Paediatric Glasgow Coma Scale Calculator

The modified eye, verbal and motor criteria for an infant or pre-verbal child, 3 to 15. The minimum is 3 and never 0, an untestable component returns no total at all, and the published paediatric versions disagree about both the maximum and the age at which they apply.

Last updated 8 Oct 2026

Paediatric Glasgow Coma Scale

Three components, 3 to 15

Eye opening (E)The eye component is the one the adult and paediatric scales share unchanged. Periorbital swelling scored as 1 rather than NT is the commonest way a paediatric total is falsely lowered, and a scalp or facial injury big enough to close an eye is common in exactly the children this scale is reached for. Eye-open coma is the opposite trap.

Verbal response (V) — infant · childThis is the component the paediatric modification exists for. An infant’s best verbal response is to coo and babble, not to give a name and a date, so the adult descriptors score a well baby as impaired. An intubated child has no verbal score at all and 1 is not a stand-in for it: record NT. The published substitute is the grimace score, developed and tested in 73 intubated children over 104 paired observations, which was MORE reliable between observers than the verbal score it replaces.

Motor response (M) — infant · childScore the best response from any limb, checking right and left separately and recording asymmetry as a focal deficit beside the score rather than inside it. The developmental floor matters here: infants under about nine months cannot consistently localise pain and children under about eighteen months may not reliably obey commands, so the top two grades are not available to a well baby. In an intubated or pre-verbal child this is the component that carries the information.

12pointsExample

Opens eyes when spoken to; irritable crying; withdraws to touch

Scoring, licence and what changes from the adult scale

Paediatric GCS = Eye opening (1 to 4) + Verbal response (1 to 5) + Motor response (1 to 6)
Minimum 3 · maximum 15 · severe 3–8 · moderate 9–12 · mild 13–15

licence and attribution: The Glasgow Coma Scale is copyright of the University of Glasgow. glasgowcomascale.org states that the scale and its tools “may all be used for clinical care and clinical research at no cost”, that “No license is required”, and that the copyright of Glasgow University should be acknowledged. It is acknowledged here. No separate licensing position for the paediatric modification could be found: that site’s permissions page names the GCS and Sir Graham Teasdale’s own derivatives and is silent on the paediatric adaptations, and the modified-for-children table reproduced here carries no permission notice of its own
what actually changes: the verbal and motor descriptors, and nothing else. Eye opening is unchanged. An infant’s best verbal response is cooing and babbling rather than orientation; the motor scale substitutes “withdraws to touch” for “localises” and “moves spontaneously and purposefully” for “obeys commands”, because those are the best responses a pre-verbal child has. The arithmetic, the range and the strata are the adult ones
the age bands disagree between versions: glasgowcomascale.org says the standard adult scale can be used without modification in children over 5. The modified table implemented here separates “infant” from “child” descriptors and states no age at all. The Adelaide scale raises its expected normal total through five age bands to over 5 years. There is no single published age at which the modification starts or stops, so record which version and which column were used
the minimum is 3: every component scores 1 for no response, so a total of 0, 1 or 2 does not exist. Where one is recorded it almost always means an untestable component was entered as a nought
NT is not 1, and it is not 0 either: an untestable component makes the sum invalid rather than low. This page returns no total when any component is NT, and reports the components that were testable. For an intubated child the published substitute for the verbal score is the grimace score, which in its development study of 73 children and 104 paired observations was more reliable between observers than the verbal score

Worked example

Opens eyes when spoken to; irritable crying; withdraws to touch
To voice = E3 · irritable cry = V4 · withdraws to touch = M5
3 + 4 + 5 = 12 points, in the 9–12 moderate stratum on the adult strata this scale carries over
Now read the age. On the Adelaide paediatric scale the expected normal total is 12 between 1 and 2 years, so in a toddler these three responses may be the age-appropriate normal rather than a moderate impairment. On the scale implemented here, which the British Paediatric Neurology Association prefers precisely because one score means one impairment at every age, 12 is 12 — and the two scales will therefore disagree about the same child
Hand it over as E3 V4 M5, total 12. A bare “GCS 12” is equally consistent with E1 V5 M6, and those are not the same clinical problem
Now suppose the child is intubated. The verbal component is NT, not 1, and this page returns no total: 3 + NT + 5 is not 8, and reporting 8 would understate responsiveness by between one and four points. The published answer is the grimace score in place of the verbal score, recorded as such

