Final answer:
The next step is to closely monitor the child, as the respiratory rate is within normal limits but their pulse is slightly lower than normal. Preparedness for CPR is warranted if the child's condition worsens or other signs of instability arise.
Step-by-step explanation:
The question relates to the appropriate response when a child has begun breathing spontaneously at a respiratory rate of 18 breaths per minute with a pulse of 50 beats per minute. Given the normal respiratory rate for a child at different ages and the Apgar criteria, it is critical to first assess if the child's current condition is stable or requires immediate intervention. The Apgar score assesses the newborn's heart rate and respiration, among other parameters, and guides the medical response. A normal respiratory rate is between 18 to 30 breaths per minute for a child about 10 years old. Considering the child's respiratory rate is within normal limits but the pulse is lower than normal (normal being 60-100 bpm for children), close monitoring is advisable to watch for any changes. Therefore, the final answer in a two line explanation in less than 300 words: The appropriate action would be to closely monitor the child and prepare for intervention if the heart rate drops further or other signs of instability appear.
A pulse of 50, if the child is not showing signs of distress or poor perfusion, might not need immediate CPR, but it warrants close observation and possibly further medical evaluation considering it is on the lower side of a normal pulse rate for children. It is vital to be prepared to intervene with CPR if the condition worsens. However, if the child's pulse falls or signs of poor perfusion such as blue skin, lethargy, or weakness are observed, immediate CPR should be initiated, per resuscitation guidelines.