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Related Subjects:Sick Neonate |APGAR Scoring |Approach to Assessing Sick Child |Sick Child with Acute Gastroenteritis |Sick Child with Respiratory Distress |Sick child Diabetes Mellitus Type 1 and DKA

Identifying a Sick Child/Neonate

• Assessment of children is sometimes difficult as the signs and symptoms of illness may not be as marked or as readily expressed as those in adults. Also, the normal value of vital signs vary with age, thus their interpretation requires discrete knowledge of age-appropriate values.

Initial Impression

• It is the first quick assessment of the child by just looking and listening (without even touching) which can be done within seconds of encountering the child. It consists of assessing consciousness, breathing and colour.

Primary Assessment: On examination, assess ABCDE :

• A - Airway: Clear/ Maintainable/ Not Maintainable – Look for the presence of inspiratory sounds viz., bubbly sounds, snoring, stridor, grunting and wheeze are suggestive of partial or complete obstruction of the airway.
• B - Breathing: Presence of tachypnoea, bradypnea, chest retractions, nasal flaring, increased effort while breathing, head bobbing, abnormal chest sounds, asymmetrical air entry, cyanosis are suggestive of respiratory distress.
• C - Circulation: Presence of tachycardia, bradycardia, weak/absent peripheral pulses, prolonged capillary refill time, hypotension, mottling, cold extremities, deteriorating consciousness, acidotic breathing are suggestive of inadequate peripheral circulation (shock).
• D - Disability: AVPU scale (Alert, Responsive to Voice, Responsive to Pain, Unresponsive), Glasgow coma scale (GCS), Pupillary response to light.
• E - Exposure: Temperature, skin rash, petechiae, purpura, injury

History Taking

• Ask for: High-grade fever, rash, persistent vomiting, noisy breathing, laboured breathing, poor feeding, lethargy, decreased urine output, acute onset of pallor, abdominal distension, any allergies, medications and past history of any significant illness.
• A decreased level of consciousness, confusion and agitation may each be an indication of inadequate circulation to the brain- suggestive of either hypoxia (impending respiratory failure), shock or primary brain dysfunction.
• After initial impression and primary assessment, one is able to rule out any life-threatening problems and broadly classifies the sick child into the following categories: respiratory distress, respiratory failure, compensated shock, decompensated shock and primary brain dysfunction.

Sick Neonate

References

• Reference article