The three components, infant and child

The modified-for-children criteria as reproduced by the MSD/Merck Manual, corroborated descriptor for descriptor against an independent reproduction of the same table. Only the verbal and motor columns differ from the adult scale; see the adult Glasgow Coma Scale calculator for the 2014 adult descriptors and the NT rule they share.
Points	Eye opening	Verbal (infant · child)	Motor (infant · child)
6	—	—	Moves spontaneously and purposefully · Obeys commands
5	—	Coos and babbles · Orientated and appropriate	Withdraws to touch · Localises a painful stimulus
4	Spontaneous	Irritable crying · Confused	Withdraws to pain
3	To speech	Cries to pain · Inappropriate words	Abnormal flexion (decorticate) to pain
2	To pain	Moans to pain · Incomprehensible sounds	Abnormal extension (decerebrate) to pain
1	None	None	None

The Adelaide scale’s expected normal total for age, and why it matters

This is the OTHER published paediatric scale, from Adelaide, and it is a static citation rather than something this page computes: it assesses only expressive language, omits withdrawal from the motor scale, and its maximum therefore rises with development to 14 rather than 15. A normal newborn scores 9 on it. The practical consequence is that an Adelaide 14 and a child’s Glasgow Coma Scale 15 can describe the same well child, so a total quoted without its scale is ambiguous by a point or more. This plugin has no table interpolation, which is a second reason the figures above are printed and not calculated.
Age	Expected normal verbal	Expected normal motor	Expected normal total
Birth to 6 months	2	3	9
Over 6 to 12 months	3	4	11
Over 1 to 2 years	4	4	12
Over 2 to 5 years	4	5	13
Over 5 years	5	Adult	14

Three components, two rival paediatric scales, and one invalid sum

The Glasgow Coma Scale describes responsiveness in three dimensions: whether the eyes open, what the child says, and what the limbs do. In a pre-verbal child two of those three need rewording, because the adult descriptors score a healthy infant as impaired: a well six-month-old cannot give their name and date of birth and cannot reliably obey a command. The modification implemented here keeps the adult arithmetic — eye 1 to 4, verbal 1 to 5, motor 1 to 6, total 3 to 15 — and substitutes developmentally appropriate responses: coos and babbles at the top of the verbal scale, withdraws to touch and moves spontaneously and purposefully at the top of the motor scale. The minimum is 3 for the same reason as in the adult: every component scores 1 for no response, so a reported total of 0, 1 or 2 is not a very low score but a scoring error, usually an untestable component entered as a nought.

There is more than one published paediatric scale, and they are not interchangeable. The Adelaide paediatric coma scale, described by Simpson and Reilly and tested prospectively in 60 head-injured children aged 0 to 72 months, takes the opposite approach: instead of rewording the descriptors so that one total means one impairment at any age, it keeps a shorter scale and raises the expected normal total with age — 9 at birth, 11 at 6 to 12 months, 12 at 1 to 2 years, 13 at 2 to 5 years and 14 over 5. Its maximum is 14 rather than 15, because it assesses only expressive language and omits withdrawal from the motor scale. Kirkham and colleagues’ review records that the British Paediatric Neurology Association recommends the child’s Glasgow Coma Scale for UK use, on the reasoning that a given score then implies the same impairment at any age and can be used in audit and research without transformation. The age at which any paediatric modification applies also differs between sources: the scale’s own site says the adult version can be used unmodified over 5 years, the modified table reproduced here states no age at all, and the Adelaide scale bands to over 5. So record which scale and which column were used, because a total alone is ambiguous by at least a point.

The untestable component is where a paediatric total goes wrong most often. An intubated child has no verbal score; swelling can close an eye; neuromuscular blockade removes the motor response. In each case the published guidance is to record the component as NT and report no total, because a missing component scored as 1 produces a figure that is systematically low and looks exactly like deterioration. This calculator therefore refuses to sum when any component is NT. For the intubated child there is a published substitute: Tatman and colleagues developed a grimace score and tested it in 73 children over 104 paired observations, finding it more reliable between observers than the verbal score it replaces. Agreement on the components themselves is moderate to good, with kappa values of roughly 0.5 to 0.6, and it is worst at the intermediate levels and with inexperienced observers.

