While children typically have a lower severity of illness than their adult counterparts during visits to the emergency department (ED), they also present with some of the most serious illnesses. Furthermore, there are a wide range of possible illnesses with potentially devastating outcomes for children. Unfortunately, the relative rarity of critically ill or injured children means that clinical experience potentially may be lacking or even atrophied over time.
As if communication with young children was not challenging enough, the child presenting with an altered mental status (AMS) is an exceptional opportunity for testing one's sleuthing ability. The reality is that we see far more adults with AMS than we do children. Consequently, we might be tempted for just a moment to doubt our abilities.
By Ronald M. Perkin, MD, MA
Professor and Chairman, Department of Pediatrics, Brody School of Medicine at East Carolina University; Chairman, Committee on Physician Health, Pitt County Memorial Hospital, Greenville, NC; and Jay Weaver, JD, EMT-P, Attorney, Private Practice; Adjunct Faculty, Northeastern University, Boston.