Assessing children can often be a tricky task, and this is usually down to a number of different factors. Children of all ages can present very differently, and unlike adults, they are not always able to clearly explain what is wrong. Depending on their age and developmental stage, they may be unable to talk, struggle to describe symptoms, or become fearful and distressed during assessment.
This is often made more challenging by anxious or panicked parents, which can heighten the child’s own distress and make it harder to gain an accurate picture. Children may also compensate well until they suddenly deteriorate and locating the source of a problem is not always straightforward. All of this means that assessing a child requires a slightly different approach, combining observation, communication and clinical judgement to build a clear overall picture.
That’s why I’ve put together my top ten tips for assessing children, based on my experience as a paediatric nurse. However, before outlining these tips, it’s important to say that they are based on experience rather than formal guidance. They are not set out in a strict order or meant to be followed step by step. Instead, they’re practical suggestions to support your assessment and help you build a clearer overall picture when assessing children in practice.
Assessing children can quickly become overwhelming if you don’t have a clear approach from the start. Unlike adults, children may not be able to explain what is wrong, and their presentation can change rapidly.
Having a structured way of thinking helps you stay focused, ensures nothing important is missed and allows you to prioritise what matters most. Whether this is a mental checklist or a recognised framework, approaching every assessment in a consistent way will build confidence and support safer clinical decision-making.
There are a few key structures that can help with this. The ABCDE approach is widely used to assess acutely unwell patients in a prioritised way, something we will explore in more detail later. Other tools such as PEWS can support you in recognising early signs of deterioration, and having a clear structure for history taking helps you build a fuller clinical picture, especially when communication is limited.
Using these together allows you to stay systematic while still adapting to the individual child.
The ABCDE approach is a structured and prioritised way of assessing any unwell child and is a key skill in paediatric practice. It allows you to identify and manage life-threatening problems in order of importance, rather than focusing on a diagnosis too early. This is especially important in children, as they can compensate well and then quickly deteriorate.
Starting with:
The key with ABCDE is not just to assess, but to treat as you go. If you identify a problem at any stage, you should act on it immediately before moving on. This approach helps to keep your assessment focused, safe, and consistent, particularly in more acute situations.
Taking a thorough history is a key part of assessing any child.
Taking a thorough history is a key part of assessing any child and can often give you the biggest clues as to what might be going on. In many cases, especially with younger children, the history provided by parents or carers is just as important as your clinical examination. They know what is normal for their child and are often the first to notice when something isn’t quite right.
It’s also important to involve the child where possible. Depending on their age and developmental stage, they may be able to describe their symptoms, point to where it hurts, or give you valuable insight into how they are feeling. Speaking directly to the child, as well as the parent or carer, helps build trust and can give you a clearer overall picture.
Start with the presenting complaint and explore this further, when it started, how it has progressed, and anything that makes it better or worse. It’s also important to ask about feeding, fluid intake, urine output, sleep, behaviour, and any recent illnesses or contacts. Don’t forget to check past medical history, medications, allergies, and immunisation status.
Parental concern should never be overlooked. If a parent feels their child is different from usual or more unwell than expected, this should always be taken seriously, even if observations appear normal. Combining a structured history with clinical findings helps build a clearer overall picture and supports safer decision-making.
Understanding what is normal for a child’s age is essential when assessing whether they are unwell.
Understanding what is normal for a child’s age is essential when assessing whether they are unwell. Unlike adults, children’s vital signs vary significantly depending on their age, and what may be normal for one age group could be concerning in another. Without this knowledge, it can be easy to either overestimate or underestimate how unwell a child is.
Heart rate, respiratory rate, and blood pressure all change as children grow, and recognising these differences helps you identify early signs of deterioration. For example, a fast heart rate in a young infant may be normal, whereas the same rate in an older child could indicate illness.
It’s also important to look at trends rather than relying on a single set of observations. A child whose vital signs are gradually changing, even within normal ranges, may be deteriorating. Using tools such as PEWS alongside your clinical judgement can help highlight these changes and support timely escalation where needed.
As briefly mentioned in point 3, parents and carers are often the best source of information when it comes to their child. They know what is normal for them, their behaviour, routines, and how they usually respond when unwell. Because of this, they are often the first to recognise when something is not quite right, even before any obvious clinical signs appear.
Taking the time to listen to parental concerns can provide valuable insight and should never be underestimated. Phrases such as “they’re just not themselves” or “this is different from usual” can be early indicators of deterioration, particularly in younger children who cannot communicate their symptoms clearly.
Involving parents in the assessment and examination also helps build trust and can make the child feel more comfortable and settled. A calm and supported child is often much easier to assess. Combining parental input with your clinical findings allows you to form a more accurate and holistic picture of the child’s condition.
Communication is a key part of assessing children and can have a big impact on how well the assessment goes. Children may feel anxious, scared, or unsure of what is happening, which can make it harder to gain accurate observations. Adapting your communication to the child’s age and developmental stage helps build trust and makes the process smoother.
