Signs of Shock in Children

1. Apprehension and irritability, which are early signs
2. Thirst
3. Tachycardia for age (see Vital Signs, p. 372).
4. Tachypnea for age (see Vital Signs, p. 373).
5. Pallor, that is, paleness
6. Decreased tissue perfusion in the hands and feet
7. Decreased urine output (should be at least 0.5 mL/kg/h)
8. Narrowed pulse pressure (difference between systolic and diastolic blood pressure decreases)
9. Decreased blood pressure for age (see Table 4–1 and 4–2), which is a late sign. (Blood pressure does not drop early in pediatric shock because of the elasticity of the child’s blood vessels, which adjust readily to decreased vascular volume.)

NOTE: Children develop hypovolemic shock more quickly than adults because of their small blood volumes and large amounts of extracellular fluid that normally undergo rapid turnover.