PALS Tachycardia: Sinus Tachycardia vs SVT in Children

A fast heart rate in a child is usually sinus tachycardia — a response to fever, pain, dehydration or fear. The skill the PALS course teaches is recognising the smaller number of children with SVT, who need specific treatment.

Sinus tachycardia

Rate varies with activity and temperature, P waves are normal, and there is usually an obvious cause. Treat the cause: fluids for dehydration, antipyretics, analgesia. See normal heart rates by age.

SVT

Starts and stops abruptly, with a fixed rate that does not change with activity, and absent or abnormal P waves. Infants may present with poor feeding, irritability or signs of heart failure.

Stable SVT

1. Vagal manoeuvres: ice to the face for infants; blowing through a narrow straw or similar for older children.
2. Adenosine as a rapid IV push with an immediate flush, with a larger second dose if needed. See PALS drugs.

Unstable SVT

With poor perfusion, altered mental state or hypotension, perform synchronised cardioversion, with sedation if it does not delay treatment — see weight-based energies.

Wide complex tachycardia

A wide QRS may be ventricular tachycardia. Seek expert consultation; unstable patients need synchronised cardioversion. If the pulse is lost, follow the cardiac arrest algorithm. For adults, see the ACLS tachycardia algorithm.

This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.

More PALS guides: PALS assessment, algorithms and skills

• PALS Course in Abu Dhabi — dates, format and booking
• The PALS Systematic Approach: Assess, Categorise and Treat a Sick Child
• Respiratory Distress vs Respiratory Failure in Children
• Upper Airway Obstruction in Children: Croup, Foreign Bodies and Anaphylaxis
• Lower Airway Obstruction in Children: Asthma and Bronchiolitis
• Lung Tissue Disease and Disordered Control of Breathing in PALS
• Shock in Children: The Four Types Taught in PALS
• Septic Shock in Children: Recognition and the First Hour
• Fluid Resuscitation in Children: Boluses and Reassessment
• PALS Bradycardia Algorithm: Oxygen First, Then CPR and Drugs
• PALS Cardiac Arrest Algorithm: Shockable and Non-Shockable Rhythms
• PALS Post-Cardiac Arrest Care: After ROSC in Children
• PALS Drugs: Adrenaline, Adenosine, Amiodarone, Atropine and More
• Weight-Based Dosing in PALS: Estimating Weight and Avoiding Errors
• Intraosseous (IO) Access in PALS: When and How It Is Used
• Paediatric Vital Signs by Age: Heart Rate, Breathing and Blood Pressure
• PALS Defibrillation and Cardioversion: Energies per Kilogram
• All PALS guides, by topic

Other life support and first aid courses: BLS Course · ACLS Course · First Aid Course · Training calendar

Frequently asked questions

How do you tell sinus tachycardia from SVT in a child?

SVT starts abruptly with a fixed, very fast rate and abnormal or absent P waves; sinus tachycardia varies and has a cause.

What is the first treatment for stable SVT in an infant?

Vagal manoeuvres such as ice to the face, then adenosine.

How is adenosine given?

As a rapid IV push followed immediately by a flush.

What if the child with SVT is unstable?

Synchronised cardioversion.

What heart rate suggests SVT?

Typically 220 or more in infants and 180 or more in children, with the other features.

Sources and further reading

What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.

• CPR and ECC Guidelines — American Heart Association
• PALS course options — American Heart Association

Last reviewed 21 September 2026 by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.