6 Peds Clinical Tips to Help You Thrive

Pediatric clinicals are so different from adult Med-Surg clinicals that it’s helpful to know a few things in advance so you can get the most out of this valuable experience. In this article I’m sharing my top 6 peds clinical tips. Want to listen to this info instead? Click here or search for episode #360 of the Straight A Nursing podcast in your favorite podcast player.

#1: Know pediatric developmental stages

A big part of the nursing care of children is customizing your plan based on the child’s developmental stage. And this is where Erickson’s eight stages of psychosocial development come into play. The eight stages are: 

• Trust vs. Mistrust (infancy from birth to 18 months).
  • Child does not intuitively trust strangers (this includes you!)
  • Child benefits from caregiver consistency (this means the same nurses as much as possible)
  • Allow the child to sit on their parent’s lap whenever possible
  • Respond to crying so the child knows their needs are being met
  • Ensure the child receives consistent care and attention, which helps them feel secure and develop trust
• Autonomy vs. Shame and Doubt (toddler years from 18 months to 3 years)
  • Child is learning to exert their independence
  • Give the child options so they feel a sense of control (for example, “Would you like to get your blood pressure measurement taken on this arm or that one?”
• Initiative vs. Guilt (preschool years from age 3 to 5)
  • The child is developing a sense of purpose and learning to do things with more independence
  • Give the child small tasks and praise their accomplishments (for example, “Hold the stethoscope right here while I listen to your heart.”)
• Industry vs. Inferiority (School age from 6 to 11)
  • Help the child feel productive as they are focusing on learning and feeling capable
  • Help the child feel they are progressing and learning (for example, “Tell me what you’ve learned to do when your blood sugar is low.”)
  • Let the child help with procedures and assessments, give them small tasks they can complete successfully (for example, “I’m going to have you hand me supplies while I change this dressing.”)
  • Provide the child with positive feedback.
  • If the child is well enough to do schoolwork, ensure they have adequate time and space to do so.
• Identity vs. Role Confusion (adolescence age 12 to 20 years)
  • Children in this stage are going through a lot of physical changes, which affects how they see themselves.
  • The adolescent is developing their self-confidence and self-esteem.
  • Same-age support groups are highly beneficial at this stage.

Other things to take into consideration with children of different ages are: 

• Toddlers age 1 to 3 years fear separation from their parents and being alone.
• Preschoolers age 3 to 5 years fear body mutilation, separation, pain, blood and the unknown. Provide simple explanations and opportunities for the child to take out their aggressions (Play-Doh is a great option!).
• School age children age 6 to 12 years are very concerned with body mutilation and harm while also fearing loss of status with their peers. Children this age will often name their long-term devices such as PICC lines or PEG tubes as a way to personalize them. Allow children as much freedom of movement and independence as possible. The playroom is a great way for the child to participate in therapeutic play. Note, there should be no meds, treatments, or invasive assessments in the playroom – you want to keep this a safe place for the children.
• Adolescents have significant concerns about body image and social isolation. Allowing friends to visit and even bring food when appropriate is helpful for a child this age. In addition, ensure the adolescent has as much privacy as possible and let them wear their own clothes when feasible.

#2: Memorize pediatric vital signs

One thing you’ll notice very quickly is that pediatric vital signs vary widely, depending on the age of the child. Unfortunately, you just need to memorize these. However, PALS utilizes a down-and-dirty estimation of hypotension in children age 1 to 10, which is simply to multiply the child’s age in years by 2 and then add 70. Anything below this number is considered hypotension requiring intervention. So, for a child who is 8 years old, anything less than 86 systolic is considered hypotension and should be evaluated further.

#3: Know how to do weight-based drug calculations and formula calculations

Take some time to brush up on weight-based drug calculations since you will be using these a lot in pediatrics. In adults, doses are mostly standardized, but because children vary so widely, medications are often dosed based on the child’s weight.

