I always remembered from decades ago working in the ED as a tech...children look great and compensate until they don't. They cannot sustain high just above normal vital signs for very long until they tire. Children just don't have the reserves of energy.
This was handy today when one of my complex tech dependent kiddos was just above normal and my gut said too much change, too much effort and increased work of breathing and put kiddo back on the vent. Continuous assessment looking for the trend of small changes that helped me make a quick care decision within my scope and plan of care. The relief was immediate even the mom commented how comfortable he looked when she came to relieve me at the end of my shift.
I think the hardest thing for many non-pediatric specialists to realize is that children are not small adults and have their own unique needs and challenges. Many are "afraid" of the medically complex population I work with but having a strong knowledge background, a willingness to learn/research and knowing the child's baseline has served me well over the years.
All of my continuous pulse ox kiddos have the probe on the foot or great toe (depending on age/size). Knowing normals for age is great but finding out the baseline for a complex child is just as important. I have 18-30) a 7yo child who has baseline respirations 40-50/min and HR 100-130. If respirations stay 54 or HR sustained >140 kiddo needs to be put on the vent to prevent exhaustion or "pooping out"