Content
Infants and small children differ from adults physiologically and psychologically. Children and adolescents are also developmentally different from adults. The principles of paediatric assessment are the same as those for adult assessment; however, age influences the pattern of presentation, assessment and management, as children are prone to rapid deterioration.
Consistency of triage is optimised for this population when age, historical data and clinical presentation are all included in the triage assessment. 2
History-taking in paediatrics relies on information provided by primary carers and sometimes by the child or young person. It is important to develop a rapport with the patient and the carer in order to elicit the maximum amount of information in a relatively short timeframe.
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Interpreting the meaning of the information provided by carers is an additional challenge when triaging children, as the information that is given in this context will be influenced by the carer’ s own knowledge and experience. 80
The importance of privacy for parents, children and young people at triage should not be ignored. Simple health problems may be an opportunity for parents to seek assistance regarding more sensitive issues.
Young people have high mental and emotional needs and require greater privacy. They may wish to discuss their health concerns without the presence of their parents.( Refer to Chapter 5 for triage guidelines relating to mental health issues.)
Clinical urgency
A number of clinical features have been found to be significantly predictive of serious illness in infants and young children. 81-89
Hewson et al. 90 demonstrated the value of several easily assessed parameters in positively identifying infants with serious illness, including activity levels, alertness, skin temperature, feeding patterns and fluid output. In particular, the following parameters were predictive of serious illness:
• Decreased feeding(< ½ normal intake in preceding 24 hours)
• Breathing difficulty
• Having fewer than four wet nappies in the preceding 24 hours
• Decreased activity
• Drowsiness
• Being pale and hot
• Febrile illness in a child under three months old.
Department of Health and Ageing – Emergency Triage Education Kit