Scores eye opening, verbal and motor response in infants and preverbal children, for a total from 3 to 15 with the components shown.
Result
Choose the best response in each of the three groups.
Sources
5 studies
5
studies
13,499
citations
50
PubMed papers
Evidence
Known limitations
In 2,043 children with blunt head trauma, 327 aged 2 or younger were scored on the pediatric GCS. Its area under the curve was 0.97 for brain injury needing acute intervention and 0.72 for injury on CT, compared with 0.87 and 0.82 for the standard GCS in older children.
Acad Emerg Med: Journal Metrics Score 1.6, Q2 · cited 173 times
In the PECARN cohort of 42,041 children, 10,499 were under 2. The pediatric GCS identified clinically important brain injury with an area under the curve of 0.77, similar to 0.81 for the standard GCS in older children, but was less accurate for any injury on CT (0.61 against 0.71).
Acad Emerg Med: Journal Metrics Score 1.6, Q2 · cited 121 times
In 20,137 children with head injury, 280 (1.3%) had a clinically important brain injury. Compared with a GCS of 15, the odds were 17.5 times higher at 14 and 484.5 times higher at 3; the area under the curve was 0.79.
Emerg Med J: Journal Metrics Score 1.3, Q2 · cited 14 times
In 42,412 children with a GCS of 14 or 15 after head trauma, the PECARN rule for children under 2 had a negative predictive value of 100% (1,176 of 1,176) and a sensitivity of 100% (25 of 25) for clinically important brain injury in validation.
When 66 doctors and nurses scored eight written pediatric scenarios of children aged 1 to 15 years, consistency was poor overall (Cronbach alpha 0.53) and worst for the verbal response. Only staff with 5 to 10 years of experience reached acceptable consistency (0.78).
Med Princ Pract: Journal Metrics Score 2.8, Q1 · cited 15 times
PubMed · Free full text · DOI
The original gcs paper has been cited 13,499 times, and 50 PubMed articles mention the pediatric Glasgow Coma Scale in their title or abstract. Citation counts from OpenAlex and article counts from PubMed, retrieved November 9, 2026. Journal Metrics Scores and quartiles are from this site’s current release; follow the journal name for details.
After the result
8 or less · 9 to 12 · 13 to 15
Severe: airway, urgent imaging and neurosurgical input. Moderate: imaging, close observation and senior review. Mild: at 13, imaging is usually needed; at 14 or 15, use a validated head injury rule (PECARN, CATCH or CHALICE).
Next steps
Avoid common errors
5 common errors to avoid
and 3 more
Before you use the result
1Scoring the wrong age version
A preverbal child cannot be oriented or obey commands, so the adult verbal and motor items underscore a healthy infant. Use the pediatric wording until the child talks and follows commands.
2Crying is not one score
An irritable cry scores 4, crying only to pain 3 and moaning to pain 2. In one survey of staff scoring written scenarios, scoring was least consistent for the verbal response (Caruana 2024).
3Sedation, paralysis and intubation
Score before sedation where possible, and record the drugs given. With an endotracheal tube, record the verbal response as T rather than 1.
4Local factors
Swollen eyelids can stop the eyes opening and a limb injury can limit movement. Record what could not be tested and why.
5Only the total
Report E, V and M. The same total of 9 can be E3 V2 M4 or E2 V2 M5, which are different children.
Formula
Eye (1 to 4) + best verbal (1 to 5) + best motor (1 to 6) = 3 to 15.
E (1–4) + V (1–5) + M (1–6)
Eye (1 to 4) + best verbal (1 to 5) + best motor (1 to 6) = 3 to 15.
The scale
| Score | Preverbal child | Adult wording |
|---|---|---|
| 4 | Spontaneous | Spontaneous |
| 3 | To sound | To sound |
| 2 | To pain | To pain |
| 1 | None | None |
| Score | Preverbal child | Adult wording |
|---|---|---|
| 5 | Age-appropriate vocalisation | Oriented |
| 4 | Cries, irritable | Confused |
| 3 | Cries to pain | Inappropriate words |
| 2 | Moans to pain | Incomprehensible sounds |
| 1 | None | None |
| Score | Preverbal child | Adult wording |
|---|---|---|
| 6 | Spontaneous movements | Obeys commands |
| 5 | Withdraws to touch | Localising pain |
| 4 | Withdraws to pain | Withdrawal from pain |
| 3 | Abnormal flexion to pain | Abnormal flexion to pain |
| 2 | Abnormal extension to pain | Abnormal extension to pain |
| 1 | None | None |
Wording (as in the source) from the pediatric and adult columns of Table 1 in Alsuwais et al. (Eur J Pediatr 2025). Severity of traumatic brain injury by total: 3 to 8 severe, 9 to 12 moderate, 13 to 15 mild.
