THE DIAGNOSIS OF ACUTE MOUNTAIN-SICKNESS IN PREVERBAL CHILDREN

Objective: To establish diagnostic criteria for acute mountain sicknes s (AMS) in preverbal children. Design: Nonrandomized control trial. Se tting: Ambulatory. Participants: Children aged 3 through 36 months and adults from the Denver, Cole, area (altitude, 1610 m). Main Outcome M easures: The Lake Louise Scoring System was modified, using a fussines s score as the headache equivalent and a pediatric symptom score to as sess appetite, vomiting, playfulness, and ability to sleep. Acute moun tain sickness was assessed by combining the fussiness and pediatric sy mptom scores to produce what we termed the Children's Lake Louise AMS Score (CLLS). Interventions: Parents recorded the fussiness score at 1 1 AM, 1, 3, and 5 PM, and the pediatric symptom score at 3:00 PM each day. Each subject traveled twice, with 1 day considered a control. Day s 1 and 2 were measurements at home; day 3 reflected travel without al titude change to 1615 m; and 1 week later, day 4 involved travel to 34 88 m. On days 3 and 4 the accompanying adults completed the Lake Louis e Scoring System. Results: Twenty-three subjects (1.4 boys; mean +/- S D age, 20.7 +/- 9.0 months) participated. The mean CLLS demonstrated n o differences on days 1, 2, or 3. On day 4, 5 subjects (21.7%) had AMS , established as a CLLS of 7 or higher, and these scores normalized 2 hours after descent. Forty-five adults participated a:ld 9 (20%) had A MS. Conclusions: We define AMS in preverbal children as a CLLS of 7 or higher with a fussiness score of 4 or higher and a pediatric symptom score of 3 or higher, in the setting of recent altitude gain. The inci dence of AMS in preverbal children (21.7%) was similar to that in adul ts (20%).