What Is the Pediatric Assessment Triangle?
The Pediatric Assessment Triangle (PAT) is a rapid, visual assessment tool that takes 30 to 60 seconds to complete. It evaluates three components: appearance, work of breathing, and circulation to the skin. The PAT is performed from across the room before touching the child. It provides an immediate general impression that guides your initial management priorities.
Appearance
Appearance is the most important component of the PAT because it reflects the adequacy of ventilation, oxygenation, brain perfusion, and overall homeostasis. Use the "TICLS" mnemonic: Tone (is the child moving and resisting examination, or limp and floppy?), Interactiveness (does the child reach for objects, look at you, or respond to the environment?), Consolability (can the child be comforted by a caregiver, or are they inconsolable?), Look/Gaze (does the child make eye contact, or have a glassy, unfocused stare?), Speech/Cry (is the cry strong and spontaneous, or weak and absent?).
Work of Breathing
Assess work of breathing by looking and listening from across the room. Abnormal findings include nasal flaring, retractions (supraclavicular, intercostal, subcostal, substernal), head bobbing (in infants), tripod positioning, audible stridor or wheezing, and grunting. The absence of visible breathing effort in a child who appears ill is concerning and may indicate respiratory failure rather than improvement.
Circulation to Skin
Assess circulation by looking at the child's skin color. Pallor (pale skin) suggests poor perfusion or anemia. Mottling (irregular skin color patches) suggests shock. Cyanosis (blue discoloration) suggests severe hypoxia. Look at the lips, mucous membranes, and nail beds for the most reliable assessment of skin color in children with darker skin tones.
Using the PAT on the NREMT
The NREMT expects you to rapidly categorize pediatric patients based on PAT findings. A normal PAT (normal appearance, no increased work of breathing, normal skin color) means the child is stable. An abnormal appearance with normal work of breathing and normal circulation suggests a primary brain problem (altered mental status, toxicological emergency). Increased work of breathing with normal appearance and normal circulation suggests respiratory distress. Abnormal circulation with normal appearance may indicate compensated shock. When all three components are abnormal, the child is in cardiopulmonary failure.