There’s no good criteria for an unstable child. Nor for adults - that’s the “clinical gestalt” docs spend 80+ hours a week developing in training. That said, a

There’s no good criteria for an unstable child. Nor for adults - that’s the “clinical gestalt” docs spend 80+ hours a week developing in training. That said, a few things to look out for (I steal the below list from Dr Tim Horeczko): Appearance: “TICLS” Tone – the newborn should have a normal flexed tone; the 6 month old baby who sits up and controls her head; the toddler cruises around the room. Interactiveness – Does the 2 month old have a social smile? Is the toddler interested in what is going on in the room? Consolability – A child who cannot be consoled at some point by his mother is experiencing a medical emergency until proven otherwise. Look/gaze – Does the child track or fix his gaze on you, or is there the “1000-yard stare”? Speech/cry – A vigorously crying baby can be a good sign, when consolable – when the cry is high-pitched, blood-curling, or even a soft whimper, something is wrong. If the child fails any of the TICLS, then his appearance is abnormal. Work of Breathing: Children are respiratory creatures – they are hypermetabolic – we need to key in on any respiratory embarrassment. Look for nasal flaring. Uncover the chest and abdomen and look for retractions. Listen – even without a stethoscope – for abnormal airway sounds like grunting or stridor. Grunting is the child’s last-ditch effort to produce auto-PEEP. Stridor is a sign of critical upper airway narrowing. Look for abnormal positioning, like tripodding, or head bobbing Circulation to skin: Infants and children are vasospastic – they can change their vascular tone quickly, depending on their volume status or environment. Without even having to touch the child, you can see signs of pallor, cyanosis, or mottling. If any of these is present, this is an abnormal circulation to the skin. Failing any one of these is worth a serious doc visit. And, I’ll add one of my own: any infant that works so hard at sucking down milk that it makes them sweat gets a free trip to the ER.