As a paramedic we attend a lot of paediatric emergencies. These are some of the few tips that I use every time I assess a child after an accident, medical emergency, and not so urgent event. Even the seasoned paramedic will tell you that he or she doesn’t feel comfortable assessing a critically ill child. Children are not like small adults, they compensate remarkably well, but rarely have a decompensatory period.
This is how I assess a critically ill child:
Like everything else, we start to make assumptions or determine basic warning signs as we walk through the door and get our “first impression” – is the child well or not well.
To do this, we can look at a variety of structured approaches that ultimately, most paramedics will develop as part of their gut instinct. One such structured approach that I have found useful is called the TICLS assessment tool. Where the clinician looks for the child’s:
Tone – good is a child that is grabbing; bad is a still or floppy child.
Interactiveness – good is a child that is interested in the world and smiling; bad is a child uniterested in the world
Consolability – good is a child that is easily comforted by gentle rocking and by being wrapped up firmly; bad is an unconsolable child.
Look – good is a child that looks at you and follows your movement; bad is a child that is staring or not engaging in eye movements.
Speech/cry – a child who cries or talks is a good sign; a child who is moaning, grunting or QUIET is bad!
Remember, as an adult, you appear much larger to a child and more confronting, so here are some basic guidelines for assessing children:
1. Try and involve the parents/carers as much as possible before, during and after you do anything! This may not be possible if the parent or carer is hysterical.
2. Crouch down and get down to the child’s height. I like to talk to someone at face height and I’m sure a child has no desire to look up at a giant who is asking them personal questions.
3. Speak in a slow, calm, confident tone. Children are very intuitive and will easily pick up if you appear flustered or nervous that there is something seriously wrong!
4. Use age specific examples to explain what you are going to do and why. Don’t try and play something down. If you are going to insert a cannula, it is going to hurt, let the child know, but explain that it will only hurt for a few seconds and then you can take away their pain.
5. Children are very different from adults, if you ever give a medication (particularly an IV injection or IM injection, always cross check with your partner).
Beware of the patient who displays Paediatric Warning Signs!