hey everyone it's Sarah with registered nurse rn.com and in this video I want to demonstrate how to assess vital signs on an infant so let's get started when assessing vital signs on an infant you want to start with the most non-invasive Vital Signs first while the infant is calm and resting therefore first you're going to check the respirations followed by the heart rate then the temperature the weight the length the head circumference and then the chest circumference before you assess the infant's vital signs you want to make sure that you gather your supplies so what you're going to need is an infant size stethoscope followed by a measuring tape a thermometer a scale and a watch to count with and you want to make sure that you sanitize everything that you're going to use on that infant before and after use and of course perform hand hygiene before beginning first we're going to check respirations and we're going to do that first while the infant is laying here nice and calm so we get an accurate reading and a normal respiratory rate in an infant is about 30 to 60 breaths per minute so before we even start counting respirations we want to look at that infant and we want to make sure that they're not in any respiratory distress so one way we can tell is we can look at the nose infants love to breathe through their nose so we were checking their nostrils and we're looking for nasal flaring and if you see that that's not a good sign also you want to look at that chest and you want to look for anything like chest retractions and what that looks like it literally looks like the skin has just been pulled over the ribs and you can see the ribs very well and this infant does not have either of those things in addition you want to look at the infant's skin color and make sure it's appropriate for their skin tone and that you don't see any signs and symptoms of cyanosis so to count respirations what we're going to do is we're going to count for one full minute the rise in the fall of the chest Now with an adult you probably remember that if the rate was regular we could count for 30 seconds and multiply by two well this isn't the case with infant you're going to do it for one full minute because infant's breathing pattern is irregular they have what's called periodic breathing where they'll breathe and then they'll stop for a second so we're going to count for one full minute and we're looking at that rise and that fall of the chest and infants like to breathe abdominally so if you're having trouble what you could do is you could lightly place your hand on the chest and feel the rise in the fall but you want to be careful not to disturb the infant and get them crying so I'll demonstrate and I'll count with each rise and with each fall just to give you an example so here we go one two three four five six seven eight nine ten so you want to count that rise in that fall for one full minute and then document that number so his respirations were 38 which again is normal because a normal rate is about 30 to 60 breaths per minute to count the heart rate you want to make sure that you're using the appropriate size diaphragm and bell and we have an infant here so we're using an infant size and for an infant who is less than a month a normal heart rate is about 100 to 190 beats per minute and this can vary if the infant is crying or if they're sleeping now if the infant is over one month that heart rate goes down a little bit the normal ranges it's about 90 to 180 beats per minute so to count the heart rate what we're going to do is we're going to use the apical pulse we're not going to use the radial pulse like how we do in adults so to find the apical pulse what you want to do is you want to find the fourth intercostal space now on an adult remember it was the fifth fossil space at the microvicular line but for an infant it's at the fourth intercostal space lateral to the midclavicular line so you want to find the clavicle and then we have the breast bone and we're going to go down and we're going to fill in between those little ribs and we're going to go to the fourth space so there's one two three four and then we're going to just go lateral to the midclavicular line so we're going to go about right here and this is about where the apical pulses on our infant and we're going to place our stethoscope there and we're going to listen for one full minute now an infant's heart rate can have sinus arrhythmia where it's irregular because their heart rate is can be affected with the respirations where their heart rate will actually speed up and slow down with respiration so that's where you want to count for one full minute now counting an infant's heart rate can be difficult because it is fast and one thing that I have found that definitely helps me is I find that heart rate and then I like tap my finger along with that heart rate and count and our infant's heart rate here is about 142. to check the temperature in the infant we're going to check it via the axillary route so we're going to place the thermometer tip in the armpit of the infant and I've already placed a little protective sheath over the thermometer so a normal temperature in an infant can vary anywhere between 97.5 to 99.3 degrees Fahrenheit to take the temperature make sure that you turn the thermometer on and then you're going to place the tip of the thermometer deep inside the fold of the armpit and then you're just going to put the arm down and you're going to wait for the thermometer to beep to tell you the reading okay our thermometer is beeping so it is done and the reading is 99.1 so we would document this and this Falls within normal range to obtain a weight on an infant you want to remove the infant's clothing and any soiled diaper a dry diaper can be used so place the infant on the scale and obtain the weight here this infant weighs 10 pounds 2 ounces so you'd want to document that way and then look at the infant's previous weights this patient weighed 8 pounds at Birth and now at this two-week appointment they weigh 10 pounds 2 ounces so that is a very good weight gain from their birth weight to measure length what you want to do is you want to lay the baby on a surface that you can Mark you'll need a PIN for this and you may need someone's help to help you measure the baby because you're going to measure from head to heel so lay the baby back you'll want to put their head midline like this and then just mark their head and then you want to take the leg and extend it outward like this make sure it's nice and extended you may have to work with them a little bit and then Mark it at the heel and a normal length in an infant is about 18 to 22 inches and then we're going to gently lift the baby up so we're going to measure this and we're actually measuring this in inches and the infant is 22 inches to measure head circumference you're going to need a measuring tape and you want one that measures in centimeters now a normal head circumference in an infant is about 33 to 38 centimeters and what we want to do is we want to place the tape measure around the largest diameter of the head so to do that we're going to place a little bit above the eyebrows and then we're going to wrap that around and place it around the most prominent part at the back of the head so let's do that so gently just lift the head up and put the measuring tape behind it and then pull your measuring tape around remove his head a little bit and let's see what we get and his head circumference is about 37 centimeters to measure chest circumference you want to get your measuring tape again you'll be measuring this in centimeters and you're going to take it and use the nipple line as your guide so you're going to wrap it around there and then measure it and his is about 36 and this should be about one to two centimeters less than what the head circumference was okay so that wraps up this demonstration on how to assess vital signs on an infant and be sure to check out the other videos in this Pediatrics series