Table. Secondary severity assessment of acute asthma in children 0–5 years

Note: If features of more than one severity category are present, record the higher category as overall severity level

	Mild/Moderate (all of):	Severe (any of):	Life-threatening (any of):
Speech	Can talk or vocalise	†	Unable to vocalise due to dyspnoea
Posture	Can walk or crawl	Lethargic	Collapsed or exhausted
Breathing	Respiratory distress is not severe	Paradoxical chest wall movement: inward movement on inspiration and outward movement on expiration (chest sucks in when person breathes in) or Use of accessory muscles of neck or intercostal muscles or ‘tracheal tug’ during inspiration or Subcostal recession (‘abdominal breathing’)	Severe respiratory distress or Poor respiratory effort
Consciousness	Alert	†	Drowsy or unconscious
Skin colour	Normal	†	Cyanosis
*Respiratory rate*	Normal	Tachypnoea	Bradypnoea (indicates respiratory exhaustion)
Heart rate	Normal	Tachycardia	Cardiac arrhythmia or Bradycardia (may occur just before respiratory arrest)
Chest auscultation	Wheeze or Normal lung sounds	†	Silent chest or Reduced air entry
Oxygen saturation (pulse oximetry)	>94%	90–94%	<90% or Clinical cyanosis

† Not applicable – may be the same as moderate and does not determine severity category

	Heart rate (beats/minute)	Respiratory rate (breaths/minute)
<1 year	110–160	30–40
1–2 years	100–150	25–35
2–5 years	95–140	25–30

Source: Samuels M, Wieteska S. (Eds) Advanced paediatric life support: the practical approach. 5th edn. Wiley-Blackwell, Oxford; 2011.

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