This chapter follows on from the section on observation of the sick child, further developing these skills in the advanced physical assessment of children. Utilizing the ABCDE approach (ALSG 2005), this section will allow you to identify the deteriorating child and consider appropriate action.

While the majority of children who become unwell will recover with minimal intervention, the rapidity with which a child can deteriorate can lead to anxiety in even experienced practitioners. A rapid clinical assessment of a seriously ill child will identify any potential respiratory, cardiovascular or neurological failures (Lissauer and Clayden 2007). Rapid assessment allows for initiation of appropriate treatment to prevent progression to respiratory or cardiac arrest (Cameron et al. 2006).

The ABCDE approach allows for a systematic assessment of the child to take place:

• A – airway
  
• B – breathing
  
• C – circulation
  
• D – disability
  
• E – exposure.

A baseline of vital signs including ‘temperature, heart/pulse rate, respiratory rate and effort, blood pressure, pain assessment and level of consciousness’ (RCN 2011: 5) should always be carried out as part of this assessment. Look at how the child interacts with the adults and other children around them. Are they playing and interested in their surroundings or are they sitting quietly and apathetically?