1. Paediatric monitoring and response chart. Hospital:. Name:. Age:
Paediatric monitoring and response chart Hospital: Name: Age: Weight: UR number:
Frequency of observations:
Date
Time
Temp °C
≥ 39
>39
<36
AIRWAY / BREATHING
Respiratory Rate (bpm)
≥ 80 70 60 50 40 30 20 10
SpO2 (%)
95-100
90-95
80-90
70-80
<70
Oxygen
L/min
Respirat distress
Severe
Mod.
Mild
Normal
CIRCULATION
Heart rate (bpm)
≥ 200
190
180
170
160
150
140
130
120
100 90 80
<60
Cap refill
≥ 3 secs
< 3 secs
Blood Pressure (mmHg) > < (systolic BP danger ranges)
≥ 150
110
DISABILITY
AVPU response to stimuli
Alert
Verbal
Pain
None
Pain score ( /10)
Blood sugar level
TREATMENTS GIVEN 

2. Instructions on the use of Paediatric monitoring and response chart
Specify frequency of observations: hourly, 2nd hourly, 4th hourly, etc
Use the chart to record vital observations on every patient
Record all vital observations, including oxygen saturation and blood pressure on admission and thereafter
When graphing observations, place a dot in the box and connect it to the previous dot with a straight line. For SpO2 and Temperature write the exact number in the appropriate section, e.g. 87%, or 38.5.
Respond to all observations in the red and orange zones
Respond if an observation is deteriorating
Mandatory emergency call for:
Any observations in the red zone, OR
Airway obstruction or severe stridor
Apnoea or cyanosis on oxygen, or severe respiratory distress, or SpO2 or RR in red zone
Cardiac or respiratory arrest, or HR or BP in red zone
Sudden deterioration in conscious state or seizures
Staff are very worried about the clinical state of the child
If more than 2 observations in the Orange zone, call a doctor to review, or call a MET