Pediatric assessment triangle


  • Tool used to succinctly evaluate and form a general impression (sick/not sick) of a pediatric patient
  • Consists of three domains: Appearance, Breathing, and Circulation



  • Muscle tone
  • Irritability/consolability
  • Gaze (tracking, eye contact, vacant stare)
  • Age-appropriate speech


In addition to respiratory rate this includes assessing for:

  • Grunting or noisy breathing
  • Use of accessory muscles of respiration
    • Intercostal or supraclavicular retractions
    • Belly breathing
  • Nasal flaring


  • Look for pallor, mottling, or cyanosis
  • Check capillary refill


Children with an abnormality noted in any aspect of the pediatric assessment triangle require resuscitation

  • Breathing difficulty with normal appearance and circulation usually implies respiratory distress
    • Child is in distress but still adequately oxygenating to maintain distal perfusion and mental status
  • Breathing difficulty with abnormal appearance and/or circulation usually implies respiratory failure
    • Child's oxygenation is no longer sufficient to support distal perfusion and/or mental status
  • Poor appearance and circulation usually implies shock

See Also

External Links