 = 18

Plot BMI on chart by age and gender

Below -2 z score for age and gender — underweight
Above +1 z score for age and gender — overweight (5–19 years), risk of overweight (2–5 years)
Above +2 z score for age and gender — obese (5–19 years), overweight or obese (0–5 years)
OR use WHO Anthro calculator to work out z score

Table 2.8 BMI-for-age — girls 2–5 years (z score)

WHO child growth standards

Table 2.9 BMI-for-age — boys 2–5 years (z score)

WHO child growth standards

Table 2.10 BMI-for-age — girls 5–19 years (z score)

WHO child growth standards

Table 2.11 BMI-for-age — boys 5–19 years (z score)

WHO child growth standards

Supporting resources

WHO — Measuring and weighing a child
WHO Anthro calculator