Pulse Oximeters: Does Your Child Need One?

The COVID-19 pandemic ushered in a rise in home pulse oximetry marketing, to measure the amount of oxygen in the blood. But does your child need one? The answer depends on whether you understand the device's limitations that are required for safe use.

Pulse oximeter – who's it for?

If your child has a condition that affects their heart or lungs, doctors may recommend that you use a home pulse oximeter, either intermittently throughout the day or continuously overnight. Some of those conditions may include congenital heart conditions, chronic lung conditions, or sleep apnea.

Some doctors recommend that kids with asthma or other respiratory conditions keep a pulse oximeter in a home first aid kit, for use during an asthma attack or acute event.

In this season of viral illnesses, some providers recommend having them for spot checks at home when kids are showing other signs of illness such as fevers, cough, and congestion.

Should you use a pulse oximeter?

It depends. A Cochrane Review surveyed multiple studies that evaluated home pulse oximeter use in people with asthma. It found no evidence to support or refute that home pulse oximetry guided decision-making for people experiencing an asthma exacerbation.

Another study found that consumer baby monitors including pulse oximetry performed more inconsistently than FDA-approved monitors. They also do not prevent sudden unexpected deaths in infants.

So what does that mean? Home pulse oximetry can be beneficial depending on the reason you are using it, who is recommending it, and what kind of device you are using.

Sometimes, more information isn’t helpful, especially if it’s not reliable. For some families, monitoring their child’s oxygen status is necessary due to a medical condition. Others value the peace of mind they feel by monitoring their baby. Ultimately, pulse oximeters are best used with health provider guidance and oversight.

How a pulse oximeter works

A pulse oximeter measures the amount of oxygen in the blood by emitting and detecting infrared light. While pulse oximeter devices vary by design, the function is the same. A light on the oximeter probe shines through the skin to measure the amount of oxygenated blood in red blood cells and displays a number as a percentage.

Notably, many studies have found that pulse oximeters provide higher oxygen readings for people with darker-pigmented skin. This falsely high reading could hide low oxygen levels. There is a growing call from medical researchers to address this significant racial disparity in medical technology and monitoring.

Ways to wear a pulse oximeter

There are many different pulse oximeter designs. The COVID-19 pandemic spotlighted home pulse oximeters as a measure of early hypoxia, which rapidly increased consumer marketing for these products, so they are not standardized.

Typically, pulse oximeters are worn as a clip over the finger or earlobe. Some pulse oximeters that are used continuously have a probe on a cord that is attached to a plugged-in machine. The probe is wrapped around a finger or toe overnight.

Low pulse oximeter reading – what to do?

Typically blood oxygen levels, referred to as SpO2, should be greater than 95%. If your pulse oximeter is reading lower than that, try troubleshooting first:

• Check position. Is the oximeter situated over a nailbed? Is movement interfering with a good read? Wait a minute or two for the monitor to provide a measurement.
• Check size. Smaller children need a different size pulse oximeter than adults.
• Check cleanliness. Is the monitor clean? If not, you can clean with an alcohol swab or a disinfectant wipe. Nail polish and artificial nails will also interfere with the sensor.
• Check temperature. Are your child’s hands or toes cold? Try warming them up before checking a reading.

If you see a low reading, do not rely on technology alone. A home pulse oximeter can provide you with one piece of data, but use it in the context of other information. Look for other signs of low oxygen by asking:

• What symptoms does your child have?
• How fast are they breathing? Set a timer for one minute and count their breaths.
• Are they using muscles around their belly and neck to help them breathe?
• What color is the skin around their mouth or nailbeds?
• What is their heart rate?

Call your doctor or seek emergency medical care for concerns of low oxygen or breathing problems.