A Clinical Approach to Altered Level of Consciousness in the Pediatric Patient

Altered level of consciousness in infants, children, and adolescents represents a spectrum of disease ranging from mild agitation to coma, and fluctuations in between. Early recognition and immediate management of airway, breathing and circulation are often required before a specific etiology has been identified. Common causes include toxic ingestions, systemic or central nervous system infection, metabolic derangements, and structural lesions. Consultation with pediatric subspecialists and referral to tertiary care facilities for intensive care is often required. Outcomes are typically good, with most patients experiencing full recovery, depending on severity of underlying disease. This review provides a clinical approach to the pediatric patient with altered level of consciousness, reviewing the initial management strategies required for stabilization, preliminary investigations that will aid in delineating cause for symptoms, and resources for specific situations.