# Pediatric assessment triangle

Use appearance, breathing, and skin circulation for a rapid first impression.

Population: Pediatric. Scope: Assessment.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: Revised August 19, 2019 · Implemented April 1, 2020.
Canonical page: https://www.ocmedic.com/guides/pediatric-assessment/
Official source: [PR-001 — Pediatric Assessment Triangle](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12401.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## First impression

- Use visual and auditory observations. The triangle is particularly useful in children younger than 5.
- Continue assessment and use the applicable pediatric standing order for treatment.

## Source documents

- [PR-001 — Pediatric Assessment Triangle](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12401.pdf)
- [PR-002 — Glasgow Coma Scale (Score)](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/PR-02%20GCS%20%28Score%29%2011-2023.pdf)
- [SO-P-035 — Acute Respiratory Distress - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf)
- [SO-P-065 — Altered Mental Status - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-65%20Alterned%20mental%20status.pdf)
- [310.00 — 9-1-1 Advanced Life Support Base Contact, Standing Order, and Transport Criteria](https://www.ochealthinfo.com/sites/healthcare/files/2025-03/310.00%20ALS%20Base%20Contact%204-2025.pdf)

## 1. Appearance

- Tone: observe movement and posture.
- Interaction: look for alertness and engagement with people or surroundings.
- Consolability: assess response to a caregiver.
- Look/gaze: observe eye contact and tracking.
- Speech/cry: listen to the strength and character of the voice or cry.

## 2. Work of breathing

- Observe breathing effort and listen for abnormal respiratory sounds.

## 3. Circulation to skin

- Observe skin color for pallor, mottling, or cyanosis.

## Turn the impression into a focused assessment

- Use the triangle as a rapid visual/auditory impression, then assess airway, ventilation, perfusion, and mental status. It does not supply a stand-alone diagnosis or treatment order.
- When documenting depressed consciousness, use the age-appropriate GCS components; PR-002 has separate scoring for age 2 and younger.

## Find the next pathway

- For respiratory distress, use SO-P-035 and reassess the response to oxygen, airway support, and the specific treatment. For altered mental status, SO-P-065 includes a glucose check and treatment of poor perfusion.
- 310.00 identifies pediatric respiratory distress and circulatory compromise as base-contact triggers, with a pediatric-capable base preferred. A reassuring momentary appearance does not cancel the source’s BRUE contact criteria.