Origin
Best response
Not testable
Test cases
3 published cases, each also a test case
3 published cases; the calculator reproduces every score.
Worked examples
A 3-month-old girl fell from the third step of a staircase while being carried by her mother and struck her right temporal region; she was less responsive. On admission her pediatric GCS was 9 (E3V2M4), with a large temporal swelling.
“Her Pediatric Glasgow Coma Scale score was 9 (E3V2M4).”
Entered as: Eye opening: To sound (3); Best verbal response: Moans to pain (2); Best motor response: Withdraws to pain (4).
Source: Takemoto H et al., Cureus 2026 (PubMed · Free full text · DOI)
A previously healthy 20-month-old boy with meningococcal meningitis complicated by cerebral venous sinus thrombosis had depressed consciousness with marked irritability. The report gives a pediatric GCS of 9/15 (E2V2M5).
“a Pediatric Glasgow Coma Scale score of 9/15 (E2V2M5)”
The same total as the first example from a different pattern, which is why the three components should always be reported. The severity bands come from head injury; here the score tracks the level of consciousness, not the severity of a brain injury.
Entered as: Eye opening: To pain (2); Best verbal response: Moans to pain (2); Best motor response: Withdraws to touch (5).
Source: Altelly A et al., Cureus 2026 (PubMed · Free full text · DOI)
A 4-month-old boy had a ten-day history of swelling over the right frontal and supraorbital region after a minor fall. He was alert and responsive, with a GCS of 14: spontaneous eye opening, an irritable cry and spontaneous limb movement.
“The Glasgow Coma Scale (GCS) score was 14 (E4: spontaneous eye opening; V4: irritable cry; M6: spontaneous limb movement).”
The report gives the pediatric wording for each component. A score of 14 is not normal mental status.
Entered as: Eye opening: Spontaneous (4); Best verbal response: Cries, irritable (4); Best motor response: Spontaneous movements (6).
Source: Abukar AA et al., Int Med Case Rep J 2026 (PubMed · Free full text · DOI)
FAQ
7 questions and answers
and 5 more answers
Questions
It is the Glasgow Coma Scale with the verbal and motor responses reworded for children who cannot yet talk or follow commands. Eye opening is scored 1 to 4, the best verbal response 1 to 5 and the best motor response 1 to 6, for a total of 3 to 15, the same range as the adult scale.
For preverbal children. The large PECARN studies used this version for children under 2 years and the standard scale from 2 years. The official Glasgow Coma Scale site says the scale can be applied without modification to children over 5 years old; for younger children it describes a different pediatric version (the Adelaide scale). Record which version you used.
On this version, a healthy, alert infant scores 15: spontaneous eye opening (4), age-appropriate vocalization such as cooing or babbling (5) and spontaneous purposeful movement (6). An infant who cries irritably scores 4 for verbal response. On the Adelaide version the expected normal total is lower in infants.
A total of 8 or less defines severe traumatic brain injury, 9 to 12 moderate and 13 to 15 mild. Even within the mild range, risk rises as the score falls: in 20,137 children with head injury, a GCS of 14 carried 17.5 times the odds of a clinically important brain injury compared with 15 (Kochar 2020).
The verbal response cannot be tested, so it is recorded as T and the eye and motor scores are reported with it, for example E2 VT M4. The official Glasgow Coma Scale site advises not reporting a total when a component is not testable, so the calculator shows the components without a total or severity band. Some units write 6T; a score with T cannot be compared with a full total.
In 42,041 children with blunt head trauma, the pediatric scale in children under 2 identified clinically important brain injuries as well as the standard scale in older children (area under the curve 0.77 against 0.81), but was less accurate for any injury on CT (0.61 against 0.71) (Borgialli 2016).
The same total can come from very different findings. The two children with a score of 9 on this page were E3 V2 M4 and E2 V2 M5. In one survey of staff scoring written scenarios, scoring was also least consistent for the verbal response (Caruana 2024), so the components show what was actually seen.
Further reading
10 references with PubMed and DOI links
10
references
5
free full text
From Teasdale G et al., Lancet 1974 to the newest case reports.
References
Contributed by Dr. Meng Zhao (MD · Former Neurosurgeon · Medical AI Researcher), from the original publications listed here. Last updated November 6, 2026. LinkedIn
The calculator code is tested against every worked example on this page before each release.
This calculator supports, and does not replace, clinical judgment. It is meant for healthcare professionals and is not medical advice for patients. Report an error through the contact page.
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