The Glasgow Coma Scale is copyright of the University of Glasgow, and glasgowcomascale.org states that it may be used for clinical care and clinical research at no cost with no licence required, provided the copyright is acknowledged. It is acknowledged here. A score is not a diagnosis, and a published figure describes the cohort it came from rather than the child in front of you. A single value is a snapshot of one examination: a child whose illness is evolving can score differently an hour later, so a reassuring score does not exclude deterioration, and the trend across serial assessments by the same examiner carries more than any one reading. The derivation populations named above are head-injured children; the strata are the adult ones carried across. Published item wordings and severity bands differ between sources and between units, so the reader’s own unit’s chart and protocol take precedence over any banding printed here.

Frequently asked questions

What is the lowest possible paediatric Glasgow Coma Scale score?

Three. Each component scores 1 for no response, so 3 is the floor on the modified scale exactly as on the adult one. A reported total of 0, 1 or 2 usually means an untestable component was recorded as a nought.

What changes between the adult and the paediatric Glasgow Coma Scale?

The verbal and motor descriptors, and nothing else. Eye opening is identical. An infant’s best verbal response is cooing and babbling rather than orientation, and the motor scale substitutes withdraws-to-touch for localises and moves-spontaneously-and-purposefully for obeys-commands. The range stays 3 to 15 and the severity strata are the adult ones.

How do you score the paediatric GCS in an intubated child?

You do not score the verbal component. Record it as NT, report the two components that were testable, and do not sum: a missing component entered as 1 gives a total that is systematically low and mimics deterioration. The published substitute is the grimace score, which was more reliable between observers than the verbal score in its development study of 73 intubated children.

At what age do you switch from the paediatric to the adult scale?

The sources genuinely disagree, which is the honest answer. glasgowcomascale.org says the standard scale can be used without modification in children over 5. The modified infant-and-child table reproduced here gives no age. The Adelaide scale bands its expected normal total up to over 5 years. Record the version used rather than the age alone.

Is the Glasgow Coma Scale copyrighted, and can I reproduce it?

It is copyright of the University of Glasgow. glasgowcomascale.org states that the scale and its associated tools “may all be used for clinical care and clinical research at no cost”, that “No license is required”, and that the Glasgow University copyright should be acknowledged — as it is on this page. That site makes no separate statement about the paediatric modifications, which are attributed there to the Adelaide group.

Related calculators

References

Royal College of Physicians and Surgeons of Glasgow / University of Glasgow. Glasgow Coma Scale: permissions. glasgowcomascale.org/permissions (accessed 10 October 2026).
Royal College of Physicians and Surgeons of Glasgow. Glasgow Coma Scale: frequently asked questions — the section on infants and young children, the Adelaide modification and its expected normal total for age. glasgowcomascale.org (accessed 10 October 2026).
MSD Manual Professional Edition. Modified Glasgow Coma Scale for Infants and Children. Rahway, NJ: Merck & Co (accessed 10 October 2026) — the source of the infant and child descriptors reproduced here.
Kirkham FJ, Newton CRJC, Whitehouse W. Paediatric coma scales. Dev Med Child Neurol. 2008 — compares the GCS, the child’s GCS, the Adelaide, Jacobi, MCSI and Blantyre scales and their interobserver agreement.
Tatman A, Warren A, Williams A, Powell JE, Whitehouse W. Development of a modified paediatric coma scale in intensive care clinical practice. Arch Dis Child. 1997;77(6):519 — the grimace score, 73 children and 104 paired observations.
Simpson DA, Cockington RA, Hanieh A, Raftos J, Reilly PL. Head injuries in infants and young children: the value of the Paediatric Coma Scale. Childs Nerv Syst. 1991;7(4):183–190 — 60 head-injured children aged 0–72 months (abstract read; full text paywalled). The scale was first described in Simpson D, Reilly P. Paediatric Coma Scale. Lancet. 1982;2:450.

Not medical advice. For healthcare professionals and education. Reference intervals vary by laboratory and assay — always use your own laboratory's. Never base a dose or a treatment decision on this page alone. Full disclaimer at calcengines.com/disclaimer/