Clinical Assessment

The assessment and management of Airway, Breathing, Circulation, Disability and Exposure is as per the advanced paediatric life support (APLS) guidelines. [5] The history taken may need to be brief in the first instance whilst ABCDE is are assessed.

Early recognition of a decreased consciousness is essential and several conscious level scoring systems have been described. [5]


A   Alert
V   Responsive to verbal stimuli
P    Responsive to painful stimuli
U   Unresponsive

Glasgow Coma Score (GCS)

The modified Glasgow coma score (GCS) is recommended for recognition and for assessing changes in conscious level in a child (Table 1). [1,6] Changes in conscious level should be observed by recording the modified GCS every 15 minutes if GCS is less than or equal to 12, or every hour if greater than 12. [1]  Performing an accurate GCS recording is easier said than done, particularly in the preverbal child.

Table 1 Child’s Glasgow Coma Scale [5]

Score >5 years of age <5 years of age
Eye opening 4 Spontaneous Spontaneous
3 To voice To voice
2 To pain To pain
1 None None
Verbal 5 Orientated Alert, babbles, coos, words or sentences normal for age
4 Confused Less than usual ability, irritable cry
3 Inappropriate words Cries to pain
2 Incomprehensive sounds Moans to pain
1 No response to pain No response to pain
Motor 6 Obeys commands Normal spontaneous movements
5 Localises to supraorbital pain Withdraws to touch
4 Withdraws from nailbed pain Withdraws from nailbed pain
3 Flexion to supraorbital pain Flexion to supraorbital pain
2 Extension to supraorbital pain Extension to supraorbital pain
1 No response to supraorbital pain No response to supraorbital pain

The nationally-developed evidence-based guideline outlines the management of children and young people with a decreased conscious level. [1]

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