3. The unconscious child. Differential diagnosis

Page created on February 8, 2022. Not updated since.

Differential diagnosis

Unconsciousness can be due to one of these three mechanisms:

  • Bilateral hemispherical disorder
  • Brainstem dysfunction
  • Systemic metabolic disorder
Etiology Typical features
CNS infection (meningitis, encephalitis) Abrupt onset, warm child, tachycardia, meningeal signs
Diabetic ketoacidosis Fruity odour, known diabetes, slow onset
Hypoglycaemia Known diabetes, slow onset
Inborn error of metabolism Slow onset, hepatomegaly, jaundice
Trauma Bruising
Intoxication (drugs, heavy metal, chemical) Unattended child
Intracranial pathology (haemorrhage, infarct) Neurological asymmetry on examination, abnormal pupil, preceding headache and vomiting, papilloedema
Hypo/hyperthermia Child temperature
Drowning Wet child, cold child
Seizures Abrupt onset

Glasgow coma scale in children

GCS in older children GCS in children < 4 years Score
Eye opening



To sound

To pressure To pain 2


Best verbal response Oriented Talks normally, interacts 5
Confused Words 4
Words Vocal sounds 3
Sounds Cries 2
None None 1
Best motor response

Obeys commands

Localising Localises pain 5
Normal flexion Flexion to pain 4

Abnormal flexion (decorticate posture)


Abnormal extension (decerebrate posture)


No response


GCS 8 or lower is an indication for intubation.


For management, see topic A6.

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