Free tool · Reference · Pediatrics
Pediatric Reference.
The pediatric numbers you reach for at the bedside, in one place: normal vital signs by age, a maintenance-fluid calculator (Holliday-Segar 4-2-1), a PEWS early-warning scorer, and a plain-English guide to the FLACC and Wong-Baker FACES pain scales. Ranges follow PALS/AHA and AAP; fluids follow Holliday-Segar. Every number here supports your assessment and your facility’s protocols — it doesn’t replace them.
Maintenance fluid calculator [2]
Holliday-Segar method. Enter weight; get the daily volume and the 4-2-1 hourly rate.
Enter a weight to see maintenance fluids.
Note: The 4-2-1 rate gives the hourly maintenance infusion; the 100/50/20 rule gives the 24-hour volume (they agree). For most hospitalized children, current AAP guidance favors isotonic maintenance fluids (e.g., 0.9% saline or balanced solutions with dextrose ± KCl) over hypotonic fluids, to reduce hyponatremia. Maintenance is a starting point — deficits, ongoing losses, and the clinical picture modify it. The fluid plan is the provider’s.
Normal vital signs by age [1]
| Age | Heart rate (awake, bpm) | Respiratory rate (/min) | Systolic BP (mmHg) |
|---|---|---|---|
| Neonate (0–1 mo) | 100–205 | 30–60 | 67–84 |
| Infant (1–12 mo) | 100–180 | 30–53 | 72–104 |
| Toddler (1–2 yr) | 98–140 | 22–37 | 86–106 |
| Preschool (3–5 yr) | 80–120 | 20–28 | 89–112 |
| School-age (6–11 yr) | 75–118 | 18–25 | 97–115 |
| Adolescent (12–15 yr) | 60–100 | 12–20 | 110–131 |
Hypotension (systolic BP) thresholds — PALS: term neonate <60; infant (1–12 mo) <70; child 1–10 yr <70 + (2 × age in years); ≥10 yr <90. Hypotension is a late sign of shock in children — tachycardia, prolonged capillary refill, and mental-status change appear first. Sleeping heart rates run lower than the awake ranges above. Ranges vary by source, and these fixed bands can over-flag well children compared with growth-centile charts — correlate clinically and use your facility’s reference.
PEWS — Pediatric Early Warning Score [3]
Brighton PEWS model (behaviour, cardiovascular, respiratory; 0–3 each, plus extras). Many hospitals use their own variant — score with your facility’s tool.
Score the three domains to see the PEWS total.
Pain scales — FLACC & Wong-Baker FACES [4][5]
FLACC — a behavioral pain scale for children roughly 2 months to 7 years or anyone who can’t self-report. An observer rates five behaviors — Face, Legs, Activity, Cry, and Consolability — from 0 to 2 each and adds them for a total of 0–10 (0 relaxed/comfortable · 1–3 mild discomfort · 4–6 moderate pain · 7–10 severe). The FLACC scale and its scoring descriptors are copyrighted by the University of Michigan and require a license to use — score and chart on the official, licensed FLACC instrument your facility provides. Licensing: U‑M Office of Technology Transfer. (For self-reporting children ~3 years and older, the Wong-Baker FACES scale below is the usual choice.)
Wong-Baker FACES® — a self-report scale of six faces from 0 (“No hurt”) to 10 (“Hurts worst”) in steps of 2, used for children ~3 years and older and others who can point to a face. Ask the child to choose the face that best matches how much they hurt — it reflects how they feel inside, not how their face looks. The official faces and instructions are copyrighted by the Wong-Baker FACES Foundation (© 1983); use the licensed scale from wongbakerfaces.org. (For the very young or non-verbal, FLACC above is the usual choice.)
References
- Pediatric Advanced Life Support (PALS), American Heart Association — normal pediatric heart rate, respiratory rate, and blood pressure ranges, and systolic hypotension thresholds. AHA PALS Provider Manual; see also Normal Vital Signs (StatPearls). (Age-band vital-sign ranges; hypotension = SBP <70 + 2×age for 1–10 yr.)
- Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics. 1957;19(5):823–832. PMID: 13431307. (100/50/20 daily & 4/2/1 hourly maintenance.) Isotonic-fluid preference: AAP Clinical Practice Guideline, Pediatrics. 2018;142(6):e20183083.
- Monaghan A. Detecting and managing deterioration in children: the Brighton Paediatric Early Warning Score. Paediatr Nurs. 2005;17(1):32–35. PMID: 15768797. (Brighton PEWS domains and scoring; institutional variants exist.)
- Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293–297. PMID: 9220806. (Five categories scored 0–2; total 0–10. The FLACC scale is copyrighted by The Regents of the University of Michigan and requires a license to use — U-M Office of Technology Transfer.)
- Wong-Baker FACES Foundation. Wong-Baker FACES® Pain Rating Scale. wongbakerfaces.org. (Self-report 0–10 faces scale; official scale is copyrighted — use the licensed version.)
Ranges and methods transcribed from these sources; institutional references and protocols take precedence.
Pairs well with