University of Oulu

Pöyry, H., Aarnivala, H., Huhtamäki, H., Pokka, T., Renko, M., Valmari, P., & Tapiainen, T. (2023). Parental ability to assess pediatric vital signs. The Journal of Pediatrics, 252, 177-182.e2.

Parental ability to assess pediatric vital signs

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Author: Pöyry, Hilla1,2; Aarnivala, Henri1,2; Huhtamäki, Heikki1,2;
Organizations: 1Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Finland
2Medical Research Center, PEDEGO (Pediatrics, Dermatology, Gynecology and Obstetrics) Research Unit, University of Oulu, Finland
3Department of Pediatrics, The University of Eastern Finland and Kuopio University Hospital, Finland
4Department of Pediatrics, Lapland Central Hospital, Rovaniemi, Finland
5Biocenter Oulu, University of Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.1 MB)
Persistent link:
Language: English
Published: Elsevier, 2023
Publish Date: 2023-03-27


Objective: To evaluate parents’ ability to accurately assess their child’s heart and respiratory rates (RRs) in the context of potential utility for telehealth visits.

Study design: In this controlled study of 203 child-parent pairs, parents measured their child’s heart rate (HR) using 4 methods: palpation, auscultation, and 2 photoplethysmographic smartphone applications. Parents measured RR by inspecting the child and tapping the smartphone application. The gold standards were electrocardiogram for the HR and the child’s breaths measured by a health care professional for 60 seconds for the RR. We plotted the measurements using a Bland-Altman plot with 95% limits of agreement.

Results: Parents underestimated HR by palpation with a calculated bias of −18 beats per minute (bpm) (SD, 19), with limits of agreement ranging from −56 to 19 bpm. Parents overestimated and underestimated HR by auscultation with limits of agreement ranging from −53 to 46 bpm. Smartphone applications did not improve the accuracy of measurements. The accuracy of parental RR measurements was low. For young children, bias was −0.8 breaths per minute (brpm) (SD, 9.8) with limits of agreement from −20 to 19 brpm, and for older children, bias was 0.9 brpm (SD 7.4) with limits of agreement from 6 to 15 brpm. The sensitivity of parental subjective opinion to recognize accelerated RR was 37% (95% CI, 25%-51%).

Conclusion: Parents were not able to assess their child’s RR or HR accurately. Digital remote assessment of children should not rely on parental measurements of vital signs.

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Series: Journal of pediatrics
ISSN: 0022-3476
ISSN-E: 1097-6833
ISSN-L: 0022-3476
Volume: 252
Pages: 177 - 182.e2
DOI: 10.1016/j.jpeds.2022.08.018
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: The Finnish Medical Foundation and The Alma and K.A. Snellman Foundation supported the study.
Copyright information: © 2022 The Authors. This is an open access article under the CC BY license (