Paeds · acute-care-resuscitation-and-toxicology
ABCDE assessment and stabilisation of the acutely ill child
Also known as ABCDE approach · Paediatric primary survey · Systematic assessment of the sick child · Resuscitation of the acutely ill child · Treat-as-found primary survey
A fellowship approach to the systematic ABCDE assessment and immediate stabilisation of the acutely ill child. Treat each life threat as it is found, reassess from A after every action, use age- and weight-appropriate oxygen, ventilation, fluid, glucose and seizure interventions, escalate before local support is exceeded, and hand over safely.
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Target exams
Red flags
- Unresponsive, absent or agonal breathing, or no central pulse: start advanced life support immediately
- Increasing work of breathing that then becomes quiet with poor air entry and falling interaction: the child is tiring and failing
- Weak or absent central pulses, mottled or cyanosed skin, or prolonged capillary refill with altered consciousness
- Ongoing convulsive seizure at 5 minutes: activate the status epilepticus pathway
- Dangerous low bedside glucose with altered consciousness, seizure or collapse
- Deterioration despite treatment, or a need for support unavailable locally: call senior, PICU or retrieval now
- Caregiver concern that the child is different from usual, or a recurrent presentation
Life stages
Care settings
Clinical exam formats
Board mappings
- Acute Care
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Current 2026 PREP curriculum — Learning Objective 2.2.3: Perform acute resuscitation and advanced life support
- Current 2026 PREP curriculum — Learning Objective 2.4.4: Assess and manage infants, children and young people with potential cardiac, respiratory or neurological emergencies or acute sepsis
- Current 2026 PREP curriculum — Learning Objective 2.4.5: Manage transfer of an unwell newborn, infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
- Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 3. Professional skills and knowledge: Clinical procedures
- 4. Professional skills and knowledge: Patient management
- 6. Leadership and team working
- 7. Patient safety, including safe prescribing
- General Paediatrics: Resuscitates, stabilises and treats extremely unwell babies, children and young people, liaising with specialist teams, as necessary
- General Paediatrics: Assumes the role of Acute Paediatric Team Leader
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Video
- General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
- General Pediatrics Content Outline — Universal Task 1: Physiology and Pathophysiology
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
- Patient Care 3: Organize and Prioritize Patient Care
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Systems-Based Practice 1: Patient Safety
- Interpersonal and Communication Skills 2: Interprofessional and Team Communication
- Medical Expert
- Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
- Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
Overview & Definition
The ABCDE approach is a structured primary survey that finds and fixes life threats in the order they will kill the child: a blocked airway kills before failing breathing, failing breathing kills before shock, shock kills before a falling conscious level. You do not need a diagnosis to start. The moment you find a threat at any step, you treat it, then you return to A and reassess the whole child. This treat-as-found, reassess-from-A discipline is what turns a checklist into resuscitation. [9] [10]
ABCDE is a stabilisation method, not a diagnostic method. It tells you which organ system is failing now and keeps the child alive while you work out why. The cause-specific pathway (sepsis, asthma, anaphylaxis, diabetic ketoacidosis, poisoning, trauma) takes over once the immediate threats are controlled, and reassessment never stops. A child can be perfectly stable on the primary survey and still need urgent work-up because the missed diagnosis is dangerous; equally, an unstable child needs treatment before the diagnosis is certain. [3] [9]
[9] [10]It sits between two other tools. The paediatric assessment triangle is the hands-off first impression from the doorway that tells you to start ABCDE. The focused secondary assessment (full history and head-to-toe examination) comes after the primary survey has made the child safe. ABCDE is the hands-on middle layer where most lives are saved or lost. [9]
The primary survey as a repeating loop
- 1
Call for help and prepare
If the child looks unwell from the doorway, call the resuscitation team, name a leader, allocate roles, and bring age- and weight-appropriate equipment and monitoring.
- 2
A to E, treat as found
Work through Airway, Breathing, Circulation, Disability and Exposure in order. Treat each threat the moment you find it rather than finishing the survey first.
- 3
Reassess from A
After any intervention, return to A and check whether the change you expected actually happened. Compare with the child's baseline and the trend.
- 4
Escalate early
Call senior, PICU or retrieval help as soon as the child may need monitoring or treatment your service cannot reliably provide, not after local options fail.
- 5
Hand over and dispose
Transfer a structured summary of identity, physiology, timed actions, response, risks and contingency to the team and location that will carry the child forward.
References11ShowHide
- [1]Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies Lancet (London, England), 2011.PMID 21411136
- [2]Fleming S, Gill P, Jones C, et al. The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis PloS one, 2015.PMID 26375953
- [3]Bjorklund A, Resch J, Slusher T Pediatric Shock Review Pediatrics in review, 2023.PMID 37777656
- [4]Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection The New England journal of medicine, 2011.PMID 21615299
- [5]Young KD, Korotzer NC Weight Estimation Methods in Children: A Systematic Review Annals of emergency medicine, 2016.PMID 27105839
- [6]McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial Lancet (London, England), 2005.PMID 16023510
- [7]Faustino EV, Hirshberg EL, Bogue CW Hypoglycemia in critically ill children Journal of diabetes science and technology, 2012.PMID 22401322
- [8]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program The New England journal of medicine, 2014.PMID 25372088
- [9]Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Pediatrics, 2021.PMID 33087552
- [10]Maconochie IK, Aickin R, Hazinski MF, et al. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Circulation, 2020.PMID 33084393
- [11]Weiss, Scott L Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026 Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2026.PMID 41869844