This document outlines key differences in paediatric and adult physiology and provides guidance on assessing and caring for paediatric patients. It describes smaller airways, reliance on diaphragmatic breathing, and higher metabolic needs in paediatric patients. It also provides mnemonics (TICLS, FLACC, CIAMPEDS) and guidelines for assessing vital signs, pain, history, and monitoring weight and IV fluids in the paediatric population. Routine assessments include weight, pulse, respiration, temperature, and blood pressure measured according to age-appropriate norms.

1. CARE OF PAEDIATRIC PATIENT

2. Difference in Adult and Paediatric
Physiology
 Airways are smaller which increases the risk of obstruction
 Rely heavily on diaphragm for breathing
 Increased metabolic rate and oxygen consumption contribute to higher
respiratory rate
 Small stroke volume but relatively high cardiac output facilitated by higher
heart rates
 Body surface area is high and this results in rapid heat loss.
 Hypoglycaemia can be present in any paediatric patient as glycogen stores in
the liver are limited
*****Paediatric patients are not just ‘Little Adults’.

3. Quick assessment of Babies and Small Children on initial presentation
Paediatric Triangle

4. Mnemonic for the assessment of appearance - TICLS
T one – active, moving around
I nteractivity – alert, playing with care giver
C onsolability - comforted
L ook/ gaze – stare, fixed gaze
S peech/ cry – strong, vigorous, weak

5. Pain assessment Mnemonic in Babies and small children - – FLACC
 F - Face No particular expression or smile. Occasional grimace or frown,
withdrawn disinterested. Frequent to constant frown, clenched jaw, quivering
chin
 L - Legs Normal position or relaxed. Uneasy, restless, tense. Kicking, or legs
drawn up
 A - Activity Lying quietly, normal position, moves easily. Squirming, shifting
back and forth, tense. Arched, rigid, or jerking
Contd……

6. Pain assessment Mnemonic in Babies and small children – FLACC
 C - Cry No cry (awake or asleep) Moans or whimpers, occasional complaint.
Crying steadily, screams or sobs, frequent complaints
 C - Consolability Content, relaxed Reassured by occasional
touching, hugging or “talking to”, distractible. Difficult to
console or comfort

7. Pain assessment tool

8. Pain assessment tool

9. Mnemonic for collecting history in Paediatric patient – CIAMPEDS
 C – chief complaints
 I – immunisations, isolation
 A – allergies
 M – medications
 P – parents impression of child’s condition
 E – events surrounding illness/injury
 D – diet and diapers
 S – symptoms associated with illness/ injury

10. Routine assessments in paediatric patients
 Weight
 Pulse
 Respirations
 Temperature
 BP (not a routine in babies)

11. Accurate assessment of Weight is important in
paediatrics
Dose of medications are based on weight
IV fluid therapy is prescribed on the basis of weight
Gives early indication of malnutrition, dehydration
Up until age 2, paediatric patients are more susceptible for rapid
deterioration with fluid loss

12. VITAL SIGNS
 Measure the pulse rate for 1 full minute in infants and children to detect any abnormal rhythms
 Pulse should be measured apically in children with cardiovascular disease or when the radial
pulse is irregular or difficult to palpate. Apical pulse assessment is done by placing the diaphragm
of the stethoscope around the fifth intercostal space in midclavicular line.
 Respiratory assessment (rate, rhythm, effort and depth) must be done in a way that the child is
not aware of it being assessed. Keep the fingers on the area where pulse is palpated where the
pulse is palpated, but observe the chest for respiration.
 Choose the appropriate BP cuff - cuff bladder length should cover 80% to 100% of the arm
circumference
 Blood pressure should be measured after the child has been quiet for at least 5 minutes.
 Document in age appropriate charts

13. Age Heart rate (bpm) Resp. rate (bpm)
Temperature
(Celsius)
1 – 11months 90-170 30-45
0-6 months 36.2–
37.4
6-12 months 35.6 –
37.6
1-2 years 90-150 20-30
1 -13 yrs
35.5 – 37.2
3-4 years 70-130
20-30
5-7 years 65-130
20-25
8-11 years 70-110 14-22
12-15 years Male 50-90
Female 55-95 12-20
Above 13 yrs
35.8 -37.6

14. IV Fluid Administration
 Weight prior to therapy and daily afterwards
 6th hourly weights measurement if ongoing fluid loss (eg; diarrhoea, vomiting etc).
 Check serum electrolyte and glucose prior to commencement of infusion and again
within 24 hours if IV therapy is to continue

15. IV Fluids maintenance calculation
Patients weight Full Maintenance mls/day mls/hour
3 to 10kg 100 x wt 4 x wt
10 - 20kg 1000 plus 50 x (wt-10) 40 plus 2 x (wt-10)
>20kg 1500 plus 20 x (wt-20) 60 plus 1 x (wt-20)
Source: The Royal Children's Hospital, Melbourne, Australia, Clinical Practice Guideline
on Intravenous fluids, viewed on 05/02/2019, Available from https://wwww.rch.org.au/clinicalguide/

16. References used
1. Chiocca, E. R. M. C., & Chiocca, E. M. M. C. A. (2014). Advanced pediatric assessment, second
edition : a case study and critical thinking review
2. The Royal Children's Hospital, Melbourne, Australia, Clinical Practice Guideline on Intravenous
fluids, viewed on 05/02/2019, Available from https://wwww.rch.org.au/clinicalguide/
3. Victorian Children’s Tool for Observation and Response (ViCTOR) This website has some useful videos
demonstration various paediatric assessment practices.
https://www.victor.org.au/implementing-victor/victor-back-to-basics/