The Yale Observation Scale

Observation VariableNormal (1)Moderate Impairment (3)Severe Impairment (5)
Quality of cryStrong, normal tone or content, not cryingWhimpering, sobbingWeak, moaning, high pitched
Reaction to ParentsCries briefly, stops or content, not cryingCries off and onContinual cry or hardly responds
State VariationIf awake, stays awake
If asleep, arouses easily
Eyes close briefly, awakes with prolonged stimulationFalls to sleep, cannot be aroused
ColorPinkPale extremities
Pale, cyanotic mottled ,ashen
HydrationSkin, eyes normal
Mucous membranes moist
Skin, eyes normal
Mouth slightly dry
Skin doughy, tented
Mucous membranes dry, Sunken eyes
Response to Social OverturesSmiles
Becomes alert
Brief smile
Alerts briefly
No smile, anxious, dull, expressionless
Can't be alerted

McCarthy PL, Sharpe MR, Spiesel SZ, et al. Observation scales to identify serious illness in young children. Pediatrics 1982; 70: 802-809

From: Appendix F, Protocols and Criteria

Cover of Diagnosis and Management of Febrile Infants (0–3 Months)
Diagnosis and Management of Febrile Infants (0–3 Months).
Evidence Report/Technology Assessments, No. 205.
Hui C, Neto G, Tsertsvadze A, et al.

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