Recognition of a Seriously Ill Child (Triage)

It is important that all health care workers learn to quickly recognize a child needing emergency
care  as soon as the child is brought to a health facility.  Fortunately this depends on a few
clinical features that are easy to learn with practice. Parents/ care givers may have tried
to treat the child at home or the child may have fallen sick quickly. They are advised to come to the health care
facility as soon as possible if the child is weak, not able to drink, has severe diarrhoea,
cold hands and feet, very high fever, or convulsion.

Causes of Cardio-Respiratory Arrest after Neonatal Period Period

These include:

  • Fluid loss: Diarrhoea, blood loss, burns.
  • Fluid maldistribution: Anaphyalaxis, septic shock, cardiac disease.
  • Respiratory distress: Pneumonia, asthma.
  • Foreign body (obstructed airway).
  • Respiratory depression: CNS infections, convulsions, poisoning.
  • In addition to the above, severe malnutrition is a common cause of death in young children.
  • Trauma can also be a cause.

The figures shown below assist you to triage and manage these children as they arrive at the health facility. Management in all these states includes the ABC’s: Airway, Breathing, Circulation.

 Summary of Steps Taken: ABCD of Resuscitation

  • Always have a resuscitation tray ready.
  • Airway/breathing: Start immediate treatment to restore breathing.
  • Circulation: Restore circulating blood volume by giving 20ml/kg of Ringer’s lactate or normal saline over 15 minutes. Repeat until return of pulse; this may be repeated up to 4 times.
  • Convulsions: Give anticonvulsants if child is convulsing.
  • Carry out emergency investigation if you are able: Blood glucose, blood smear, haemoglobin.
  • Reassess every 15–30 minutes until stabilized following the same format – airway, breathing, circulation:
    • When ventilation and massage are effective, carotid and femoral pulses become palpable, pupils constrict, and the colour of mucous membranes improves.

NOTE: External cardiac massage (chest compressions): apply appropriate pressure over the sternum:

  • For newborn or small infants, effective cardiac output can be produced by applying maximum pressure with the tip of 2 fingers placed on the sternum just below the intermammary line or hands round the infant’s chest.
  • For larger infants and small children, use the heel of one hand over the sternum one finger breadth above the xiphisternum.
  • For big children, the heel of the right hand is placed over the heel of the left hand to provide the strength of both arms and shoulders. Hands are placed 2 finger breadths above the xiphisternum. Refer urgently after stabilizing the
    child. During transport ensure adequate airway, breathing, and circulation. Make sure you write a comprehensive report of what you have done to the receiving hospital clinician.