Compiled from “Brady Emergency Care – Ninth Edition”

2001Chapter 31 – Infants and Children

AssessmentPediatric Vital signs differ slightly from

adults with typically higher pulse and respiration rates, and lower blood presssures.

Younger patients may not be able to convey symptoms well making assessment more critical.

Respiratory failure and shock can occur more easily in children and should be top of mind.

Assess children with the assistance of parent or caregiver when possible.

Vital Signs – Respiration ratesNewborn 30-50Infant (1-5 mos) 25-40 6 mos – 5 yrs 20-306-10 yrs 15-30Adolescent 12-20

Note these are normal rates – conditions/stress may elevate these. Lower rates should prompt consideration of assisted ventilations.

Vital Signs – Pulse RatesNewborn 120-160Infant (1-5 mos) 90-1406-12 mos 80-140Toddler (1-3 yrs) 80-130Preschool (3-5 yrs) 80-120School age (6-10yrs) 70-110Adolescent (11-14) 60-105

Vital Signs – Blood Pressure3-5yrs 78-1166-10yrs 80-12211-14yrs 88-140

Notes – BP rarely measured on children under 3

Above numbers are systolic. Diastolic is typically 2/3 systolic.

Respiratory Difficulty - Symptoms Stridor / crowing / grunting Muscle retractions in ribs/shoulders Flared nostrils Cyanosis Decreased or increased rate

Respiratory Difficulty - TreatmentTreat with O2, maintain airway, consider

blocked airway for young children.Ventilate at 20 breaths/minUse pediatric BVM – watch rise/fall –

appropriate volumePosition head neutral / sniffing positionSmall trachea / large tongue

ShockCauses

dehydration infection trauma blood lossallergypoisoning

Signsrapid respirationscoldweak peripheral

pulsedecreased urine

outputaltered mental

statusno tears when

crying

Ventilate an infant and child mannequin.

Shock - TreatmentMaintain AirwayHigh flow O2Keep warmImmediate transportSuction carefully – vegas nerve

FeverVarious causesCool cautiously

SeizuresVarious causes – History?Maintain airway Treat for shockTransport – Epilepsy patients or other history

may defer transport.

Altered Mental StatusCauses

Poisoning Injury Illness

TreatmentAirwayTreat for shockTransport (Immediate) – Diabetic deferral

PoisoningDetermine substance if possibleCall Medical Control (ER Doc on duty) or

AMR

TreatmentMaintain airwayTreat for shockTransport

Near DrowningRule out causes

InjuriesIllness

TreatmentCPRMaintain airwayTreat for hypothermiaTreat for shockTreat any trauma

Trauma - Injury Patterns / anatomyHead – larger in proportion / lead with their

headChest – elastic ribs allow internal injuries

with no outer signsAbdomen – belly breathers, watch abdomen

for respirations

BurnsConsider percentages of burned area – rule

of nines.Sterile dry dressingsAvoid hypothermia

Abuse and NeglectPsychologicalNeglectPhysicalSexual

Physical Abuse Injury Patternsshaped weltsswellingpoorly/partially healed bruiseshigh instance of broken bones or injuriesbitesburns

Determining Signs of AbuseMultiple visits for the same patient or siblingsPast injuries – note back and buttocksPoorly healed wounds/fractures (i.e. no treatment

received)Cigarette burns, bilateral burns, glove/stocking

pattern.Caregiver responses:

Different stories for the same injuryUnconcernedDifficulty controlling angerDepressionRefusal of transport / reluctant to give history

Physical Abuse – Treatments and ProceduresTreat injuries as per protocolsDocument wellGather information in a passive mannerDO NOT accuse or pass judgmentDO report your suspicions to AMR staff and

ICVerify documentation

Special Needs ChildrenTracheostomy tubes –obstruction, dislodged,

bleeding. Suction tube, maintain airway

Ventilators – maintain airway and manually ventilate as needed.

Central IV line – infection, bleeding, clooted, cracked. Apply pressure and dress as needed.

Gastric tubes – Assure airway, asses mental status – hypoglycemic

Shunts – Maintain airway as necessary