survey, and triage decision Ideally, triage should take no more than to minutes Documentation of triage findings and interventions as well as reassessment of patients in the waiting room is also included in triage workflow Care of pediatric patients requires a core understanding of developmental stages and their associated risk factors, injury and illness patterns, and physiologic compensatory mechanisms As such, the triage process should be completed only by ED nurses experienced in caring for pediatric patients who demonstrate sound assessment, clinical judgment, and decision-making skills Should the triage provider’s assessment indicate the need for immediate lifesaving intervention, the triage process should end and the patient moved to a treatment area for care and further assessment Pediatric Assessment Triangle Once a child presents to the ED, an initial rapid assessment is conducted to determine “sick” or “not sick” utilizing the pediatric assessment triangle (PAT) This assessment should be completed during the first moments of interaction by any level healthcare provider and is separate from the primary survey Developed as a standardized tool for children of all ages, the PAT identifies overall general severity of illness or injury through focused, hands-off observation of three components of cardiopulmonary assessment: appearance, work of breathing, and circulation to the skin The triage provider should allow the child to remain with their caregiver, evaluating each parameter without touching the patient Examination can be completed within 30 seconds, allowing for prompt recognition of immediate physiologic needs and their associated level of urgency General Appearance General appearance is considered the most important factor in the assessment of a pediatric patient While a child may meet “alert” criteria on the AVPU (Awake, Verbal, Painful, Unresponsive) responsiveness scale, they can also display subtle signs of illness, injury, and deterioration through alterations in their general appearance The mnemonic “tickles” (TICLS) can be utilized to identify deviations from normal characteristics through evaluation of tone, interactiveness, consolability, look/gaze, and speech/cry ( Table 6.3 ) Work of Breathing In children, assessment of work of breathing provides accurate insight into the adequacy of oxygenation and ventilation through identification of abnormal findings and observation of compensatory mechanisms The triage provider should listen from a distance for abnormal sounds including snoring, grunting,