GCS in Pediatrics

Summary

This video provides guidance on performing the Glasgow Coma Scale (GCS) assessment on infants, children, and adolescents. It highlights the challenges of assessing pre-verbal children and emphasizes the need to differentiate between normal childhood behaviors and neurologic deficits. The script details how to use the GCS for different age groups, explaining the eye, verbal, and motor responses for each. It also covers techniques to elicit responses, such as pain stimuli, and the importance of collaboration with senior medical staff for accurate assessments during trauma situations.

Takeaways

• 😀 Infants and young children are pre-verbal, making the verbal portion of the Glasgow Coma Scale (GCS) challenging to assess.
• 😀 Children’s reactions to assessments may be influenced by fear and stress, which can result in uncooperative behavior such as crying or avoiding eye contact.
• 😀 Use the appropriate section of the GCS poster based on the child's developmental level: infant, child, or adult.
• 😀 For infants and toddlers (0-2 years), use cooing or babbling to score verbal response as 5, while inconsolable crying equals a 3.
• 😀 Children between 2-3 years old may start developing the verbal skills necessary to move to the child section of the GCS assessment.
• 😀 Older children and adolescents can typically follow commands and provide verbal responses, similar to adult GCS assessments.
• 😀 Eye-opening should be assessed by speaking loudly, applying touch, or using pain to elicit a response if necessary.
• 😀 Inconsolable crying or inappropriate verbal responses (e.g., irrelevant words) can help assess neurological status in young children.
• 😀 When assessing motor response, for infants, spontaneous movement is normal, while for older children, following commands like showing two fingers indicates normal function.
• 😀 If necessary, pain responses can be elicited using techniques like nail bed pressure, trapezius squeeze, or sternal rub.
• 😀 GCS should be reassessed at 5 minutes and before leaving the code room. Reassess if there is a significant change in mental status.

Q & A

Why is conducting a Glasgow Coma Scale (GCS) assessment challenging for infants and young children?

Infants and young toddlers are pre-verbal and cannot follow commands to open their eyes, squeeze fingers, or wiggle toes, making it difficult to assess the verbal and motor portions of the GCS. Additionally, their behavior may be influenced by fear or stress, which can complicate the assessment.

What is the significance of a child’s behavior in a chaotic code room during a GCS assessment?

In a chaotic code room, a child may cry, scream, or refuse to cooperate due to fear. These behaviors can be normal responses to stress but also complicate the GCS assessment. It’s important to differentiate between these behaviors and neurological deficits.

How can you encourage a child to cooperate during a GCS assessment?

You can engage children by using toys, jingling items, or interacting with familiar objects to draw their attention. For infants, making noises like silly sounds or snapping fingers may encourage them to respond.

When should the 'infant' section of the GCS be used, and for what age group?

The 'infant' section of the GCS should be used for children aged 0–2 years who are pre-verbal or have limited verbal abilities. These children may coo, babble, or cry, which will guide the assessment.

What age range is typically appropriate for using the 'child' section of the GCS?

The 'child' section of the GCS is typically used for children aged 3–6 years, who are verbal and capable of following simple commands, such as showing two fingers or gripping a hand.

How is the verbal response scored for a crying child during a GCS assessment?

For crying children, if they are consolable, they score a 4. If they are inconsolable with a high-pitched scream, they are scored a 3. If a child has no verbal effort but responds with a grunt, they score a 2.

What does a score of 5 in the verbal response section indicate for a child?

A score of 5 in the verbal response section indicates that the child is using age-appropriate words such as 'ouchy' or 'mama' in the context of the situation.

What should be done if a child’s eyes do not open spontaneously during the eye-opening portion of the GCS assessment?

If the child’s eyes do not open spontaneously, you should lean in, speak loudly, and call the child's name to see if they respond. If there is no response, you may need to apply a painful stimulus to elicit eye opening.

How can a painful stimulus be applied to assess motor response in infants and children?

Painful stimuli can be applied by pressing on the nail bed, performing a trapezius squeeze, or using a sternal rub. These methods help determine if the child responds to pain, which is important for assessing their motor function.

What is the role of the GCS poster during the assessment process?

The GCS poster serves as a reference to guide the examiner in accurately scoring the eye-opening, verbal, and motor responses for each age group. It is placed in code rooms and should be used as a tool to ensure proper assessment, with the total score being calculated by the charge nurse.