Pause and observe
Look and listen before approaching. Note interaction with caregivers, body position, visible effort, skin color, and overall responsiveness.
How → Why → Practice
Form a rapid first impression before touching the child.
Assess appearance, work of breathing, and circulation to the skin; decide whether findings are normal or not normal; choose the immediate priority; and document objectively.
0 of 3 lessons complete
Lesson 1
HOW: Perform the Pediatric Assessment Triangle
Observe from the doorway or across the room before equipment, hands-on assessment, or upsetting the child.
Assess appearance
Use TICLS: tone, interactiveness, consolability, look or gaze, and speech or cry. Appearance reflects brain perfusion, oxygenation, and overall function.
Assess work of breathing
Look for abnormal airway sounds, retractions, nasal flaring, head bobbing, tripod positioning, seesaw breathing, or decreased effort.
Assess circulation to skin
Look for pallor, mottling, or cyanosis. This is a visual first-look assessment and is not the same as obtaining a blood pressure.
Classify the pattern
Decide which PAT arms are abnormal. One or more abnormal arms indicate a potentially sick child and guide the next assessment priority.
Move to ABCs
The PAT is not a diagnosis. Immediately follow with primary assessment, age-appropriate vital signs, focused history, interventions, and reassessment.
TICLS for appearance
Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry. Assess what is normal for the child’s age and developmental level.
Helpful observation clues
- Strong or weak cry
- Tracks caregiver or environment
- Normal posture and muscle tone
- Visible retractions or nasal flaring
- Pallor, mottling, or cyanosis
Do not delay for the PAT
- Apnea or agonal breathing
- Severe airway obstruction
- Unresponsiveness
- Profound cyanosis
- Cardiac arrest
Lesson 2
WHY: Understand what the pattern suggests
The PAT is a rapid severity tool. It helps identify physiologic instability and directs attention before a full diagnosis is known.
Appearance is powerful
Abnormal appearance may reflect impaired oxygenation, ventilation, perfusion, glucose, temperature, or neurologic function.
Effort can disappear
A child in respiratory failure may show less visible work because fatigue is replacing compensation. Quiet does not always mean improved.
Skin reveals perfusion
Pallor, mottling, and cyanosis can signal poor circulation or oxygenation, but lighting, temperature, and baseline skin characteristics matter.
Patterns guide priority
The combination of abnormal arms is more useful than one isolated observation and should be followed by ABC assessment and reassessment.
PAT patternPossible categoryImmediate focus
All three arms normalStable first impressionContinue systematic assessment
Abnormal work of breathing onlyRespiratory distressAirway, oxygenation, and breathing support
Abnormal appearance + breathingRespiratory failureVentilatory support and rapid transport
Abnormal appearance + circulationShockPerfusion support and rapid transport
Abnormal appearance onlyNeurologic or metabolic concernABCs, glucose, temperature, and focused exam
All three arms abnormalCardiopulmonary failureImmediate resuscitative support
Knowledge check
Full scenario mode: complete this assessment for the active patient. Teaching sections and patient changes are locked until you leave the scenario.
Lesson 3
PRACTICE: Observe, classify, and document
Review the first-look scene, reveal the PAT findings, classify the pattern, choose the immediate EMT priority, and write a PCR-style observation.
Randomized pediatric patient
Pediatric encounter
Pediatric Assessment Triangle
Practice feedback