Tips for counting neonate's RR and HR?

[MyAimIsTrue, BSN]

I'm a student nurse doing an internship in the postpartum unit. I would love pointers and tips about doing the baby's assessment, especially regarding how to count their fast RR and HR.

Thank you!

[AZBlueBell]

Such a simple thing that works so well for me is to tap your finger on the crib (or against your thumb) when counting. It really helps focus you in on that one and only sound you should be listening too, especially since it is so fast!

[jennylee321]

Counting HR is pretty straight forward after some practice. Always try to take HR and RR when baby is settled because counting a HR of 200 is not fun.

For RR you can count the chest rises but I often place my hand on the chest to count because babies sometimes have periods of shallow breathing that you might miss if you are just watching.

[cayenne06, MSN, CNM]

Don't forget that newborns naturally have a variable RR, so you really need to do a full minute. I agree that a hand on the chest can be easier than trying to watch for a rise. I will use my steth to count too sometimes, but that can be difficult unless the baby is in a deep sleep, flat, and shirtless under a warmer. Plus the stethescope itself might make them squirmy or fussy. Having a parent cuddle them can help keep them calm, The tapping is really helpful for HR.

Make sure you check breath sounds and peripheral perfusion too. Newborns are in a transitional state and the plain old numbers won't give you all the info you need. Don't worry too much about an exact count- it's okay if you count 30 and your preceptor counts a little more or less, as long as you are in the same ballpark. You are looking at the whole picture and the overall trends in their vitals.

You just have to lay your hands on as many newborns as possible, even though its super boring to stand there counting over and listening over and over again. You have to hear/feel/see normal over and over again, so you can pick it up when something seems a little hinky.