Pediatric Glasgow Coma Scale
Activity | Score | Infant(0-12m0) | Score | Child(1+yr) |
Eye opening | 4 | Spontaneously | 4 | Spontaneously |
3 | To speech | 3 | To command | |
2 | To pain | 2 | To pain | |
1 | No response | 1 | No response | |
Best verbal response | 5 | Coos,babbles | 5 | Oriented |
4 | Irritable,cries | 4 | Confused | |
3 | Cries to pain | 3 | Inappropriate words | |
2 | Moans,grunts | 2 | Incomprehensible | |
1 | No response | 1 | No response | |
Best motor response | 6 | Spontaneous | 6 | Obeys command |
5 | Localizes pain | 5 | Localizes pain | |
4 | Withdraws from pain | 4 | Withdraws from pain | |
3 | Flexion(decorticate | 3 | Flexion (decorticate) | |
2 | Extension (decerebrate) | 2 | Extension (decerebrat) | |
1 | No response | 1 | No response |
Score 13–15: May indicate mild dysfunction, although a person with no neurologic disabilities would receive a GCS of 15.
Score 9–12: May indicate moderate dysfunction.
Score 3–8: Is indicative of severe dysfunction.
If a child is unable to speak as a result of damage to the speech centres of the brain (dysphasia), then a 'D' should be placed in the appropriate space on the assessment tool (Appleton and Gibbs 1998 ; Shah 1999 ).
If a child has a tracheostomy or an endotracheal tube in situ, a 'T' should be marked in the appropriate space on the assessment tool (Aucken and Crawford 1999 ; Fischer and Matthieson 2001 ).
References
Appleton R, Gibbs J (1998) Epilepsy in Childhood and Adolescence (2nd edition). London, Martin Dunitz Ltd.
Shah S (1999) Neurological assessment (RCN Continuing Education). Nursing Standard 13(22): 49-56.
Aucken, S., Crawford, B. (1998) Neurological assessment. In: Guerrero, D. (ed) Neuro-Oncology for Nurses. London: Whurr Publishers.
Fischer J, Mathieson C (2001) The history of the Glasgow Coma Scale: implications for practice. Crit Care Nurs Q 23 (4):52-8. PMID: 11852950.