Pediatric assessment triangle

The Pediatric Assessment Triangle is a tool used in emergency medicine to form a general impression of a pediatric patient. In emergency medicine, a general impression is formed the first time the medical professional views the patient, usually within seconds. The Pediatric Assessment Triangle is used as a method of quickly determining the acuity of the child, and can determine whether the child is in respiratory distress, respiratory failure, or shock.

The Pediatric Assessment Triangle is taught, among other contexts, in Advanced Pediatric Life Support courses.

The Pediatric Assessment Triangle consists of three areas of assessment: Appearance; Work of Breathing; and Circulation to Skin.

The "Appearance" portion of the Pediatric Assessment Triangle measures a variety of things, designed to determine whether the child is experiencing mental status changes (as these can be difficult to identify in an infant or young child). Components of the "Appearance" item also help to determine whether the child's airway is clear.

The acronym "TICLS" (pronounced "tickles") is sometimes used by emergency medical providers to recall the components of the "Appearance" item:

"Work of Breathing" measures respiratory effort and visible signs of respiratory distress.

A normal score on the "Work of Breathing" item requires that the child's breathing be noiseless, effortless, and painless. The child should not appear to be trying harder than usual to breathe.

An abnormal score on this item indicates that the child is exhibiting an abnormal respiratory effort. The respiratory effort may be increased (indicating that the child is trying harder than normal to breathe), decreased, or absent.

Signs of increased work of breathing include:

A child exhibiting decreased work of breathing may be bradypneic (breathing too slowly) or too weak to engage the muscles required for inhalation.

"Circulation to Skin" is measured by skin color and obvious bleeding. Circulation, as measured by skin color and capillary refill, is an excellent indicator of perfusion in children.

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