Avner JR Altered states of consciousness. Pediatr Rev. 2006; 27:(9)331-338

Bowker RP, Stephenson TJ, Baumer JH Evidence-based guideline for the management of decreased conscious level. Arch Dis Child Educ Pract Ed. 2006; 91:(4)ep115-ep122

Bowker R, Green A, Bonham JR Guidelines for the investigation and management of a reduced level of consciousness in children: implications for clinical biochemistry laboratories. Ann Clin Biochem. 2007; 44:(6)506-511

Introducing the Guideline on the Management of a Child with a Decreased Conscious Level: a nationally developed evidence-based guideline for hospital practitioners (The Paediatric Accident and Emergency Research Group, The University of Nottingham). 2013.;18;105-116.pdf

Crossman AR, Neary D Neuroanatomy: an illustrated colour text, 4th edn. Edinburgh: Churchill Livingstone; 2010

Desachy A, Vuagnat AC, Ghazali AD Accuracy of bedside glucometry in critically ill patients: influence of clinical characteristics and perfusion index. Mayo Clin Proc. 2008; 83:(4)400-405

Hoffmann F, Schmalhofer M, Lehner M, Zimatschek S, Grote V, Reiter K Comparison of the AVPU scale and the Pediatric GCS in prehospital setting. Prehosp Emerg Care. 2016; 20:(4)493-498

Ibekwe RC, Ibekwe MU, Onwe OE, Nnebe-Agumadu UH, Ibe BC Non-traumatic childhood coma in Ebonyi State University Teaching Hospital, Abakaliki, South Eastern Nigeria. Niger J Clin Pract. 2011; 14:(1)43-46

Jellinger KA Functional pathophysiology of consciousness (article in German). Neuropsychiatr. 2009; 23:(2)115-133

Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC Analysis of missed cases of abusive head trauma. JAMA. 1999; 281:(7)621-626

Kavanagh FA, Heaton PA, Cannon A, Paul SP Recognition and management of febrile convulsions in children. Br J Nurs. 2018; 27:(20)1156-1162

Payne FL, Fernandez DN, Jenner L, Paul SP Recognition and nursing management of abusive head trauma in children. Br J Nurs. 2017; 26:(17)974-981

Reynolds S, Marikar D, Roland D Management of children and young people with an acute decrease in conscious level (RCPCH guideline update 2015). Arch Dis Child Educ Pract Ed. 2018; 103:(3)146-151

Sheets LK, Leach ME, Koszewski IJ, Lessmeier AM, Nugent M, Simpson P Sentinel injuries in infants evaluated for child physical abuse. Pediatrics. 2013; 131:(4)701-707

Sofiah A, Hussain IHMI Childhood non-traumatic coma in Kuala Lumpur, Malaysia. Ann Trop Paediatr. 1997; 17:(4)327-331

Song JL, Wang VJ Altered level of consciousness: evidence-based management in the emergency department. Pediatr Emerg Med Pract. 2017; 14:(1)1-28

Suganthi V, Senthil Kumar M, Raman Sasi Kumar B Non–traumatic coma in children: clinical profile and outcome. Journal of Evolution of Medical and Dental Sciences. 2016; 5:(17)867-870

Tintinalli J, Stapczynski JS, Cline D, Ma O, Meckler G, Yealy D Tintinalli's emergency medicine, 8th edn. New York (NY): McGraw-Hill Education; 2015

Wong CP, Forsyth RJ, Kelly TP, Eyre JA Current topic: Incidence, aetiology, and outcome of non-traumatic coma: a population based study. Arch Dis Child. 2001; 84:(3)193-199

Zeman A What in the world is consciousness?. Prog Brain Res. 2005; 150:1-10

Decreased level of consciousness in a child: recognition and management

27 February 2020
15 min read
Volume 29 · Issue 4


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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