Here’s an example of weight-based problem:

You are caring for a child s/p appendectomy who is complaining of moderate pain. The MD has ordered acetaminophen 15 mg/kg. The child weighs 48 pounds and the medication comes in a concentration of 10 mg per ml. How many total mg and total ml will the child receive? Round to the nearest tenth. 

Answer: 327.3 mg and 32.7 ml.

Formula calculations will ask you to dilute formula and tube feedings to a specific percentage. Here’s an example of how this type of problem might look

The MD has ordered 60 ml PediaCare formula to be administered at 2/3 strength. How much formula and water will you use to create the proper dilution?

Answer: 40 ml PediaCare and 20 ml water

Struggling with dosage calculations? No problem! I can teach you a foolproof step-by-step process in my program, Confident Calculations so you can score 100% on your nursing school math exams. 👇

#4: Know the key differences between an adult and child airway

There are significant differences between pediatric and adult airways, including the size (it’s much smaller in diameter and length), its position (the larynx is located more toward the anterior than in adults) and its shape (the airway narrows at the cricoid ring whereas in adults its more narrow at the vocal cords). The other big difference is the size of the tongue which is relatively larger in the oropharynx than in an adult, making occlusion more likely and intubation more difficult.

The main issue that you’ll likely be dealing with is the short, narrow airway. Imagine a newborn having an average internal tracheal diameter of 2.5 mm…there’s not much room there for edema or obstruction of any magnitude. Even a small obstruction will greatly increase airflow resistance, putting the patient at risk for respiratory distress. Of course, as the child ages, the tracheal diameter increases. By age 1 it’s about 4.5 mm, by age 6 it’s closer to 6 mm, and by 14 years it is at or approaching adult sizes of approximately 8 mm diameter.

Pediatric patients also have physiological differences that make them more prone to respiratory distress and respiratory failure. For starters, infants have significantly higher oxygen consumption than do adults with one study showing an infant’s demands at 6 mL/kg/min versus just 3 ml/kg/min in an adult. Further, infants have lower functional residual capacity (the amount of air left in the lungs after exhalation), so even brief periods of apnea can cause desaturation to occur quickly. Also, from my observation of pediatric patients, they tend to decompensate quickly. They can compensate quite well but for shorter periods of time, and when they crump, they crump hard. So any pediatric respiratory distress should be viewed as an urgent situation and requires close monitoring along with expert intervention.

#5: Know what a child in distress looks like

Young children are naturally curious about their environment and the people around them. So one of the first things to assess in your young patients is how alert and responsive they are to the environment. If the child is engaging with others, moving around, acting curious and getting into things, they are generally not in distress. However, a child who is listless or minimally interactive with the environment is a child you must take very, very seriously. 

In addition, nasal flaring, accessory muscle use, grunting, stridor, and cyanosis are ominous signs of impending or current respiratory failure. Remember, children can compensate quite well for a while, but when they decompensate, they do so very, very quickly.

#6: Understand that assessing a child is a lot different from assessing an adult

The final thing to know about pediatric clinicals is that assessing a child is nowhere as easy as assessing an adult. In most cases, adults cooperate with assessments, but children naturally avoid strangers and painful or irritating stimuli. Plus, they tend to move around a lot and have short attention spans. If your assessment is taking more than a few minutes, the child is likely going to become distracted and want to move on to exploring something more interesting. With that said, a few tips for assessing children include: 

• Incorporate play as appropriate for the child’s age
• Involve the child as much as possible
• Let the child touch and explore equipment (such as a stethoscope) before using it on the child
• Start with the least irritating assessment and move toward most irritating – this usually means measuring blood pressure last
• Break the assessment up into small chunks rather than doing it all at once when feasible
• For a very sick child, start with the most critical assessments first (in children this will often be respiratory, but always take each child’s unique situation into account).

I hope these tips help you enter pediatric clinicals more prepared and feeling more confident. Most of all, remember to embrace the unexpected, be flexible, and have fun!

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Last Updated on August 2, 2026 by Maureen Osuna, MSN, RN