1. ASSESSING SEVERITY OF ILLNESS IN THE CHILD By Dr. Derek Louey

2. ASSESSING SEVERITY OF ILLNESS Applies particularly to neonates/infants/toddlers Don’t be intimidated Follow a systematic approach Assess severity first - diagnosis comes later

3. ASSESSING SEVERITY OF ILLNESS Initial assessment Occurs without needing to touch the child Can be performed rapidly in less than 1 minute Done at triage Taking of vital signs

4. ASSESSING SEVERITY OF ILLNESS Airway Breathing Circulation Disability (Neurological) Exposure LIFE-THREATENING ILLNESSES ACT BY EXERTING THEIR EFFECT ON THE ABOVE

5. AIRWAY Stridor Tracheal tug Drooling

6. BREATHING Increased work Increasing fatigue Decreased effectiveness

7. BREATHING Increased work Recession  RR Grunting Nasal flare Accessory muscle

8. BREATHING Increasing fatigue  RR  breath sounds  chest/abdominal movement Apnoeic spells (c.f. periodic breathing)

9. BREATHING Decreasing effectiveness Cyanosis  Alertness

10. CIRCULATION Pallor/Peripheral cyanosis  capillary refill

11. DISABILITY Conscious state Eye contact Activity Cry

12. DISABILITY Conscious state Lethargic/Dull/Expressionless Irritable Not recognizing mother Seizures Not responding to pain Quiet/Unresponsive

13. DISABILITY Eye contact/Smile Lack of social smile Not Fixing/Following/Focusing Glassy stare

14. DISABILITY Activity Require assistance Not ambulating

15. DISABILITY Cry Unable to be placated by mother Whimpering/Sobbing Irritable Weak/Moaning/High pitched

16. EXPOSURE Mottled Petechiae Unexplained bruising (NAI)

17. VITAL SIGNS Different reference range for different ages BP is an important value often forgotten Hypothermia is suggestive of sepsis Pulse oximetry - ‘the fifth vital sign’ Weigh the child Check blood sugar

18. WHY WEIGH THE CHILD? Changes of weight are a good guide to degree of dehydration Determines drug dosing Determines IV fluid calculations

19. SIGNS OF SEVERE ILLNESS Resting stridor Marked intercostal/sternal recession with accessory muscle use and tachypnea Cyanosis Capillary refill > 4sec (normal < 2 sec) /  HR Impalpable pulse or hypotension or  HR Not fixing/following or responding to environment

20. REASURRING SIGNS No stridor or only stridor with activity Mild recession Good colour Capillary refill < 2 sec Responding to mother and examiner/Able to be placated by mother

21. PRACTICAL TIPS Maintain a calm and reassuring manner (helps the parents and yourself) Keep a handy reference at triage of age- related ranges of paediatric vital signs When assessing capillary refill - choose an area of the trunk and apply pressure for 4 secs before releasing

22. PRACTICAL TIPS Assess pulse at brachial artery (inside elbow) Use age appropriate BP cuff (width 2/3 circumferance) Use paediatric probe for pulse oximetry

23. PRACTICAL TIPS Weighing the child use proper paediatric scales (NOT adult scales) ideally unclothed with small babies Record to within 0.1kg for a neonate Record to 0.5kg for an infant