Pediatric assessment triangle: appearance, work of breathing, circulation to skin.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A 5-month-old lies still, does not track your face and makes no sound when you pinch a fingernail. This is:
Answer: A. A well infant makes eye contact, tracks faces and protests handling, so the absence of all three is the pediatric equivalent of an unresponsive adult. Sleeping babies rouse and cry when a fingernail is pinched; an infant who does not is not asleep and not merely shy with strangers.
Question 2 of 5
A 4-year-old has a strong pulse of 110 but is breathing only 6 times a minute with poor chest rise. You should ventilate with a bag-valve mask at a rate of about:
Answer: A. Current AHA pediatric guidance for an infant or child with a pulse and inadequate breathing is one breath every 2 to 3 seconds, reflecting a child's faster normal rate and higher oxygen demand. One every 6 seconds is the adult rate, and too slow for a small child. A 30:2 ratio applies only to a pulseless patient, and this child has a strong pulse.
Question 3 of 5
During pediatric JumpSTART triage, a 5-year-old is not breathing even after the airway is positioned, but has a palpable peripheral pulse. You should:
Answer: A. Children often arrest from breathing problems first, so JumpSTART gives an apneic child who still has a pulse five rescue breaths: if breathing starts, she is immediate; if not, expectant. Tagging her expectant without the breaths applies the adult rule to a child. CPR is not performed during triage, because it ties one rescuer to one patient.
Question 4 of 5
A 2-year-old in a warm room has capillary refill of four seconds, mottled skin and a weak brachial pulse. These findings indicate:
Answer: A. In a warm environment a young child's capillary refill is a reliable perfusion window, and delayed refill with mottling and a weak central pulse is compensated shock. Calling it normal for a toddler ignores the three findings agreeing with each other, which is exactly how pediatric shock is missed until the child decompensates.
Question 5 of 5
A toddler makes strong eye contact, cries vigorously when examined and has pink skin. Your general impression is:
Answer: A. Interaction, a strong cry and pink skin are appearance, work of breathing and circulation all reading normal, which is the pediatric general impression of a child who is not yet in trouble. A decompensating child is quiet, floppy and mottled — vigorous protest is reassuring precisely because it costs energy the sick child no longer has.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Pediatric assessment triangle: appearance, work of breathing, circulation to skin.
- Infant respiratory rate 30–60 and heart rate about 100–160.
- Hypotension age 1–10: systolic below 70 plus twice the age in years.
- Croup is gradual with a barking cough; epiglottitis is sudden, febrile and drooling.
- Sunken fontanelle and few wet diapers suggest dehydration.
Field priorities
- Suspected epiglottitis: keep the child calm with the parent and do not examine the throat.
- Bradycardia in a sick child is a pre-arrest sign.
- Report suspected abuse; document objectively.
Coaching the patient
- A brief seizure with high fever between 6 months and 5 years is usually a febrile seizure.
Red flags: act now
- A quiet, floppy, drowsy child
- Falling blood pressure
- Injuries that do not fit the story
Pediatric Essentials: FAQs
What are the priority actions for Pediatric Essentials in the field?
Suspected epiglottitis: keep the child calm with the parent and do not examine the throat. Bradycardia in a sick child is a pre-arrest sign. Report suspected abuse; document objectively.
What findings in Pediatric Essentials change your plan or your transport decision?
A quiet, floppy, drowsy child. Falling blood pressure. Injuries that do not fit the story.
What do I need to know about Pediatric Essentials for the NREMT?
Pediatric assessment triangle: appearance, work of breathing, circulation to skin. Infant respiratory rate 30–60 and heart rate about 100–160. Hypotension age 1–10: systolic below 70 plus twice the age in years. Croup is gradual with a barking cough; epiglottitis is sudden, febrile and drooling.
What should the crew communicate or document for Pediatric Essentials?
A brief seizure with high fever between 6 months and 5 years is usually a febrile seizure.
