Pediatric Assessment: Compare Patient Assessment Findings to Normal

by on October 17, 2011

in EMS Tips

Most times “Sick” will hit you over the head when you see a child from across the room or as you stand in the doorway. Other times it is less obvious and a good way to determine if the child is ill and how ill is to compare your assessment findings to normal.

Activity: What is the child’s level of activity during play with others or alone like compared to normal?

Bathroom: When was the child’s last bathroom activity or soiled diaper? Is the frequency and volume as expected?

Consolable: Are parents or caregivers able to console the child with quiet talk, soothing touch, and or distraction?

Drinking: Is the child drinking normal volume and at a normal rate? Sips, when a child normally gulps, might indicate airway swelling, discomfort, or irritation.

Eating: Is the child eating normal amounts and at regular times?

Fever: Does the child have a fever? Review this tip on infant rectal temperature assessment.

Sick or not sick? Compare normal to abnormal.

ABCDEF … I couldn’t keep the list going, but here are a few other things to consider.

Pain and Discomfort

Look for non-verbal clues about pain which might include eye rubbing, hair pulling, or other self-soothing behaviors. For a verbal child ask about where the pain is located, what it feels like, and use the faces pain assessment scale. For an adolescent use the OPQRST pain assessment questions.

Parent Interventions

Have the parents administering any medications? What, when and how much? And importantly what was the child’s response.

Pedi-U Podcast

Make sure you listen to the Pedi-U Podcast, an amazing informative and free pediatric education resource.


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  • http://www.drtrirunner.com Erika @ Dr.TriRunner

    Another acronym to add to the book… I like it! Question for you – at what age do you stop using capillary refill as a marker for adequate circulation? 

    • http://everydayemstips.com Greg Friese

      I have never been a fan of or a regular assessor of capillary refill because of its limitations such as difficult to assess in poor ambient light conditions or if the patient is cold. That being said no single sign at a single time is a marker of inadequate circulation. One set of vital signs or one assessment finding is merely interesting. Multiple signs, trending over time, tell a story about the patient.

    • http://510medic.com 510medic

      Interestingly enough (and somewhat related) I’ve read a few studies which looked at how much arterial occlusion is necessary to delay capillary refill time.  In adults, it can take up to 90% decrease in arterial blood flow to increase refill time by one second.  Obviously this isn’t a direct corollary to pediatric cap refill in hypotensive states, but it is certainly food for thought!

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