INTRODUCTION

As people grow and age, their bodies and minds go through various stages of development. These changes affect how they think, feel, and interact with the world. For an Emergency Medical Responder (EMR), understanding these stages is crucial to provide age-appropriate care.

In emergency medical care, identifying a patient’s age group is essential as it can influence the type of treatment provided. Since age isn’t always obvious, responders may find it helpful to categorize patients by appearance. These guidelines rely on common patterns of injuries or illnesses for different age ranges, and responders should also follow local protocols when deciding on care for children versus adults.

Typically, respiratory issues are more common in infants and children and can escalate to heart issues if untreated. In contrast, cardiac emergencies are often more prevalent in adults and adolescents. A quick visual assessment can usually distinguish between an infant, child, or adult. For example, a small 1-year-old is typically categorized as an infant, while a younger-looking 13-year-old may still be viewed as a child. Such classifications are designed to enable quick and appropriate care without needing to confirm exact age.

The following general age groupings aid responders in these situations:

• Infant: Appears to be under 1 year old.
• Child: Appears to be between 1 and 12 years old. For AED use, children are generally those aged 1-8 years or weighing less than 55 pounds.
• Adult: Appears to be 12 years or older.

These guidelines support efficient response times, as responders can use visual cues to make quick assessments and deliver the necessary care without delay, even if the patient’s exact age isn’t clear.

Developmental Stages

Infant (Birth to 1 Year)

Infants, especially newborns, are highly vulnerable due to their complete dependence on caregivers for comfort, basic needs, and communication. Newborns, from birth to about 28 days, are particularly delicate and sensitive to separation from their parents or feeling cold, which can cause distress. It’s important to perform assessments on newborns gently, minimizing separation from caregivers whenever possible to keep them calm and comfortable.

As infants grow through the first year, they begin to develop abilities such as recognizing voices, and after a few months, they may even start to recognize familiar faces. However, they still rely heavily on caregivers for security and are easily distressed by unfamiliar people or environments. Crying is a common way infants communicate, though only parents or close caregivers can often identify subtle differences in their cries that may signal hunger, discomfort, fear, or pain. To avoid triggering distress, handle infants gently and try to keep them near their caregivers whenever possible during assessments.

Understanding Vital Signs Across the Lifespan: Norms, Variations, and Clinical Insights for the Infant

Infant (Birth to 1 Year)

• Normal Vital Signs:
  • Heart rate (HR): 100–160 bpm
  • Respiratory rate (RR): 30–60 breaths/min
  • Blood pressure (BP): 70–100 systolic
  • Temperature: 97.7–99.7°F (36.5–37.6°C)
• Why Different:
  Infants have higher metabolic rates and immature thermoregulation, requiring faster heart and respiratory rates to meet oxygen and energy demands.
• Common Considerations:
  Watch for dehydration (e.g., dry mouth, reduced wet diapers), respiratory distress (e.g., nasal flaring, grunting), or infection (e.g., fever, lethargy).
• Example Shift:
  During dehydration due to diarrhea, an infant’s HR might rise to 180 bpm, RR to 70, and temperature to 100.4°F, signaling stress or shock.

In infancy, EMS issues are often related to rapid physical development, vulnerability to infections, and environmental factors. Below are common challenges and examples to discuss:

Challenges:

• Respiratory distress from infections (e.g., RSV, bronchiolitis).
• Dehydration due to fever or diarrhea.
• Sudden infant death syndrome (SIDS).

Toddler (1–3 Years)

Toddlers are naturally curious and are beginning to explore their independence, yet they still rely on caregivers for comfort and guidance. They readily recognize familiar faces and may become fearful or distressed in the presence of unfamiliar people or environments. This age group can be anxious about being separated from their parents and may not respond well to strangers, even if a caregiver is nearby.

When assessing a toddler, it can help to allow them to stay close to their parents and to speak softly. Using toys, stuffed animals, or other comforting objects can be effective in calming them, helping them feel secure, and even assisting them in expressing discomfort or pain. Since toddlers are highly curious and explore through touch and taste, they are also at increased risk for injuries like poison ingestion. Taking a gentle, reassuring approach can help ease their anxiety and facilitate cooperation during assessments.

