Shock Types in Children
Children maintain blood pressure remarkably well until late in shock, which makes early shock easy to miss. The PALS course teaches clinicians to look beyond blood pressure and to classify shock by severity and type.
In short
Severity: compensated (blood pressure maintained) or hypotensive. Type: hypovolaemic, distributive (including septic and anaphylactic), cardiogenic or obstructive. The type decides the treatment.
Early shock shows as fast heart rate, cool peripheries, prolonged capillary refill, weak peripheral pulses and reduced urine output, while blood pressure is still normal. Once blood pressure falls below the threshold for age — see vital signs by age — shock is hypotensive, and arrest may be close.
The commonest type in children: dehydration from vomiting and diarrhoea, or bleeding. Treatment centres on fluid resuscitation, and blood for haemorrhage.
Blood vessels dilate abnormally: septic shock, anaphylaxis and, less commonly, neurogenic shock. Warm peripheries do not rule it out.
The heart cannot pump effectively, for example with myocarditis or congenital heart disease. Signs of fluid overload such as an enlarged liver and crackles may appear, so fluids are given in smaller amounts with careful reassessment, and expert help is needed early.
Blood flow is physically blocked: tension pneumothorax, cardiac tamponade, a large pulmonary embolism, or duct-dependent congenital heart lesions in newborns. The cause must be relieved.
If a vein cannot be found quickly, intraosseous access is used.
This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.
Other life support and first aid courses: BLS Course · ACLS Course · First Aid Course · Training calendar
Hypovolaemic, distributive, cardiogenic and obstructive.
Shock in which blood pressure is still maintained despite poor perfusion.
Hypovolaemic shock, usually from dehydration.
Because the heart may not cope with a large volume, so smaller amounts are given with reassessment.
It causes distributive shock.
Paediatric emergencies are learned by doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site PALS and a two-year AHA PALS Provider eCard.
See PALS dates and register PALS course overview Group booking enquiry
What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.