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Decreased level of consciousness in a child: recognition and management

27 February 2020
15 min read
Volume 29 · Issue 4

Abstract

A child presenting with decreased level of conscious (dLOC) is of great concern due to the wide range of possible causes, and potential for death or serious long-term sequelae. It is therefore vital that health professionals can recognise a child with dLOC quickly, intervene appropriately and escalate for senior review as a matter of urgency. This article provides an explanation for the mechanisms of decreased consciousness, outlines the different causative pathologies, and provides a simple and logical approach to the first-line recognition and management that a health professional may apply when faced with such a patient. Illustrative case studies have been included, to demonstrate how children with dLOC may present in clinical practice

A child who presents with decreased level of consciousness (dLOC) may cause great concern to the clinical team involved. The list of potential causes is long and features a wide range of pathologies, many of which are rare but can have severe outcomes if not diagnosed correctly and treated in a time-critical manner. Nurses frequently meet these children at initial presentation, and therefore play a vital role in the care of such patients. The aim of this article is to provide a logical and practical guide to the identification and initial management of the varying differential diagnosis in a child presenting with dLOC. Two illustrative case studies are also included to highlight how these cases may present and show how health professionals have made a difference in the overall management of these children.

Consciousness can refer to either the state of wakefulness, awareness, or alertness in which most humans function while not asleep. Decreased consciousness is considered to be present when there is a deficiency in wakefulness, awareness and/or alertness. It is therefore crucial for health professionals to be aware of a child's normal behaviour and level of consciousness and they may need to verify this with the parents if there is doubt (Jellinger, 2009).

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