Understanding Vital Signs Across the Lifespan: Norms, Variations, and Clinical Insights for the Toddler

Toddler (1–3 Years)

• Normal Vital Signs:
  • HR: 90–150 bpm
  • RR: 24–40 breaths/min
  • BP: 80–110 systolic
  • Temperature: 97.9–99.7°F (36.6–37.6°C)
• Why Different:
  Toddlers’ growing bodies require sustained metabolic activity, and their smaller airways make them more susceptible to respiratory complications.
• Common Considerations:
  Monitor for signs of airway obstruction, dehydration, and febrile seizures (common with rapid temperature increases).
• Example Shift:
  A toddler with croup may show a barking cough, increased RR (45 breaths/min), and oxygen saturation dropping below 92%, requiring intervention.

During the toddler years, EMS challenges are often tied to mobility, curiosity, and an underdeveloped immune system.

Challenges:

• Choking and poisoning due to ingestion of small objects or substances.
• Febrile seizures caused by rapid fever increases.
• Trauma from falls or accidents.

Preschool Age (3–6 Years)

Preschoolers are beginning to develop basic reasoning and communicate their thoughts more clearly, but they may struggle with complex ideas and can be especially fearful of injury or illness. They often associate sickness or pain with punishment and may think it’s their fault, which can heighten their anxiety. To help them feel safe, use simple language to explain what you’re doing and offer lots of positive reassurance.

Keeping parents nearby can provide comfort, as preschoolers often fear medical equipment and may be especially disturbed by the sight of blood. Using dressings or bandages can sometimes ease their fears by “covering up” the problem. By patiently addressing their concerns and using straightforward explanations, you can help reduce their anxiety and build a sense of trust during assessments.

Understanding Vital Signs Across the Lifespan: Norms, Variations, and Clinical Insights for the Preschooler

Preschool Age (3–6 Years)

• Normal Vital Signs:
  • HR: 80–140 bpm
  • RR: 22–34 breaths/min
  • BP: 89–112 systolic
  • Temperature: 97.9–99.7°F (36.6–37.6°C)
• Why Different:
  Larger lungs and hearts compared to toddlers allow for lower HR and RR, but they still have high metabolic demands for growth.
• Common Considerations:
  Assess for signs of respiratory distress (e.g., retractions), infections, and behavioral changes due to illness or pain.
• Example Shift:
  A preschooler with a mild asthma attack might exhibit HR of 150 bpm, RR of 40, and accessory muscle use for breathing.

Preschool-aged children face EMS issues related to their increased independence and exposure to group environments.

Challenges:

• Asthma exacerbations or allergic reactions due to environmental triggers.
• Injury from play or sports activities.
• Early onset of behavioral or emotional issues.

School Age (6–12 Years)

School-age children are capable of understanding more detailed explanations and tend to be more cooperative during exams, especially when the situation is explained to them clearly. They are often literal thinkers, so it’s essential to use precise language to avoid misunderstandings. This age group may have fears related to severe injury, blood, or death, which can provoke anxiety.

To help them feel secure and in control, include school-age children in discussions about their care and provide reassurance, particularly from familiar faces like parents or caregivers. Although they are generally comfortable cooperating with strangers, consistent reassurance is important to ease any worries. This age group may also have strong imaginations about injury or death, so addressing their questions thoughtfully can help them feel more at ease during assessments.

School Age (6–12 Years)

• Normal Vital Signs:
  • HR: 70–120 bpm
  • RR: 18–30 breaths/min
  • BP: 97–120 systolic
  • Temperature: 97.8–98.6°F (36.5–37°C)
• Why Different:
  Their cardiovascular and respiratory systems are more efficient, reflecting developmental progress.
• Common Considerations:
  Look for subtle signs of illness, as children may underreport symptoms. Monitor for anemia or growth delays.
• Example Shift:
  A child with pneumonia may show HR of 130 bpm, RR of 35, fever of 102°F, and crackles on auscultation.

For school-aged children, EMS challenges often arise from increased physical activity, peer influences, and growth spurts.

Challenges:

• Sports injuries, including fractures and concussions.
• Early signs of chronic illnesses like diabetes or obesity-related complications.
• Behavioral health emergencies, such as anxiety or bullying-related stress.

