How does the Pediatric GCS differ from adult GCS?

The Pediatric GCS modifies the verbal component for preverbal children (under age 2). Instead of orientation, it assesses age-appropriate responses: smiles/coos (5), irritable crying (4), cries to pain (3), moans (2), none (1). Eye and motor components are similar to adult GCS.

What is a normal Pediatric GCS score?

A normal Pediatric GCS is 15 for children and adolescents (same as adults). For infants, age-appropriate baselines vary but a score of 15 with the modified verbal scale indicates normal responsiveness. As with adult GCS, scores ≤ 8 indicate severe injury.

When should the Pediatric GCS be used?

Use the Pediatric GCS for children under 2 years of age or any preverbal child. For children aged 2 and older who can speak, the standard adult GCS can be used. The Pediatric GCS is used in pediatric trauma assessment, PICU monitoring, and the PECARN head injury decision rule.

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Pediatric Glasgow Coma Scale (pGCS)

Assess level of consciousness in infants and children. Modified verbal and motor components for age-appropriate responses.

Inputs

Eye Opening (E)

Verbal Response (V)

Motor Response (M)

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Select all components to calculate pGCS.

Severe (≤ 8)Coma — consider intubation

Moderate (9–12)Altered consciousness

Mild (13–15)Minor injury / normal

Disclaimer: For educational purposes only. Not a substitute for clinical judgment.

When to use

Use pGCS for children under 2 years old or any child who is not yet verbally fluent. For older, verbal children, the standard adult GCS is often applicable.

Clinical pearls

Score range is identical to adult GCS (3–15).
GCS ≤ 8 suggests severe brain injury and often requires airway protection ("less than 8, intubate").
In non-verbal children, "oriented" (V5) means smiling, cooing, or interacting appropriately for age.
Motor response is the most prognostic factor in severe TBI.

References

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet. 1974;2(7872):81-84.
Reilly PL, et al. Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale. Childs Nerv Syst. 1988;4(1):30-33.

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About This Tool

What Is the Pediatric GCS?

The Pediatric Glasgow Coma Scale (pGCS) is a modification of the standard GCS designed to assess the level of consciousness in infants and young children (typically < 2 years). Because young children cannot obey commands or answer orientation questions, the Verbal and Motor components are adjusted to reflect age-appropriate behaviors such as cooing, crying, and spontaneous movement.

Scoring Differences

Verbal: Instead of "Oriented" (Adult V5), an infant scores V5 for cooing/babbling. "Confused" (Adult V4) becomes irritable crying that is consolable. V3 is crying to pain, V2 is moaning to pain.

Motor: "Obeys commands" (Adult M6) is replaced by spontaneous movement. "Localizes pain" (Adult M5) becomes withdrawing to touch.

🔑 Clinical Pearls

Always record the best response for each component.
Report the breakdown (E, V, M) not just the total score. E4V5M6 gives more information than "GCS 15".
A drop in GCS of ≥ 2 points suggests significant clinical deterioration.
Intubation and sedation invalidate the verbal component — document as "E4V1tM6" (t for tube) or similar.

Formula last verified: February 2026