Overview :
One of the components of the Glasgow coma scale is the best verbal response, which cannot be assessed in nonverbal small children. A modification of the original Glasgow coma scale was created for children too young to talk.
Parameters:
(1) eyes opening
(2) best verbal or nonverbal response (depending on development status)
(3) best motor response
| Eye Opening | Score |
| spontaneously | 4 |
| to verbal stimuli | 3 |
| to pain | 2 |
| never | 1 |
Nonverbal Child | Verbal Child's Best Verbal Response (Glasgow coma scale) | Score |
smiles, oriented to sound, follows objects, interacts | oriented and converses | 5 |
consolable when crying and interacts inappropriately | disoriented and converses | 4 |
inconsistently consolable and moans; makes vocal sounds | inappropriate words | 3 |
inconsolable, irritable and restless; cries | incomprehensible sounds | 2 |
| no response | no response | 1 |
| Best Motor Response | Score |
| obeys command | 6 |
| localizes pain | 5 |
| flexion withdrawal | 4 |
| abnormal flexion (decorticate rigidity) | 3 |
| extension (decerebrate rigidity) | 2 |
| no response | 1 |
Additional markers associated with prognosis:
(1) oculovestibular reflex (all children with absent reflexes died; 50% of children with impaired reflex died; 25% with normal reflexes died)
(2) abnormal pupillary response (77% with bilateral fixed and dilated pupils died)
(3) intracranial pressure (pressures > 40 torr with CCS scores of 3, 4 or 5 was inevitably fatal)
children's coma scale =
= (score for eye opening) + (score for best nonverbal or verbal response) + (score for best motor response)
Interpretation:
• minimum score is 3, which has the worst prognosis
• maximum score is 15, which has the best prognosis
• Scores of 7 or above have a good chance for recovery.
• Scores of 3-5 are potentially fatal, especially if accompanied by fixed pupils or absent oculovestibular responses or elevated intracranial pressure.
• Normal children under 5 years may have lower scores than adults because of reduced best verbal and motor responses.
