Table 1.

Different methods of measuring and interpreting capillary refill time in children

Method	Interpretation
Apply pressure to the nail bed or other area with visible circulation; measure the length of time it takes for blanching to disappear	A capillary refill time <2 s is normal and >4 s is abnormal. A capillary refill time between 2 and 4 s should prompt further consideration of the presence of shock
The preferred location to test capillary refill time is the sternum. If the finger or toe is used, the leg or arm must be elevated. Press firmly for 5 s	A capillary refill time >5 s indicates an inadequate cardiac output
After fingertip pressure to a distal extremity, blood should refill the area in <2 s after release	A capillary refill time >2 s in the setting of other signs of shock indicates a compensated shock state
Press on the sternum or digit at the level of the heart for 5 s	A capillary refill time >2 s is a clinical feature of shock
Cutaneous pressure on the sternum or on a digit for 5 s	A refill time >2 s can indicate poor skin perfusion, a sign that may be helpful in early septic shock
Grasp the child’s thumb or big toe between finger and thumb and look at the pink of the nail bed. Apply minimal pressure necessary for 3 s to produce blanching of the nail bed. The time to capillary refill is from the moment of release until a total return of the pink colour	Capillary refill time should be <3 s. If >3 s the child may have a problem with shock

Adapted and modified from Pandey and John.⁴⁴