Paediatric ECG lead placement

Placement of paediatric ECG leads

In young children, the right ventricle normally extends to the right side of the sternum. To appropriately display right ventricular potentials, ECGs for children in the under five-year age group must include an alternate lead (‘V4R’) on the right side of the chest, at a point analogous to the left-sided V4.

Precordial leads:

  • V1: 4th intercostal space, right sternal border
  • V2: 4th intercostal space, left sternal border
  • V3: midway between V2 and the placement of V4 in adults (5th intercostal space, left mid-clavicular line)
  • V4R: 5th intercostal space, right mid-clavicular line. Use this lead for V4R, must label as such on ECG.
  • V5: anterior axillary line, same horizontal plane as V4
  • V6: mid-axillary line, same horizontal line as V4
Limb leads:
  • Place on top part of arm or leg (less muscle interference)


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MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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