• The human heart beats constantly which can be felt with the palm of the hand and also heard with a stethoscope.

• The heart rate is a very important parameter to measure and may hint various diagnosis.

• Whenever the child is stressed there is a rise in heart rate. The stress can be because of infection, fever  or exertion.

• Occasionally when the stress is overwhelming, the heart may begin to fail and the child may have a low heart rate. Low heart rate can also occur if there are congenital defects in the heart like conduction defects.

• The normal heart rate depends on the age of the child.

• New born babies are born with a high heart rate that slowly comes down with age.

The normal heart rate for children is given below

• NEWBORNS  – 140 to 160 beats per minute

• Infants less than 1 year-  110 to 160 beats per minute

• Children 1 – 2 years- 100 to 150 beats per minute

• Children 2- 5 years- 95 to 140 beats per minute

• Children 5- 12 years- 80 to 120 beats per minute

• Child over 12 years- 60 to 100 beats per minute

Method to measure heart rate

Equipment needed-

• Watch with seconds needle.

• Stethoscope

Procedure

• The heart rate is better heard at the Apex of the heart.

• Apex is the prominent part of left ventricle which is present on the left side of chest in 4th or 5th intercostal space ( space between the 4th and 5th rib on left side)

You can do this by two methods

Method 1

• Explain that you would be palpating the left side of chest to the parents and the child.

• Assure them that is would be painless.

• In young children, it might help if they sit on parents lap.

• Now, with your hands cleanly washed and warmed (by rubbing your palms together) , place it on the chest of the child such that the base of your palm is towards the sternum (centre chest bone) and fingers directed towards the child’s side of chest.

• This should be done at the left side of the chest approximately at the level of nipple, which corresponds to 4th and 5th intercostal space.

• In this method you are trying to feel for the heart beat.

• Mentally note the site where you can feel the heartbeat.

• Now with a stethoscope place the bell of stethoscope on the area and hear the heartbeat for one full minute

• Note the value and time taken.

Method 2

• In this method you try to find the apex of heart without palpating with your hand.

• This is easy when you know where the apex is. Apex of heart is generally at between the 4th and 5th intercostal space. That is the space between the 4th and 5th rib on left side

• Now standing by the side or front of the child, feel the top of sternum (central chest bone to which the ribs are attached)

• The top of sternum feels like a ’U’ shape. Now run your fingers downwards slowly. You will feel a bulge about 1 to 2 centimetres below.

• This bulge corresponds to the 2nd intercostal space.

• Palpate your fingers sideways to feel the space.

• The rib below this space is the 3rd rib. now continue counting the ribs downwards.

• When you reach the space between the 4th and 5th ribs, move your fingers laterally corresponding to the midclavicular point( clavicle is the collarbone. Midclavicular means midpoint of clavicle)

• Now place the bell of stethoscope here and count the heartbeat for one complete minute.

• Record this value with the time taken.