EDAITUTOR
ED Reference · Paeds Essentials v1.0 Educational use only

How to Assess
a Sick Child

A structured, end-of-bed-to-ABCDE approach — the assessment triangle · age-based vitals · the red flags — to spot the child who is sick, or about to be.

TriangleABCDERed flags

↔ Prefer the one-screen quick card?

🔴 Children compensate — then crash

A child can maintain a normal blood pressure until they are peri-arrest. Tachycardia, work of breathing and altered behaviour are the early signs; hypotension is late. Trust the Paediatric Assessment Triangle, use age-based vital sign ranges, and escalate early. If your gut says the child is sick, treat them as sick.

First look
  • End-of-bed assessment before you touch
  • Well or unwell? Interactive or floppy?
  • Paediatric Assessment Triangle
  • Then a structured ABCDE
  • Weight / age → drug & equipment sizing
⚪ tipThe child's appearance and interaction tell you more in 5 seconds than any single number.
🟢 RCH · Starship
The Triangle
  • Appearance: tone, interactivity, consolability, look/gaze, speech/cry
  • Work of breathing: noises, position, recession, nasal flare
  • Circulation to skin: pallor, mottling, cyanosis
  • Two sides abnormal → critically unwell
⚪ tipThe PAT is a hands-off tool — it frames severity before you start ABCDE.
🟢 APLS · RCH
ABCDE
  • A: airway patency, added sounds, positioning
  • B: rate, work, SpO₂, air entry
  • C: HR, cap refill, pulses, perfusion; BP is late
  • D: AVPU / GCS, glucose (don't ever forget glucose), pupils
  • E: temperature, rash, exposure, don't forget the nappy
🟢 APLS · RCH
Red flags
  • Abnormal appearance / reduced conscious level
  • Grunting, severe recession, apnoea
  • Mottled / pale / cyanotic, prolonged cap refill
  • Non-blanching rash · bulging fontanelle
🔴 red flagAny single crossed threshold plus a gut feeling of "unwell" → escalate and reassess.
🟢 NICE · RCH
How to assess a child well — a safe routine

Look before you touch

Form an impression from the doorway — appearance, breathing and colour — before disturbing the child.

🟢 RCH

Use age-based numbers

A "normal" HR at 6 months is tachycardic at 12 years — always interpret vitals against the right age band.

🟢 APLS

Weight everything

Estimate weight early (tape / formula) so fluids, drugs and equipment are ready before you need them.

🟢 RCH

Reassess, then reassess

Sick children change fast — repeat the triangle and vitals after every intervention and set clear review points.

🟢 NICE

Age-based vital signs — know the normal ranges
infant < 1 yr

< 1 year

HR 110–160 · RR 30–40 · SBP 70–90

APLS · verify chart
toddler 1–4 yr

1–4 years

HR 100–150 · RR 25–35 · SBP 80–95

APLS · verify chart
child 5–11 yr

5–11 years

HR 80–120 · RR 20–25 · SBP 90–110

APLS · verify chart
adolescent 12+ yr

12+ years

HR 60–100 · RR 15–20 · SBP 100–120

APLS · verify chart
hypotension

SBP threshold

Minimum acceptable SBP ≈ 70 + (2 × age in yrs) — a late sign.

late sign
fever

Temp & age

Any fever < 3 months is a red flag; note the < 1 month / 1–3 month rules.

< 3 months
⚪ interpret in contextNumbers guide, they don't diagnose — a "normal" HR in a mottled, drowsy child is still a sick child. Ranges to be finalised against the local paediatric observation chart.
Assess step-by-step — a repeatable routine
1

End-of-bed

  • Well vs unwell impression
  • Interactive, tone, colour
2

The Triangle

  • Appearance · WOB · circulation
  • Frames severity hands-off
two sides = critical
3

ABCDE

  • Structured primary survey
  • Glucose & temperature every time
4

Focused Hx & exam

  • Feeds, output, activity, immunisations
  • Head-to-toe, expose fully
5

Synthesise & act

  • Sick / not sick / uncertain
  • Treat, escalate, reassess
reassess
Serious illness not to miss
shock · time-critical

Sepsis

Fever/hypothermia + abnormal appearance or perfusion. Follow the paediatric sepsis pathway.

sepsis pathway
rash

Meningococcaemia

Non-blanching rash, unwell child — don't wait for the full picture.

antibiotics now
metabolic

DKA

Tachypnoea, dehydration, drowsiness — check glucose & ketones.

check glucose
surgical

Intussusception

Intermittent pain, drawing up legs, redcurrant stool, lethargy.

surgical review
safeguarding

Non-accidental injury

Inconsistent history, pattern injuries — consider & escalate.

safeguard
airway/resp

Severe bronchiolitis / asthma

Apnoea, exhaustion, silent chest — early senior help.

escalate
⚪ escalate earlyThe safest move with a sick child is early senior and paediatric involvement. Confirm destination and retrieval (PIPER) with local protocols.
Don't miss
  • Compensated shocknormal BP with tachycardia & poor perfusion
  • Hypoglycaemiathe silent cause of the "off" child
  • Sepsissubtle early signs, rapid decline
  • NAIhistory that doesn't fit the injury
🟢 NICE · RCH
Quick rules
  • Never forget glucose in the unwell child
  • Hypotension is a late, pre-arrest sign
  • Two abnormal triangle sides → critical
  • Fever < 3 months → full workup
  • Trust the parent — and your gut
  • When in doubt, reassess & escalate
🟢 RCH · NICE
Escalation
  • Call for senior & paediatric help early
  • Prepare weight-based drugs & airway kit
  • Activate retrieval (PIPER) if beyond local capability
  • Clear ISBAR handover & documented review points
🔴 red flagDeteriorating despite treatment → escalate now, don't wait for the next set of obs.
🟢 ANZCOR · RCH

ED AI Tutor — ED Reference Series · v1.0 · For clinician education only. Not a substitute for clinical judgment, local guidelines or senior oversight. Assessment of a sick child must always be correlated with the clinical picture and escalated appropriately.