Adolescence (12–18 Years)

Adolescents can understand complex medical information and are generally cooperative, but they often take risks without fully appreciating the potential consequences. Privacy and appearance are particularly important to them, especially when facing the possibility of disfigurement or long-term effects. To build trust, treat adolescents with respect, maintain their privacy, and, when appropriate, hold conversations with them privately.

The adolescent age range varies significantly, with younger teens transitioning from childhood and older teens nearing adulthood, often taking on adult responsibilities. While most adolescents can communicate effectively about their symptoms, they may sometimes experience heightened anxiety, especially in groups, where a sense of shared distress can spread. Adolescents are often aware of serious risks like permanent disability or death and may need reassurance to help manage these fears. Providing understanding, patience, and maintaining their modesty can make a meaningful difference in helping them feel safe and respected during medical care.

Adolescence (12–18 Years)

• Normal Vital Signs:
  • HR: 60–100 bpm
  • RR: 12–20 breaths/min
  • BP: 110–131 systolic
  • Temperature: 97.8–98.6°F (36.5–37°C)
• Why Different:
  Adolescents approach adult physiological norms as their bodies mature.
• Common Considerations:
  Assess for stress-related changes (e.g., tachycardia), poor dietary habits, and conditions like hypertension or obesity.
• Example Shift:
  Stress during a public speech may elevate HR to 120 bpm and BP to 135/85.

Adolescents often face EMS challenges related to risky behaviors, hormonal changes, and emerging independence.

Challenges:

• Substance use or overdose.
• Mental health crises, including self-harm or suicidal ideation.
• Trauma from motor vehicle accidents or high-risk activities.

Early Adulthood (18–30 Years)

During early adulthood, most people are in good health and at the peak of their physical abilities. They are often active and may be involved in accidents or injuries that require emergency care. Individuals in this stage are typically able to make their own medical decisions, but they may still need reassurance in stressful situations.

Early Adulthood (18–30 Years)

• Normal Vital Signs:
  • HR: 60–100 bpm
  • RR: 12–20 breaths/min
  • BP: 120/80 mmHg
  • Temperature: 97.8–98.6°F (36.5–37°C)
• Why Different:
  Full physiological maturity allows for stable and efficient vital signs under normal conditions.
• Common Considerations:
  Monitor for stress, anxiety, or underlying conditions like undiagnosed hypertension.
• Example Shift:
  Post-exercise HR of 140 bpm and BP of 135/85 returning to baseline within 5–10 minutes signals good cardiovascular fitness.

In early adulthood, there are several common EMS issues related to the lifestyle, environment, and developmental stage of this age group. Here are some of the key challenges along with examples and stories that can bring these issues to life.  Using these scenarios, break out into groups or online discussion boards and utilize the Socratic questioning method below to go through these scenarios:

Middle Adulthood (30–60 Years)

As people enter middle adulthood, they begin to notice signs of aging, such as changes in vision or hearing, as well as other physical changes like graying hair. Chronic health conditions may begin to emerge, but people in this age group generally continue with their normal routines. When responding to patients in this stage, be aware of any underlying health issues that may impact their care.

Middle Adulthood (30–60 Years)

• Normal Vital Signs:
  • HR: 60–100 bpm
  • RR: 12–20 breaths/min
  • BP: 120/80 mmHg
  • Temperature: 97.8–98.6°F (36.5–37°C)
• Why Different:
  Age-related vascular changes and stress levels may begin to influence BP and HR.
• Common Considerations:
  Screen for chronic conditions (e.g., hypertension, diabetes) and lifestyle-related impacts like obesity.

Example Shift:
A sedentary lifestyle might elevate resting HR to 90 bpm and BP to 140/90, indicating prehypertension.

