EMT-Basic Exam: The Basics of Pediatric Care (Infants and Children) - Assessing Infants and Children

Once you have determined that the scene is safe, you can begin your initial assessment. Because many children don’t like to be touched, you may want to form your general impression as you approach them. Determining whether a child is healthy, sick, or injured is typically not challenging if you know what to look for.

As you approach children, note their involvement with the surrounding environment. Is the child interacting with people or objects? Is the child quiet, listless, or disinterested? Is the child displaying appropriate emotions for his or her age and the emergency setting? Does the child recognize his or her parents?

An experienced EMT-Basic with knowledge of the developmental stages of children can spot a healthy or sick child in seconds.

Once you have formed your general impression, assess the child’s mental status using AVPU distinctions—this acronym stands for alert, responds to voice, responds to pain, and unresponsive. The parents play an important role in determining a young patient’s mental status. Have the parents speak to the child to see if he or she recognizes or responds to vocal stimuli. Also instruct the parents to tell you immediately if they notice a change in the child’s behavior; a parent knows what is “normal” for the child and will notice if something is wrong.

Next, open the airway, if necessary, and assess the patient’s breathing. Look for the following signals as you continue your assessment:
- Nasal flaring
- Use of accessory muscles
- Retractions
- Airway noises
- Quality of crying or speaking
- Presence or absence of breath sounds
- Equal bilateral expansion of the chest
- Wheezing or stridor

While you assess the patient’s respiratory system, note any changes in skin color. If a child needs oxygen, he or she will not automatically become cyanotic. Instead, the child’s skin will look patchy or mottled at first.

In infants specifically, use the brachial and femoral pulses to assess circulation. While checking a child’s heart rate, compare the rates of both pulses to determine both quality and equality. If the rates differ, the infant may be suffering from poor circulation.

If the patient is too young to assess blood pressure, assess the capillary refill. The EMT-Basic performs this action by applying and releasing pressure on the nail bed. If perfusion is adequate, the capillary refill should only take about 2 seconds.

A capillary refill of more than 2 seconds could indicate shock.



Capillary refill is used to assess the circulation of children under the age of 6.

After completing your initial assessment, decide if your patient is a priority patient. Young patients experiencing an altered mental status, respiratory distress, and poor circulation are priority patients and should be transported and treated immediately.

As you gather a focused history from the child (if he or she is old enough) and the parents, perform the physical examination starting with the heart and lungs. Then assess the patient’s lower half before moving to the child’s head. Save any painful areas for the end of your assessment. This approach is called trunk-to-head. The process of assessing for DCAP-BTLS allows you to gather key information from the parent and the patient while simultaneously building the patient’s trust.

Related Topics You Should Review:
- Determining mental status (AVPU)
- Working with emotional parents
- Opening a newborn’s or infant’s airway
- Oxygen administration techniques
- Performing a physical exam (DCAP-BTLS)