Table 6.

Panama Functional Classification for Pediatric PH as Proposed by Pulmonary Vascular Research Institute (PVRI) Pediatric Task Force, 2011

	0 to 0.5 year	0.5 to 1 year	1 to 2 years	2 to 5 years	5 to 16 years
I	Asymptomatic, growing and developing normally, no limitation of physical activity (PA). Gains head control, increases body tone, rolls over, sits without support gradually	Asymptomatic, growing on centiles, no limitation of PA. Mobile, sitting, grasping, crawling, playing	Asymptomatic, growing on centiles, no limitation of PA. Standing, starting to walk, climbing	Asymptomatic, growing on centiles, no limitation of PA. Attending school normally and playing sports with classmates	Asymptomatic, growing on centiles, no limitation of PA. Attending school normally and playing sports with classmates
II	Slight limitation of PA, unduly dyspneic and fatigued, falling behind developmental milestones. Comfortable at rest and gaining weight	Slight limitation of PA, unduly dyspneic when playing. Delayed milestones but normal growth and comfortable at rest	Slight limitation of PA, unduly dyspneic when playing. Delayed milestones but normal growth and comfortable at rest	Slight limitation of PA, unduly dyspneic as compared to classmates. <75% attendance at school. Comfortable at rest and normal weight gain	Slight limitation of PA, unduly dyspneic as compared to classmates. <75% attendance at school. Comfortable at rest and normal weight gain
IIIa	Marked limitation of PA, unduly fatigued. Quiet, needs frequent naps, poor feeding, growth, and regression of learned milestones. Comfortable at rest	Marked limitation of PA, unduly fatigued while playing. Quiet, needs frequent naps, poor feeding, growth, and regression of learned milestones. Comfortable at rest	Marked limitation of PA, unduly fatigued while playing. Quiet, needs frequent naps, poor feeding, growth, and regression of learned milestones. Comfortable at rest	Marked limitation of PA, regression of milestones, not climbing stairs, reluctant to play with friends. Less than ordinary activity causes symptoms. <50% attendance at school	Marked limitation of PA, no attempt at sports. Less than ordinary activity causes symptoms. Comfortable at rest. <50% attendance at school
IIIb	IIIa plus severely compromised growth and feeding	IIIa plus severely compromised growth and feeding	IIIa plus severely compromised growth and feeding	Unable to attend school, mobile at home, needs wheelchair outside. Compromised growth, poor feeding plus IIIa	Unable to attend school, mobile at home, needs wheelchair outside. Compromised growth, poor feeding plus IIIa
IV	Unable to carry out any PA without severe symptoms and is not interacting with family. Right heart failure (RHF) plus syncope	Unable to carry out any PA without severe symptoms and is not interacting with family. RHF plus syncope	Unable to carry out any PA without severe symptoms and is not interacting with family. RHF plus syncope	Unable to carry out any physical activity without severe symptoms, unable to attend school, not interacting with friends, wheelchair dependent, RHF plus syncope	Unable to carry out any physical activity without severe symptoms, unable to attend school, not interacting with friends, wheelchair dependent, RHF plus syncope

Modified, with permission, from Lammers AE, et al., 2011 (328). Under Creative Commons License.