PALS Pediatric Assessment Triangle
ACLS Certification Association videos have been peer-reviewed for medical accuracy by the ACA medical review board.
Article at a Glance
- The Pediatric Assessment Triangle is part of the systematic assessment of the pediatric patient and is performed from across the room.
- In this assessment, the clinician evaluates the child’s appearance, breathing, and circulation.
- Appearance refers to muscle tone, interaction, consolability, looking around, and speech (TICLS).
- Work of breathing should be assessed from across the room.
- Circulation refers to the color of the child’s skin and signs of edema.
The pediatric assessment triangle is the first part of the systematic approach to assessing a pediatric patient. The assessment is instinctual and dependent on the provider’s observations. There’s no numbers or grading, but that doesn’t mean the process lacks structure. The components are known as A, B, and C: The three components of the pediatric assessment triangle are appearance, breathing, and circulation.Components of the Pediatric Assessment Triangle
Related Video – Understanding the ACLS Systematic Approach Algorithm
Appearance actually means the child’s mental status. While you may be used to treating adult patients via alert and oriented x 4 (AO x4) or the Glasgow coma scale, these methods do not work very well in children. Instead, we use a helpful acronym called TICLS to assess from across the room. An acronym to assess pediatric mental status is “TICLS.” “T” stands for muscle tone. The child should have some muscle tone. “I” stands for instructiveness. The child should interact with their environment. “C” stands for consolability. If the child is inconsolable, it may be an indicator of pain. “L” stands for looking around. The child should track their environment and be aware of their surroundings. Finally, “S” stands for speech. The child should be speaking appropriately for their age and baseline.Appearance
TICLS
You must diagnose whether the child has a hard time breathing. Some symptoms to watch for are head bobbing, tugging, nasal flaring, and audible sounds. Grunting, stridor, or wheezing indicates the child is having difficulty breathing. Read: PALS Drugs – Epinephrine & AmiodaroneBreathing
To assess circulation from across the room, look at the patient’s skin color. They may be pale, hypoxic, or have present cyanosis. Look for any redness or periorbital edema, which may indicate an allergic reaction. That could lead to distributive shock, which is a definite circulatory issue. The child’s skin color may indicate circulation issues.Circulation
Summary
Remember the acronym ABC when thinking of the components of the pediatric assessment triangle. One, check the child’s ‘Appearance’, or mental status. Two, check their ‘Breathing’ to ensure it isn’t labored. Three, check their ‘Circulation’ to ensure their skin color is normal and they aren’t exhibiting signs of potential circulatory issues.
Related Video – Treating a Seriously Ill Patient with the Systematic Approach
More Free Resources to Keep You at Your Best
Editorial Note
ACLS Certification Association (ACA) uses only high-quality medical resources and peer-reviewed studies to support the facts within our articles. Explore our editorial process to learn how our content reflects clinical accuracy and the latest best practices in medicine. As an ACA Authorized Training Center, all content is reviewed for medical accuracy by the ACA Medical Review Board.
More to Learn
Learn how to correct right mainstem intubation and achieve the target range for endotracheal (ET) tube placement. Our article helps enhance patient safety and airway management.
Understand Hypovolemia, a condition marked by a decrease in blood volume due to fluid loss or bleeding, through our informative article.