Pediatric mental status assessments
With a sickening thud, my four-year-old son's head slammed into the concrete. Despite three stern parental warnings he leaped off the front step, landed on the ice, went airborne, and cratered into the sidewalk. I feared the worst — open head wound and traumatic brain injury — when I began my assessment.
Assessing mental status in infants and toddlers is more complex than adults because they generally can't tell the date, time, precise location, or preceding events. Kids under two might not even be able to report their name when healthy. My wife asked my son, "Where are you?" He literally interpreted her question and answered, "Right here."
These are tips for gauging the mental status of infants and children:
1. Ask available parents and/or caregivers. As they know the child, they can tell you if the child's mental status is normal or abnormal.
2. Know age-related norms. Infants are generally pretty comfortable being around and handled by strangers. Toddlers are more likely to exhibit stranger anxiety. An older toddler should know basic things like their own name, age, where they live, and/or their parent’s names.
3. Recall of recent activities and favorite things. Toddlers can recall recent events like what they had for lunch or an activity they were just playing. Check longer term memory by asking a toddler about their favorite toy, game, or memory.
4. Ask the child to perform a simple task. Try things like touch your nose, cover your ears, close your eyes, or make a big mouth.
Spending time around kids is the best way to learn what is normal. Take advantage of injury prevention programs or community education events to interact with infants, toddlers, and their parents. Ask questions to see what toddlers are normally able to answer on their own.
My son survived his fall with only a painful reminder to listen to his daddy. He had no deformity, no bleeding, no altered mental status, and no loss of consciousness. He was lucky and I was relieved.
What are your tips for pediatric mental status assessment?