Pediatric emergency medicine trisk 0130 0130
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PEDIATRIC TRIAGE CONSIDERATIONS
The triage nurse needs a strong foundation of knowledge related to specific
anatomic and physiologic issues that may put a child at risk, as well as agedependent “red flags” that must be considered during triage. The nurse should
also be comfortable interacting with children of all ages as well as their
caregivers. The following are key points when assessing a child:
1. Children have a larger body surface area than adults. This places them at risk
for both heat and fluid loss.
2. Neonates have poor thermoregulation. They should not be undressed for any
extended length of time as this cold stress causes increased metabolic demands
resulting in potential physiologic decompensation.
3. Critically ill neonates/children can present with subtle signs such as
hypothermia, poor feeding, and irritability.
4. Cardiac output is heart rate dependent in neonates and young children.
Bradycardia or severe tachycardia can be very dangerous. Hypotension is a late
finding.
5. Weight in kilograms is important in order to safely administer medications to
children. Estimation of weights in critically ill children should be done utilizing
validated tools and estimated guesses by providers and caregivers are
discouraged.
6. Children are portable. The most critically ill child may arrive being carried into
your ED, you must be ready.
7. Caregivers’ perception of illness is key. Providers must listen as caregivers
know their children best and can explain when behavior is abnormal.
8. Triage nurses must be aware of risk factors for abuse. Anything that stresses a
family puts children at risk such as lower socioeconomic levels, history of
substance abuse, history of mental illness, and single caregiver households.
Young children as well as children with chronic illness or disabilities are at
increased risk. The nurse’s knowledge of child development is very important
when assessing injuries. The nurse needs to assess if the injuries can be
explained knowing the current developmental level of the child.
9. Mental health concerns, including suicidality, among children are on the rise.
Triage nurses must be cognizant of this risk no matter the presenting chief
complaint.
Triage Process
As previously described, triage is fundamental in determining the severity of
illness and immediate needs of a patient who presents to the ED. The pediatric
triage process consists of a rapid initial assessment, primary survey, secondary
