Criteria
Infant
Child
Adult
Score
Eye opening
Spontaneous
Spontaneous
Spontaneous
4
Verbal stimulus
Verbal stimulus
Verbal stimulus
3
To pain
To pain
To pain
2
None
None
None
1
(Criterion total)
(1–4)
Verbal response
Coos, babbles
Oriented, appropriate
Oriented
5
Irritable cries, consolable
Confused
Confused
4
Inconsolable, moans
Inappropriate words
Inappropriate words
3
Inconsolable, agitated
Incomprehensible
Incomprehensible
2
None
None
None
1
(Criterion total)
(1–5)
Motor response
Spontaneous, purposeful
Obeys command
Obeys command
6
Withdraw to touch
Localizes pain
Localizes pain
5
Withdraw to pain
Withdraw to pain
Withdraws to pain
4
Flexion to pain (decorticate posture)
Flexion to pain (decorticate posture)
Flexion to pain (decorticate posture)
3
Extension to pain (decerebrate posture)
Extension to pain (decerebrate posture)
Extension to pain (decerebrate posture)
2
None
None
None
1
(Criterion total)
(1–6)
Total GCS
3–15
(e)
Exposure:
(i)
Children should be completely exposed and examined, including the removal of all clothing and diaper. Avoid thermal energy loss as the infant/toddler will have a high body surface area to body volume ratio. Warmed blankets should be readily available, and they should be applied as soon as the primary survey is completed.
5.
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Vital signs and monitoring:
(a)
The Provider should utilize a multi-modal monitoring approach for a child just as they would for an adult. Urine output, vital signs, labs/ABG/i-STAT (Abbott Laboratories, Abbott Park, IL), nasogastric tube, electrocardiogram (ECG), ventilation monitoring, and frequent re-assessment are the mainstay for the monitoring of trauma patients.
(b)
Normal urine output:
(i)
Infants – 2 mL/kg/h.
(ii)
Younger children – 1.5 mL/kg/h.
(iii)
Older children – 1 mL/kg/h.
Table 2
Pediatric normal vital signs
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