Pediatric assessment triangle

Background

• Tool used to succinctly evaluate and form a general impression (sick/not sick) of a pediatric patient
• Consists of three domains: Appearance, Breathing, and Circulation

Evaluation

Appearance

• Muscle tone
• Irritability/consolability
• Gaze (tracking, eye contact, vacant stare)
• Age-appropriate speech

Breathing

In addition to respiratory rate this includes assessing for:

• Grunting or noisy breathing
• Use of accessory muscles of respiration
  • Intercostal or supraclavicular retractions
  • Belly breathing
• Nasal flaring

Circulation

• Look for pallor, mottling, or cyanosis
• Check capillary refill

Management

Children with an abnormality noted in any aspect of the pediatric assessment triangle require resuscitation

• Breathing difficulty with normal appearance and circulation usually implies respiratory distress
  • Child is in distress but still adequately oxygenating to maintain distal perfusion and mental status
• Breathing difficulty with abnormal appearance and/or circulation usually implies respiratory failure
  • Child's oxygenation is no longer sufficient to support distal perfusion and/or mental status
• Poor appearance and circulation usually implies shock

References

• https://www.health.ny.gov/professionals/ems/pdf/pediatricreferencecard-04.pdf