Pediatric Assessment Triangle

Respiratory assessment findings are age-specific and will have normal variations between ages. Performing a thorough respiratory assessment involves the assessment steps of history, inspection, palpation, percussion, and auscultation. The pediatric assessment triangle is a rapid assessment tool used for children, examining appearance, work of breathing, and circulation.

Last updated: January 20, 2026

What is the pediatric triangle of assessment (PAT)?

The pediatric assessment triangle is a tool that can be used to rapidly assess the respiratory status of a pediatric client, particularly to identify critically ill or injured children.

In emergency situations, the rapid assessment can help prioritize patients by identifying children at risk of decompensation. It is applicable across all pediatric age groups.

Components of the pediatric assessment triangle

The assessment triangle is based on 3 key observations: appearance, work of breathing, and circulation.

Appearance (TICLS)

The components of the appearance assessment have the acronym TICLS (pronounced and remembered as “tickles”):

Tone
Interactiveness
Consolability
Look and gaze
Speech and cry

Work of breathing

Evaluating the work of breathing involves observing for signs of respiratory distress or failure:

Nasal flaring (to maximize air flow)
Retractions
Posturing
Breath sounds

Circulation of skin

Assessing the child’s circulatory status involves checking for:

Skin color (pallor, mottling, cyanosis)
Early signs of shock