Paediatric ECGs take a bit of getting used to. They change with age and I always have a crib sheet with me if looking at them formally. Well, can any non-cardiologists remember off the top of their head how many little squares are allowed to make up the R wave in V1 in a 1 week old compared to what is normal in a 15 year old? I like the crib sheet from the university of Chicago available at http://learnpediatrics.com/body-systems/cardiology/approach-to-pediatric-ecg/ although the first test is to fill in the lead numbers on the last 2 pages as they seem to have been left off! I also use “How to read Paediatric ECGs” by Park and Guntheroth (Mosby Elsevier) although it probably has more detail than is necessary for non-paediatricians. October’s ED version of Paediatric Pearls provides this same link to the Chicago crib sheet and also refers the reader to a recent paper on cardiac arrythmias which has some nice illustrative ECG strips. For those of you interested in such things, there is a course on paediatric ECGs run by cardiology registrars in central London twice a year. Their website is www.paeds.co.uk/ecg and the next course is early November 2010.