Digoxin should be stopped in a child if the heart rate goes below?

AIIMS Rishikesh NO - 2019

Child Health Nursing (Pediatrics)

Hard

Appeared in: AIIMS Rishikesh NO - 2019

Explanation

The safe lower limit for heart rate before administering digoxin varies significantly with a child's age.
For infants and very young children, the standard cutoff to withhold digoxin is a heart rate below 90-110 beats per minute (bpm).
Since the question uses the general term 'child' without specifying an age, the safest and most correct choice is the one that protects the youngest and most vulnerable patients.
A cutoff of 90 bpm is the most appropriate and safest threshold among the given options to prevent severe bradycardia in an infant or young child.
Bradycardia is a primary sign of digoxin toxicity in the pediatric population.

Option A: A heart rate cutoff of 60 bpm is the standard guideline for withholding digoxin in adult patients, not children.
Option B: A heart rate cutoff of 70 bpm is used for older, school-aged children. It is not a safe threshold for infants or toddlers, whose normal heart rates are much higher.
Option D: While 110 bpm is a safe cutoff, 90 bpm is the more commonly accepted lower limit for infants. Withholding at 110 bpm might be overly cautious and could lead to sub-therapeutic dosing, although safety is the priority.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological safety and nursing considerations for administering Digoxin to pediatric patients as background academic context rather than a clinical decision trigger.
Always check the apical pulse for one full minute before administering digoxin to ensure an accurate heart rate measurement, especially in children where rates can be irregular.
Digoxin has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose is small. Meticulous assessment is critical for patient safety.
Early signs of toxicity in children are often cardiac (bradycardia, arrhythmias) and gastrointestinal (nausea, vomiting). Unlike adults, children rarely report the classic visual disturbances (yellow halos).

How to Approach the Question

First, identify the core of the question: it's asking for a specific safety parameter (heart rate cutoff) for a specific drug (Digoxin) in a specific population (a child).
Recall that pediatric vital signs, especially heart rate, are age-dependent. A 'child' is a broad category.
Analyze the options provided: 60, 70, 90, 110 bpm. These represent typical cutoffs for different age groups (adult, older child, infant).
Apply the principle of safety. When a question is ambiguous about age (e.g., just 'child'), choose the option that protects the most vulnerable group within that population. In this case, infants have the highest normal heart rate and are most at risk if the cutoff is too low.
Select the heart rate cutoff that is appropriate for an infant or young child (90 bpm), as this is the safest and most encompassing answer for the general term 'child'.

Concept Tested & Keywords

Concept Tested: Pharmacological safety and nursing considerations for administering Digoxin to pediatric patients.
Stem keywords: Digoxin, child, heart rate, stopped, below
Lead-in keywords: below
Clinical cues: The patient is a child, which requires age-specific vital sign parameters.
Clinical cues: The medication is Digoxin, which has a narrow therapeutic index and risk of cardiotoxicity.

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 76-78