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Acute Illness Observation Scale

P. L. McCarthy's technique of evaluating pediatric patients focuses on six easily observed factors that, taken together, are a sensitive indicator of serious illness in an infant. Ideally, each of these factors would be noted on every pediatric patient seen for an illness. This could be accomplished by using a rubber stamp to enter the list into the medical record. Even if the individual factors are not recorded for each visit, they should always be recorded for patients in whom they are abnormal:

Quality of Cry

1 --strong cry with normal tone or contented and not crying

2 --whimpering or sobbing

3--weak cry, moaning, or high-pitched cry

Reaction to Parental Stimulation

1--cries briefly and then stops, or is contented and not crying

2--cries off and on

3--cries continually or hardly responds

State Variation

1--if awake, stays awake, or if asleep and then stimulated, awakens quickly

2--closes eyes briefly when awake, or awakens with prolonged stimulation

3--falls asleep or will not arouse



2--pale extremities or acrocyanosis

3--pale, cyanotic, mottled or ashen


1--normal skin and eyes, moist mucous membranes

2--normal skin and eyes, slightly dry mouth

3--doughy or tented skin, dry mucous membranes and/or sunken eyes

Response (Talk, Smile) to Social Overtures, Over 2 Months

1--smiles or alerts

2--smiles briefly or alerts briefly

3--no smile, anxious face, dull expression, or does not alert

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