Pediatric Glasgow Coma Scale (GCS)
The GCS quantifies conscious level across three components — eye opening (E), verbal response (V), motor response (M) — summed to a total of 3 (deepest coma) to 15 (fully alert). In children too young to follow commands or speak, the verbal and motor descriptors are modified; eye-opening is unchanged.
GCS chart: adult/child vs infant
| Score | Eye opening (E) | Verbal — child (V) | Verbal — infant (V) | Motor — child (M) | Motor — infant (M) |
|---|---|---|---|---|---|
| 6 | — | — | — | Obeys commands | Spontaneous, purposeful movement |
| 5 | — | Oriented, converses | Coos, babbles | Localises pain | Withdraws to touch |
| 4 | Spontaneous | Confused / disoriented | Irritable cry, consolable | Withdraws to pain | Withdraws to pain |
| 3 | To speech / voice | Inappropriate words | Cries to pain | Abnormal flexion (decorticate) | Abnormal flexion (decorticate) |
| 2 | To pain | Incomprehensible sounds | Moans/grunts to pain | Abnormal extension (decerebrate) | Abnormal extension (decerebrate) |
| 1 | None | None | None | None | None |
Total = E + V + M. Record the components separately (e.g. E3 V4 M5 = 12), since the breakdown carries more information than the sum alone.
Severity bands
| Total GCS | Severity |
|---|---|
| 13–15 | Mild |
| 9–12 | Moderate |
| ≤8 | Severe — consider intubation for airway protection |
Scoring tips
| Situation | How to record |
|---|---|
| Intubated patient | Verbal scored as 1 with a “T” suffix (e.g. E2 V1T M4) |
| Eyes swollen shut | Eye scored as 1 with a “C” (closed) suffix |
| Pre-verbal / infant | Use the infant column for V and M |
| Asymmetric motor response | Record the best motor response for the total |
Reminders
- A falling GCS (a 2-point drop, or any drop to ≤8) is the trigger — trend matters more than a single value.
- Motor response is the most prognostically useful component, especially in intubated or pre-verbal children.
- Always document E, V and M individually; “GCS 12” alone hides which domain is impaired.
- Pair the score with pupils, posturing and focal signs — GCS is a screen, not a full neuro exam.
Score it at the bedside with the Glasgow Coma Scale calculator.
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.