Childhood emergencies

May 2010

FocusChildhood emergencies

Assessment of the unwell child

Volume 39, No.5, May 2010 Pages 270-275

Adriana Yock Corrales

Mike Starr


Children present to general practitioners with a wide range of problems, but most of the time they are not particularly unwell. Children with a more serious illness often compensate very well initially, so there is a risk that their illness will be overlooked or underestimated.


To outline the early recognition and management of children who are seriously ill.


The initial assessment of an unwell child includes the paediatric assessment triangle: appearance, breathing and circulation to skin; primary survey that focuses on basic life support, patient assessment and immediate management; secondary survey with a detailed history of the event and physical examination; and ongoing assessment. Medical practitioners and their clinic staff must be prepared to undertake initial emergency management of a seriously ill child, and they must have the equipment and supplies available to carry out that management effectively.

Seriously unwell children present particular challenges to the medical practitioner. The anatomy and physiology of children is different to that of adults, and this can result in differences in the presentation and severity of a range of conditions (Table 1). Children have a great ability for physiological compensation and some of the early signs of illness may not be obvious. The emphasis should be on detecting and treating the seriously ill child at an early stage to prevent deterioration.

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