A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings indicates that the treatment has been effective?

Choice A: FACES

The FACES pain scale is typically used for children aged 3 years and older. It involves children pointing to a face that best represents their pain level, ranging from a happy face at “no pain” to a crying face at “worst pain.” Since a 6-month-old infant cannot understand or communicate using this scale, it is not appropriate for this age group.

Choice B: FLACC

The FLACC (Face, Legs, Activity, Cry, Consolability) scale is designed for infants and young children who cannot verbalize their pain. It assesses five criteria: facial expression, leg movement, activity level, cry, and consolability. Each criterion is scored from 0 to 2, with a total score ranging from 0 to 10. This scale is suitable for a 6-month-old infant as it relies on observable behaviors rather than self-reporting.

Choice C: Oucher

The Oucher pain scale is a visual tool that uses photographs of children’s faces showing different levels of pain. It is generally used for children aged 3 to 12 years. Like the FACES scale, it requires the child to identify with the faces, making it unsuitable for a 6-month-old infant who cannot comprehend or communicate in this manner.

Choice D: Visual Analog Scale

The Visual Analog Scale (VAS) is a self-report tool where individuals rate their pain on a continuum, usually a 10 cm line ranging from “no pain” to “worst pain imaginable.” This scale is appropriate for older children and adults who can understand and communicate their pain levels. It is not suitable for infants who cannot provide self-reports.

Choice A Reason:

The statement “Visualize the epiglottis with a tongue depressor” is incorrect and potentially dangerous. Using a tongue depressor to visualize the epiglottis in a child with suspected epiglottitis can cause further irritation and swelling, leading to complete airway obstruction1. This procedure should be avoided unless performed by a specialist in a controlled environment with emergency airway equipment available.

Choice B Reason:

The statement “Obtain a throat culture” is not the immediate priority in suspected epiglottitis. While a throat culture can help identify the causative organism, the primary concern is to secure the airway and ensure the child can breathe. Attempting to obtain a throat culture can provoke anxiety and worsen the child’s condition.

Choice C Reason:

The statement “Transport the child to radiology for a throat X-ray” is not the best initial action. Although a lateral neck X-ray can show the characteristic “thumb sign” of epiglottitis, the priority is to maintain the airway. Transporting the child for an X-ray can delay necessary treatment and increase the risk of airway obstruction.

Choice D Reason:

The statement “Place the child in an upright position” is correct. Children with epiglottitis often find it easier to breathe when sitting upright, as this position helps keep the airway open. This is a critical step in managing the child’s condition until further medical intervention can be provided.