Using simple, clear language and explaining what you are doing can help reduce fear and improve cooperation as well as being patient with the child. It’s important to be honest, as children are often more aware than we think, and unclear or misleading explanations can increase anxiety. Speaking at the child’s level, maintaining a calm tone, and allowing time for them to respond can all make a difference.
As children get older, they should be more involved in the assessment and spoken to directly where appropriate. Older children and teenagers are often able to describe their symptoms in more detail, and involving them helps build trust and encourages them to take an active role in their care. Simple techniques such as asking questions, offering small choices, and involving them in what you are doing can help them feel more in control and improve engagement. It’s worth noting that with older children and teenagers, it may also be appropriate to offer time to speak without parents present, depending on the situation
Involving the child can also apply to younger children, with adjustments made to your questions, tone, and expectations to suit their developmental stage.
Using validated pain assessment tools can help provide a more accurate and consistent assessment.
Pain is a common presenting feature in children, but it is not always easy to assess. Children may struggle to describe what they are feeling, and pain can present in different ways depending on their age, development, and level of distress. This can make it difficult to distinguish between:
Using validated pain assessment tools can help provide a more accurate and consistent assessment. Tools such as the FLACC scale, Wong-Baker FACES, or numerical scoring systems allow you to assess pain in a structured way, depending on the child’s age and ability to communicate. Choosing the right tool is important to ensure pain is not underestimated or overlooked.
Pain assessment should always be considered alongside your overall clinical assessment. Observing behaviour, response to comfort, and parental input can all provide valuable insight. Reassessing pain regularly and evaluating the effectiveness of any interventions helps ensure the child remains as comfortable as possible.
If something doesn’t feel right, it’s important to trust your clinical judgement and seek further support.
Recognising red flags is a key part of assessing children and helps you identify those who may be more seriously unwell. While some children may present with obvious signs, others can appear relatively well before deteriorating quickly. Being aware of early warning signs allows you to act promptly and escalate care when needed.
Some red flags can include:
Changes in behaviour, such as a child becoming unusually quiet, drowsy, or difficult to rouse, should also raise concern. However these are not the only signs, as it may vary from child to child.
If something doesn’t feel right, it’s important to trust your clinical judgement and seek further support. Early recognition and escalation can make a significant difference in outcomes for unwell children.
Reassessment is an essential part of the overall process.
Children’s conditions can change over a short period of time, so reassessment is an essential part of the overall process. Relying on a single set of observations can be misleading, particularly if a child is compensating. Regular review helps you identify subtle changes and respond early if the child begins to deteriorate.
Repeating observations, reviewing symptoms, and monitoring response to any interventions are all key parts of this. Even small changes in vital signs, behaviour, or clinical presentation can be significant, so it’s important to remain vigilant.
Clear and accurate documentation is just as important as the assessment itself. Recording your findings, any concerns, and actions taken ensures continuity of care and allows others to recognise patterns or deterioration. Good documentation supports safe clinical decision-making and effective communication within the wider team.
Safety-netting is a key part of assessing and managing children, particularly in primary care where many children will be managed at home.
And finally, safety-netting is a key part of assessing and managing children, particularly in primary care where many children will be managed at home. Even if a child appears well at the time of assessment, their condition can change, so it’s important that parents and carers know what to look out for and when to seek further help.
Clear, simple advice should be given on red flag symptoms, how to manage symptoms at home, and when to return or escalate care. This should be provided both verbally and in written form to ensure understanding. Resources such as Healthier Together can be useful for providing consistent, evidence-based information that parents can refer back to at home. Making sure this information is understood helps parents feel more confident and supports earlier re-presentation if needed.
Alongside this, keeping your own knowledge and skills up to date is essential. Paediatric assessment relies on recognising subtle changes and using current guidance, so regular training and refreshers help maintain confidence and ensure safe, effective care.
Assessing children can feel challenging, but having a clear, structured approach helps bring confidence and consistency to your practice. From taking a thorough history and involving both the child and their parents, to recognising red flags and using appropriate tools, each part of the assessment plays an important role in building a complete clinical picture.
No two children will present in exactly the same way, and being able to adapt your approach based on age, development, and the situation in front of you is key. Combining structured assessment with clinical judgement, good communication, and ongoing reassessment helps ensure that subtle signs are not missed.
Ultimately, safe and effective paediatric assessment is about putting all of these elements together, remaining systematic, listening carefully, and knowing when to escalate. With practice and continued learning, this becomes more intuitive, allowing you to provide confident, high-quality care to both the child and their family.
Bonus tip (Number 11): keep your knowledge up to date. Paediatric care is constantly evolving, and staying current helps you recognise early signs, make safer decisions, and feel more confident in practice. Health Academy’s courses are a great way to support this, offering practical, flexible learning that helps you build and maintain your skills in real-world primary care.
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