Paediatric Glasgow Coma Scale
Level of consciousness in preverbal children (≤ 2 years)
Sources last checked: 2026-10-13
Paediatric Glasgow Coma Scale
Level of consciousness in preverbal children (≤ 2 years)
Several paediatric adaptations exist with slightly different verbal descriptors; this is the version used in the PECARN studies. From about age 2 (once the child speaks), use the standard GCS. Report the three components separately.
Interpretation
| 3–8 — severe | Severe TBI range (GCS 3–8, Brain Trauma Foundation paediatric guideline). |
|---|---|
| 9–12 — moderate | Moderate impairment of consciousness. |
| 13–15 — mild | Mild impairment or normal. Head trauma with GCS 14–15 is the population covered by the PECARN rules. |
What is the Paediatric Glasgow Coma Scale?
The paediatric Glasgow Coma Scale adapts the verbal and motor components of the adult GCS for preverbal children, keeping the 3–15 range. Holmes and colleagues showed in 2005 that this version, used in the PECARN network, performs as well in children aged 2 years and younger as the standard GCS does in older children.
When to use it
- Assessing consciousness in infants and toddlers after trauma or in acute illness
- Serial neurological observation
- Applying head-injury rules that require a GCS
When not to use it
- In verbal children who can follow commands — use the standard GCS
- Under sedation or neuromuscular blockade, where the score is not interpretable
How it is calculated
| Criterion | Points |
|---|---|
| Eye opening | |
| Spontaneous | 4 |
| To speech | 3 |
| To pain | 2 |
| None | 1 |
| Verbal response | |
| Coos, babbles | 5 |
| Irritable cries | 4 |
| Cries to pain | 3 |
| Moans to pain | 2 |
| None | 1 |
| Best motor response | |
| Moves spontaneously and purposefully | 6 |
| Withdraws to touch | 5 |
| Withdraws to pain | 4 |
| Abnormal flexion (decorticate) | 3 |
| Abnormal extension (decerebrate) | 2 |
| None | 1 |
Clinical pearls and limitations
- Several paediatric adaptations exist with slightly different verbal descriptors; this is the version used in the PECARN studies. From about age 2 (once the child speaks), use the standard GCS. Report the three components separately.
- Record E, V and M separately — the total hides which component is impaired.
- Several paediatric versions exist; use the same one consistently in a unit.
- A score of 8 or less marks the severe brain-injury range.
Frequently asked questions
How is the GCS different for babies?
Verbal responses are graded on cooing, crying and moaning instead of speech, and motor responses on spontaneous movement and withdrawal instead of obeying commands.
From what age is the adult GCS used?
Once the child can talk and follow commands, roughly from age 2.
What GCS means severe head injury in children?
3–8 is severe, 9–12 moderate and 13–15 mild, as in adults.
Evidence and guidelines
- Primary source: Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow Coma Scale in children with blunt head trauma. Acad Emerg Med 2005;12(9):814-819.
- Kochanek PM et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, 3rd ed. (Brain Trauma Foundation). Pediatr Crit Care Med 2019;20(3S):S1-S82.
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet 1974;2(7872):81-84.
Have a follow-up question?
Medelix answers clinical questions from current guidelines and studies — every statement with its source.
Ask Medelix about the Paediatric Glasgow Coma ScaleRelated calculators
- Glasgow Coma ScaleLevel of consciousness
- PECARN head injury rule (< 2 years)Need for CT after minor head trauma in children under 2 (GCS 14–15)
- PECARN head injury rule (≥ 2 years)Need for CT after minor head trauma in children aged 2–17 (GCS 14–15)
- APGAR scoreNewborn status at 1 and 5 minutes after birth
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