Neurosurgeons at the Adelaide Children’s Hospital, King William Street, North Adelaide, SA 5006, Australia have used a paediatric version of the Glasgow Coma Scale since 1977 for assessing conscious level in infants and young children. For the best verbal response, during the first 6 months the normally conscious infant is expected to cry or grunt spontaneously or when disturbed and the expected normal score is 2. Between 6 and 12 months, the normal infant babbles and begins to vocalize and scores 3. After 12 months, words are expected with a score of 4. Orientation by 5 years of age gives a score of 5. The normal aggregate scores at different ages are as follows: birth-6 mth: 9; 6-12 mth: 11; 12-24 mth: 12; 2-5 yr: 13; over 5 yr:14. A disadvantage of the scale is the reduced sensitivity, especially in the neonate. [1]

COMMENT: In an editorial comment, Dr AJ Raimondi corroborates the need for children’s and infant’s coma scales as substitutes for the well known Glasgow scale suitable mainly for adults. He favors an 11-point scale for infants, which incorporates ocular responses (ranging from normal pursuit to fixed pupils), verbal responses (ranging from crying to apnea), and motor responses (from flexion/ extension to flaccidity). A uniformly tested and accepted coma scale for infants and children would be advantageous. Coma scores as low as 3-4 carry the same prediction of poor outcome at any age; coma scores of 5-8 may carry a less serious significance in young children than in adults.