Which of the following is a late sign of increased intracranial pressure in an infant?

• A. Tachycardia
• B. Cheyne-Stokes respirations
• C. Increased motor response
• D. Widening pulse pressure

Answer: (B)

The key idea is that as intracranial pressure rises, the brainstem’s control of automatic functions becomes compromised, and patterns of breathing change as a late sign of deterioration.

Cheyne-Stokes respirations reflect brainstem involvement and rising ICP. This pattern shows cycles of progressively deeper and faster breathing, then a period of apnea, indicating the brain’s respiratory control centers are failing. Because brainstem dysfunction occurs later in the course of increasing ICP, this respirations pattern is a late warning sign that urgent assessment and intervention are needed.

Tachycardia is more commonly an early sympathetic response to illness or pain. Increased motor response can occur with agitation or seizures and isn’t a reliable late indicator of ICP. Widening pulse pressure relates to the Cushing reflex—hypertension with bradycardia and irregular breathing—an important sign, but in infants the respiratory pattern with apnea cycles (Cheyne-Stokes) more specifically points to advanced brainstem involvement.