Middle Adulthood Common EMS Issues and Scenarios

Middle-aged adults often experience health issues connected to lifestyle choices, chronic conditions, and emerging age-related changes. Here are some common issues and scenarios, followed by suggested activities that allow EMR students to practice appropriate responses and patient assessments

1. Cardiac Events (e.g., Heart Attack or Angina)
   • Scenario Example: A 55-year-old man experiences chest pain and shortness of breath after climbing stairs at work. He’s pale, sweating, and has a history of high blood pressure but hasn’t been compliant with his medication.
   • Expected Actions: Have students conduct a primary assessment, taking the patient’s history, checking vital signs, and practicing therapeutic communication to keep the patient calm and obtain critical information about his symptoms.
2. Hypertension and Stroke (Cerebrovascular Accident)
   • Scenario Example: A 48-year-old woman suddenly becomes disoriented and has trouble speaking while at her daughter’s soccer game. Bystanders report she briefly lost consciousness and is now struggling to answer questions. She has a history of high blood pressure and diabetes.
   • Expected Actions: Students practice a stroke assessment using the FAST method (Face drooping, Arm weakness, Speech difficulty, Time to call 911), emphasizing rapid response and maintaining the patient’s safety while awaiting advanced care.
3. Respiratory Issues, Including COPD and Asthma
   • Scenario Example: A 60-year-old former smoker with COPD begins experiencing severe shortness of breath and wheezing after gardening. He’s visibly anxious and states he can’t breathe well, despite using his inhaler.
   • Expected Actions: Students assess the patient’s airway, breathing, and circulation (ABCs) and provide basic interventions such as oxygen and positioning for comfort. They should also practice reassuring the patient and observing any environmental factors that may have triggered the exacerbation.
4. Diabetic Emergencies (Hypo/Hyperglycemia)
   • Scenario Example: A 50-year-old woman is found confused and sweating profusely at a grocery store. She has type 2 diabetes but reports feeling “fine” before this episode. Her family mentions she was rushed and skipped breakfast.
   • Expected Actions: Students check blood glucose levels, if permitted by protocols, or conduct a full primary assessment while considering hypoglycemia or hyperglycemia. They practice giving glucose gel and re-assessing the patient’s condition.
5. Accidents from Physical Activity and Aging Changes
   • Scenario Example: A 45-year-old man hurts his back lifting boxes while helping a friend move. He experiences severe lower back pain and numbness in his legs.
   • Expected Actions: Students assess for potential spinal injury and practice immobilization techniques to transport the patient. They consider the effect of age-related changes in muscle and bone structure on injury risk.
6. Falls and Fractures Due to Aging and Physical Conditions
   • Scenario Example: A 59-year-old woman with osteoporosis trips on a rug and falls in her living room, experiencing severe hip pain.
   • Expected Actions: Students practice immobilization, splinting, and safe patient-handling. This scenario can include assessing for shock and checking for other injuries due to the patient’s age and condition.

Late Adulthood (60+ Years)

In late adulthood, physical changes become more pronounced. Many older adults experience reduced mobility, diminished senses (hearing, sight, taste, smell), and a decreased ability to feel pain. They may also have multiple health conditions and take various medications. It’s important for EMRs to consider these factors when assessing elderly patients, as their health needs can be complex.

Late Adulthood (60+ Years)

• Normal Vital Signs:
  • HR: 60–100 bpm
  • RR: 12–20 breaths/min
  • BP: 120–140 systolic
  • Temperature: 96.8–98.3°F (36–36.8°C)
• Why Different:
  Aging decreases physiological reserve, reducing HR variability and thermoregulation.
• Common Considerations:
  Watch for subtle signs of infection (low-grade fever may be significant), orthostatic hypotension, and medication side effects.
• Example Shift:
  An older adult with sepsis might show HR of 110 bpm, BP of 90/60, and temperature of 100°F, indicating systemic infection and shock.

References

American Red Cross. (2017). Emergency medical response. https://www.redcross.org/content/dam/redcross/training-services/course-fact-sheets/EMR-Textbook-2017-LoRes-111017.pdf

Berk, L. E. (2017). Development through the lifespan (7th ed.). Pearson.

Santrock, J. W. (2020). Life-span development (17th ed.). McGraw-Hill Education.

Images:

Figures 5.1-5.9: Aitubo. (2025). Flux (v1.0). [Artificial intelligence system]. https://aitubo.ai/

Figure 5.10: Image derived from work by Stephane, Solie Jordan, & Pexels, via Pixabay is licensed under CC0

Figure 5.11: ”couple-old-elderly-senior-8763070” by Gerd Altmann, via Pixabay is licensed under CC0