Children often compensate well until late in illness, so early recognition of subtle signs is critical.
Normal vital signs vary with age, so interpretation requires knowledge of age-appropriate values.
Always compare with baseline behaviour – parents often notice early changes.

👀 Initial Impression (Paediatric Assessment Triangle)

Done within seconds, without touching the child:

Appearance: Alertness, tone, interactiveness, consolability.
Work of Breathing: Effort, noises (stridor, grunting, wheeze), chest movement.
Circulation to Skin: Colour (pink, pale, mottled, cyanosed), perfusion.

💡 Red Flags: Lethargy, poor feeding (especially in neonates), apnoea, grunting, stridor, petechiae/purpura.

🩺 Primary Assessment (ABCDE)

A – Airway: Is it clear/maintainable? Signs of obstruction: stridor, snoring, gurgling, grunting, wheeze.
B – Breathing: Tachypnoea, chest retractions, nasal flaring, head bobbing, asymmetry, cyanosis → suggest respiratory distress. ⚠️ Fatigue + bradypnoea = respiratory failure.
C – Circulation: Tachycardia, weak pulses, prolonged capillary refill, mottled/cool peripheries, hypotension (late). ⚠️ Children maintain BP until late → shock often evident first by tachycardia + poor perfusion.
D – Disability: AVPU scale (Alert, Voice, Pain, Unresponsive), GCS if older, pupils, tone, seizures.
E – Exposure: Full inspection – temperature, rash (esp. non-blanching), trauma, hydration, abdominal distension.

📖 History Taking

High fever, persistent vomiting, rash, difficulty breathing, noisy breathing, poor feeding, reduced urine output.
Parental concern: “not themselves”, lethargy, weak cry.
Past history: prematurity, congenital heart/lung disease, immunodeficiency.
Drugs/allergies: e.g. recent antibiotic, known asthma.
Altered consciousness or agitation = may indicate hypoxia, shock, or CNS pathology.

⚡ Classification After Initial Assessment

Respiratory distress: Increased effort but maintaining oxygenation/ventilation.
Respiratory failure: Inadequate oxygenation/ventilation → bradypnoea, low sats, exhaustion.
Compensated shock: Tachycardia, poor perfusion but normal BP.
Decompensated shock: Hypotension (late, pre-arrest sign).
Primary brain dysfunction: Reduced GCS, seizures, post-ictal, bulging fontanelle.

👶 Sick Neonate

💡 In neonates, non-specific signs (poor feeding, lethargy, temperature instability, apnoea) may be the only clues to life-threatening illness such as sepsis.

📚 References

Reference article

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