It is important to take the age and developmental level of the child into account when assessing neurological status.  There is a modified GCS for small children, however as much information can be gained from a simple AVPU scale.



 Most patients, particularly if ventilated will require sedation.  We use a mix of morphine (this may be changed to Fentanyl in future), and midazolam, in a ration appropriate to the child's age, given via infuse rite.  This can be augmented with NG chloral hydrate, up to 50mg/kg loading, followed by 15-30mg/kg q4-6hrly.  Doses beyond this, or other sedation adjuncts (phenobarbitone, dexmeditomidine, ketamine) should be discussed with the specialist of the day.

Propofol infusions are generally avoided in young children due to the risk of Propofol infusion syndrome with high doses (>4mg/kg/hr), however short term (<24 hour), or bolus Propofol can be very effective for procedures, transports, acute control etc.



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Page last reviewed: 14 May 2014